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McNaught E, Reale S, Bourke L, Brown JE, Collinson M, Day F, Hewison J, Farrin AJ, Ibeggazene S, Innes AQ, Mason E, Meads D, Scope A, Taylor C, Taylor SJ, Turner RR, Rosario DJ. Supported exercise TrAining for Men wIth prostate caNcer on Androgen deprivation therapy (STAMINA): study protocol for a randomised controlled trial of the clinical and cost-effectiveness of the STAMINA lifestyle intervention compared with optimised usual care, including internal pilot and parallel process evaluation. Trials 2024; 25:257. [PMID: 38610058 PMCID: PMC11010375 DOI: 10.1186/s13063-024-07989-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/05/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND UK national clinical guidance recommends that men with prostate cancer on androgen deprivation therapy are offered twice weekly supervised aerobic and resistance exercise to address iatrogenic harm caused by treatment. Very few NHS trusts have established adequate provision of such services. Furthermore, interventions fail to demonstrate sustained behaviour change. The STAMINA lifestyle intervention offers a system-level change to clinical care delivery addressing barriers to long-term behaviour change and implementation of new prostate cancer care pathways. This trial aims to establish whether STAMINA is clinically and cost-effective in improving cancer-specific quality of life and/or reducing fatigue compared to optimised usual care. The process evaluation aims to inform the interpretation of results and, if the intervention is shown to benefit patients, to inform the implementation of the intervention into the NHS. METHODS Men with prostate cancer on androgen deprivation therapy (n = 697) will be identified from a minimum of 12 UK NHS trusts to participate in a multi-centre, two-arm, individually randomised controlled trial. Consenting men will have a 'safety to exercise' check and be randomly allocated (5:4) to the STAMINA lifestyle intervention (n = 384) or optimised usual care (n = 313). Outcomes will be collected at baseline, 3-, 6- and 12-month post-randomisation. The two primary outcomes are cancer-specific quality of life and fatigue. The parallel process evaluation will follow a mixed-methods approach to explore recruitment and aspects of the intervention including, reach, fidelity, acceptability, and implementation. An economic evaluation will estimate the cost-effectiveness of the STAMINA lifestyle intervention versus optimised usual care and a discrete choice experiment will explore patient preferences. DISCUSSION The STAMINA lifestyle intervention has the potential to improve quality of life and reduce fatigue in men on androgen deprivation therapy for prostate cancer. Embedding supervised exercise into prostate cancer care may also support long-term positive behaviour change and reduce adverse events caused by treatment. Findings will inform future clinical care and could provide a blueprint for the integration of supervised exercise and behavioural support into other cancer and/or clinical services. TRIAL REGISTRATION ISRCTN 46385239, registered on 30/07/2020. Cancer Research UK 17002, retrospectively registered on 24/08/2022.
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Affiliation(s)
- Emma McNaught
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Sophie Reale
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Liam Bourke
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Janet E Brown
- Division of Clinical Medicine, University of Sheffield, Sheffield, S10 2RX, UK
| | - Michelle Collinson
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Florence Day
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Jenny Hewison
- Division of Health Services Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Amanda J Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Saïd Ibeggazene
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Aidan Q Innes
- Nuffield Health, 2 Ashley Avenue, Epsom, Surrey, KT18 5AL, UK
| | - Ellen Mason
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - David Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Alison Scope
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Chris Taylor
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Steph Jc Taylor
- Wolfson Institute of Population Health, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
| | - Rebecca R Turner
- Division of Psychology and Mental Health in the School of Health Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - Derek J Rosario
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK.
