FiGHTING F!T: An exercise program for adolescents and young adults during cancer treatment in Western Australia

Following patients providing informed consent and consent being sought by the participants treating clinician participants will undergo a baseline assessment. This assessment is conducted by an Accredited Exercise Physiologist (AEP) and is repeated at 10 weeks and 20weeks post recruitment. The following parameters will be collected at baseline, ten weeks and twenty weeks: • Demographic information: diagnosis, treatment, medical history. • Cardiopulmonary Exercise Testing (CPEX): to measure submaximal oxygen consumption (Vo2peak) • Anthropometrics: Body mass, height, BMI, waist/hip circumference. • Strength: 1 repetition maximum (1RM) for leg press, row and chest press strength grip strength • Physical function: 30sec push up, sit ups, sit to stand. • Body composition: using dual energy x-ray absorptiometry (DEXA) to measure fat mass, muscle mass and bone mineral density. The following feasibility data will be collected and analysed throughout the study period: • Adverse events • Information relating to withdrawal from the study • Adherence to the exercise intervention • Compliance to the study protocol. Stratification and randomisation Following baseline assessment participants will be randomised by stratified permuted block randomisation. Patients will be stratified according to intensity of their cancer treatment; High intensity vs moderate/low intensity treatment regimen (ie treatment for Hodgkin lymphoma (moderate) vs treatment for sarcoma (high)). Participants will then be randomised to either immediate exercise or usual care (delayed exercise) groups. Intervention Participants randomised to the ‘immediate’ exercise intervention group will commence their exercise program the week following their baseline assessment. The exercise sessions will be conducted in a hospital based gymnasium in a one-on-one capacity. The biweekly sessions will be conducted for 10 weeks and supervised by an AEP. The baseline testing and subsequent exercise sessions will commence prior to the beginning of the second cycle of patients’ systemic treatment. The AEP will design an individual exercise program for each participant based initially on the results of the baseline functional assessment, which will then be progressed weekly as tolerated by the individual patient. Following the 10-week intervention participants, will be reassessed and then receive no intervention (usual care) for the following 10 weeks to the final assessment at 20 weeks Control (delayed exercise) Patients randomised to the ‘delayed’ exercise intervention group will receive “usual care”, and will not be offered the additional (experimental) exercise intervention for the initial 10 weeks following baseline assessment. See details below. Exercise intervention Exercise programs for all participants will be mixed mode; incorporating a combination of aerobic and resistance exercises. All programs will follow the ACSM guidelines for cancer survivors. Over the course of the program, it is expected that each participant will engage in 30 minutes of aerobic exercise and 30 minutes of resistance training within each of the two weekly supervised sessions. ACSM guidelines recommend cancer survivors complete >150 minutes of aerobic exercise per week, therefore participants will be encouraged to complete additional aerobic exercise such as walking at home to accumulate a total of 150 minutes over the week. The exercise sessions will be designed using the results of the baseline functional assessment. The aerobic exercise will be prescribed at 60-80% of Vo2peak (as determine by the CPET) and the resistance program at 50-80% of 1RM (as determine by chest press, leg press and row). Exercise intensity will be monitored using heart rate monitors and Rating of Perceived Exertion (RPE) scales. Participants will be encouraged to exercise at a moderate to high intensity (60% to 85% heart rate max). Aerobic exercise modalities will include upright/recumbent bike cycling, treadmill walking/jogging, skipping and/or boxing. The resistance exercise will comprise of an exercise for each major muscle group, with three sets of 10-15 reps per exercise. The AEP will aim to progress exercise intensity as tolerated. Participants will also be encouraged to engage in aerobic exercise outside of supervised exercise sessions through a home based aerobic exercise prescription to be completed at independently at home. They will be asked to document their activity in exercise journals. If participants fail to attend a session they will be telephoned to determine the cause of their non-adherence. Session adherence will be recorded on a weekly basis and used for reporting at the end of the intervention.