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Caperchione CM, English M, Sharp P, Agar MR, Phillips JL, Liauw W, Harris CA, McCullough S, Lilian R. Exploring the practicality and acceptability a brief exercise communication and clinician referral pathway in cancer care: a feasibility study. BMC Health Serv Res 2023; 23:1023. [PMID: 37740170 PMCID: PMC10517509 DOI: 10.1186/s12913-023-10003-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/04/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND The majority of cancer patients and cancer care clinicians-CCCs (e.g., oncologists) believe that exercise is an important adjunct therapy that should be embedded in standard practice. Yet, CCCs do not routinely discuss exercise with their patients, nor do they regularly refer them to exercise professionals (e.g., exercise physiologists-EPs). This study evaluated the feasibility and acceptability of an evidence-based approach to improving exercise communication between CCCs and their patients, including an exercise referral pathway. METHODS Implementation and testing of the Exercise Communication and Referral Pathway (ECRP) occurred in Sydney, Australia. The ECRP included a brief oncology-initiated communication exchange with patients, CCC exercise referral to an EP, followed by EP-initiated telephone consultation with patients concerning tailored exercise advice. Participant perceptions concerning the feasibility and applicability of the ECPR were evaluated. Semi-structured interviews were conducted with CCCs (n = 3), cancer patients (n = 21), and an EP (n = 1). Inductive thematic analysis was undertaken. RESULTS Analysis generated three themes: (1) Navigating the role of CCCs in the ECRP, suggesting that oncology-initiated communication is a cue to action, however there was a lack of role clarity regarding exercise referral; (2) Implementing Patient-Orientated Care within a Standardised Pathway, highlighting the need for tailored information and advice for patients that reflects individual disease, socio-cultural, and environmental factors, and; (3) Taking Steps Towards Action, revealing the need for structural (e.g., EP initiated contact with patients) and policy changes (i.e., changes to Medicare, direct oncologist referral) to engage patients and better integrate exercise as part of standard care. CONCLUSIONS Findings provide important insights into improving oncology-patient exercise communication and developing an exercise referral pathway to increase engagement and patient reach. However, individual (e.g., experience, knowledge) and contextual factors (e.g., time, resources) need consideration when implementing an ECRP. TRIAL REGISTRATION This trial was prospectively registered with the Australian New Zealand Clinical (#ACTRN12620000358943) on March 13, 2020.
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Affiliation(s)
- Cristina M Caperchione
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, NSW, Australia.
| | - Madeleine English
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, NSW, Australia
| | - Paul Sharp
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, NSW, Australia
| | - Meera R Agar
- IMPACCT, University of Technology Sydney, Sydney, NSW, Australia
| | - Jane L Phillips
- IMPACCT, University of Technology Sydney, Sydney, NSW, Australia
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Winston Liauw
- Cancer Care Centre, St George Hospital, Sydney, NSW, Australia
- St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
- Translational Cancer Research Network, Sydney, NSW, Australia
| | - Carole A Harris
- Cancer Care Centre, St George Hospital, Sydney, NSW, Australia
- St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
- Translational Cancer Research Network, Sydney, NSW, Australia
| | | | - Ruth Lilian
- Translational Cancer Research Network, Sydney, NSW, Australia
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Reale S, Turner RR, Sutton E, Taylor SJC, Bourke L, Morrissey D, Brown J, Rosario DJ, Steed L. Towards implementing exercise into the prostate cancer care pathway: development of a theory and evidence-based intervention to train community-based exercise professionals to support change in patient exercise behaviour (The STAMINA trial). BMC Health Serv Res 2021; 21:264. [PMID: 33745448 PMCID: PMC7982309 DOI: 10.1186/s12913-021-06275-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/11/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The National Institute for Health and Care Excellence (NICE) recommend that men on androgen deprivation therapy (ADT) for prostate cancer should receive supervised exercise to manage the side-effects of treatment. However, these recommendations are rarely implemented into practice. Community-based exercise professionals (CBEPs) represent an important target group to deliver the recommendations nationally, yet their standard training does not address the core competencies required to work with clinical populations, highlighting a need for further professional training. This paper describes the development of a training package to support CBEPs to deliver NICE recommendations. METHODS Development of the intervention was guided by the Medical Research Council guidance for complex interventions and the Behaviour Change Wheel. In step one, target behaviours, together with their barriers and facilitators were identified from a literature review and focus groups with CBEPs (n = 22) and men on androgen deprivation therapy (n = 26). Focus group outputs were mapped onto the Theoretical Domains Framework (TDF) to identify theoretical constructs for change. In step two, behaviour change techniques and their mode of delivery were selected based on psychological theories and evidence to inform intervention content. In step three, the intervention was refined following delivery and subsequent feedback from intervention recipients and stakeholders. RESULTS Six modifiable CBEPs target behaviours were identified to support the delivery of the NICE recommendations. Nine domains of the TDF were identified as key determinants of change, including: improving knowledge and skills and changing beliefs about consequences. To target the domains, we included 20 BCTs across 8 training modules and took a blended learning approach to accommodate different learning styles and preferences. Following test delivery to 11 CBEPs and feedback from 28 stakeholders, the training package was refined. CONCLUSION Established intervention development approaches provided a structured and transparent guide to intervention development. A training package for CBEPs was developed and should increase trust amongst patients and health care professionals when implementing exercise into prostate cancer care. Furthermore, if proven effective, the development and approach taken may provide a blueprint for replication in other clinical populations where exercise has proven efficacy but is insufficiently implemented.
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Affiliation(s)
- Sophie Reale
- Allied Health Professionals, Radiotherapy and Oncology, Sheffield Hallam University, Sheffield, UK
| | - Rebecca R Turner
- Allied Health Professionals, Radiotherapy and Oncology, Sheffield Hallam University, Sheffield, UK
| | - Eileen Sutton
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Stephanie J C Taylor
- Institute for Population Health Sciences, Queen Mary University of London, London, UK
| | - Liam Bourke
- Allied Health Professionals, Radiotherapy and Oncology, Sheffield Hallam University, Sheffield, UK
| | - Dylan Morrissey
- Sports and Exercise Medicine, William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Janet Brown
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Derek J Rosario
- Allied Health Professionals, Radiotherapy and Oncology, Sheffield Hallam University, Sheffield, UK
- Department of Urology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Liz Steed
- Institute for Population Health Sciences, Queen Mary University of London, London, UK.
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Mitchell L, McKean M, O'Connor H, Prvan T, Slater G. Client experiences and confidence in nutrition advice delivered by registered exercise professionals. J Sci Med Sport 2020; 24:488-493. [PMID: 33051124 DOI: 10.1016/j.jsams.2020.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aims of this cross-sectional study were to describe the client experiences of registered exercise professionals (REP) in regard to nutrition advice, and to identify factors considered important when selecting a REP. DESIGN A convenience sample of fitness facility-users were recruited. Participants completed a 46 item online questionnaire. METHOD Frequency distributions were calculated for nutrition advice received from a REP, confidence in the nutrition advice received, and factors considered when selecting a REP. The effect of sex and level of education on participant responses were investigated. RESULTS A total of 455 individuals participated, of which 55.6% had worked with a REP. Participants working with a REP had received nutrition advice on body fat loss (77.4%), muscle gain (78.7%), and clinical nutrition (51.9%). Sex and level of education did not influence confidence in nutrition advice, with 60.7% of participants reporting being 'very or extremely confident' in the nutrition advice. Over half of participants (58.3%) prefer to work with a REP who offers nutrition advice. Basic and personal professional conduct were identified as 'very or extremely important' by >70% of participants when selecting a REP. CONCLUSION Clients of REP prefer to work with a REP who provides nutrition advice and are generally confident in this advice. Educating fitness facility-users on the nutrition scope of practice of REP and promoting the role of accredited nutrition professionals should be advocated. Encouraging REP to work collaboratively with nutrition professionals will help ensure clients receive appropriate nutrition care, while better allowing REP to remain within their scope of practice.
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Affiliation(s)
- Lachlan Mitchell
- Faculty of Health Sciences, The University of Sydney, NSW, 75 East St, Lidcombe, 2141, Australia.
| | - Mark McKean
- School of Health and Sport Sciences, University of the Sunshine Coast, 90 Sippy Downs Dr, Sippy Downs, Queensland, 4556, Australia
| | - Helen O'Connor
- Faculty of Health Sciences, The University of Sydney, NSW, 75 East St, Lidcombe, 2141, Australia; Charles Perkins Centre, The University of Sydney, NSW, John Hopkins Dr, Camperdown, 2006, Australia
| | - Tania Prvan
- Department of Mathematics and Statistics, Macquarie University, NSW, Balaclava Rd, North Ryde, 2109, Australia
| | - Gary Slater
- School of Health and Sport Sciences, University of the Sunshine Coast, 90 Sippy Downs Dr, Sippy Downs, Queensland, 4556, Australia
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Zhou S, Davison K, Qin F, Lin KF, Chow BC, Zhao JX. The roles of exercise professionals in the health care system: A comparison between Australia and China. J Exerc Sci Fit 2019; 17:81-90. [PMID: 31193075 PMCID: PMC6517258 DOI: 10.1016/j.jesf.2019.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 11/06/2022] Open
Abstract
Physical inactivity is identified by the World Health Organisation as the fourth risk factor for global mortality and has major implications on the prevalence of non-communicable diseases and general health of the populations. There has been substantial evidence indicating that adequate levels of physical activity, such as prescribed exercise, can be an effective intervention for prevention and treatment of many chronic health conditions, as well as for improvement of mental health, quality of life and well-being. Many countries in the world have developed policies and guidelines for promotion of participation in physical activity and application of prescribed exercise as a means of intervention for chronic health conditions. Subsequently, the roles of exercise professionals in the community and health care system who provide services to the general community members, individuals with various health conditions, as well as elite athletes, and their professional training, qualifications and standards need to be defined and implemented. This article provides a preliminary comparison of the exercise professionals and their current roles in the community and health care systems between Australia and China (including mainland, Taiwan and Hong Kong, as they have different health care systems), aiming to promote the recognition of exercise professionals in the health care systems, and facilitate the global development of the exercise-related professions, for a healthier world.
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Affiliation(s)
- Shi Zhou
- School of Health and Human Sciences, Southern Cross University, Lismore, New South Wales, Australia
| | - Kade Davison
- School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Fei Qin
- China Institute of Sport Science, Beijing, China.,School of Physical Education, Jinan University, Guangzhou, China
| | - Kuei-Fu Lin
- Department of Physical Education, National Tsing Hua University, Hsinchu, Taiwan
| | - Bik-Chu Chow
- Department of Sport and Physical Education, Hong Kong Baptist University, Hong Kong
| | - Jie-Xiu Zhao
- China Institute of Sport Science, Beijing, China
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Panza GA, Armstrong LE, Taylor BA, Puhl RM, Livingston J, Pescatello LS. Weight bias among exercise and nutrition professionals: a systematic review. Obes Rev 2018; 19:1492-1503. [PMID: 30176183 DOI: 10.1111/obr.12743] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/20/2018] [Accepted: 06/28/2018] [Indexed: 12/16/2022]
Abstract
Obesity affects approximately one-third of American adults. Recent evidence suggests that weight bias may be pervasive among both exercise and nutrition professionals working with adults who have obesity. However, the published literature on this topic is limited. This review aimed to (i) systematically review existing literature examining weight bias among exercise and nutrition professionals; (ii) discuss the implications of this evidence for exercise and nutrition professionals and their clients; (iii) address gaps and limitations of this literature; and (iv) identify future research directions. Of the 31 studies that met the criteria for this review, 20 examined weight bias among exercise professionals, of which 17 (85%) found evidence of weight bias among professionals practicing physical therapy (n = 4), physical education (n = 8) and personal/group fitness training (n = 5). Of 11 studies examining weight bias among nutrition professionals, eight (73%) found evidence of weight bias. These findings demonstrate fairly consistent evidence of weight bias among exercise and nutrition professionals. However, the majority of studies were cross-sectional (90%). Given that weight bias may compromise quality of care and potentially reinforce weight gain and associated negative health consequences in patients with obesity, it is imperative for future work to examine the causes and consequences of weight bias within exercise and nutrition professions using more rigorous study designs.
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Affiliation(s)
- G A Panza
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA.,Department of Cardiology, Hartford Hospital, Hartford, CT, USA
| | - L E Armstrong
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| | - B A Taylor
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA.,Department of Cardiology, Hartford Hospital, Hartford, CT, USA
| | - R M Puhl
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA.,Department of Human Development and Family Studies, University of Connecticut, Storrs, CT, USA
| | - J Livingston
- Department of Research Services, University of Connecticut, Storrs, CT, USA
| | - L S Pescatello
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA
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