Enhancing treatment outcomes after gynaecological cancer (ACUMEN For ALL): Using telehealth exercise delivery to promote health after cancer therapy

The total study period is 24 weeks. It comprises of a 12-week exercise training intervention and a 12-week maintenance period. After participant screening and baseline assessment, participants will be randomised to either the intervention or waitlist-control group. Participants in the delayed intervention control group will complete a 12-week control period, they will then be eligible for the intervention and the same outcome assessments will be repeated. The telehealth intervention has two components, an exercise component underpinned by a behavioural component. Both will be delivered via video-link by an accredited exercise physiologist or physiotherapist (AEPP) trained in cancer care. The exercise component is structured over 12 weeks and adheres to Exercise and Sports Science Australia recommendations, including Adult Pre-Exercise Screening System (APPS form) for risk of adverse event due to exercise. Goals will be prioritised and set, and the prescription co-designed with the participant, including strategies for longer-term maintenance. The intervention will adhere to ESSA guidelines: 1. The goal is to enhance neuromuscular strength, endurance, balance, flexibility, and cardiorespiratory fitness. The AEPP will individually tailor exercise to the functional capacity of each participant towards these goals, cognisant of participant restrictions. 2. Up to 3 x 60-minute exercise sessions per week, individually prescribed by an AEPP. The session will aim for an aerobic component (up to 40 minutes moderate-to-vigorous intensity based on a percentage range of age-predicted heart rate maximum) such as jogging -on-the-spot or fast walking and resistance component (2 x 8-12+ repetitions of major muscle group exercises at >6-10 on the OMNI perceived exertion scale, where 0=extremely easy to 10=extremely hard) such as push-ups, lunges, squats, rowing. High-intensity aerobic exercise may be prescribed during the intervention, individualised to the participants’ cardiorespiratory fitness and closely monitored by the AEPP. Exercise intensity during exercise sessions will be monitored by heart rate on the Fitbit watch, and by rating of perceived exertion using the 6-20 Borg Scale. 3. For the first six-weeks, the AEPP will directly supervise and prescribe two individual 60 minute sessions per week via Zoom (Zoom Video Communications, USA) and provide prescription for one self-managed home session. 4. In Weeks 7-12, participants will be asked to attend one supervised 60 minute Zoom session per week. Participants will also complete two self-managed, home based exercise sessions. 5. The AEPP will deliver all sessions from Wesley Choices, Wesley gym, UQ, or a private and undisturbed location using a laptop, while participants will be asked to participate from their home or another location of their choosing. The exercise intervention will be complemented by a behavioural component integrated within each exercise session. The behavioural component will enable the AEPP to help the participant define realistic achievable goals and facilitate exercise maintenance beyond the study period. The exercise intervention will therefore be complemented by a behavioural component. The aim of the behavioural component is to instil exercise self-efficacy, which refers to the person’s willingness to respond to challenges, how hard they will work at challenges, and the extent to which they will persist despite adversity or set-backs. The behavioural component will enable the AEPP to help the participant define realistic achievable goals, encourage them to achieve the desired exercises, give participants insights into the success of others in similar circumstances, and facilitate exercise maintenance beyond the study period. The AEPP will be trained in the following specific strategies demonstrated to promote self-efficacy: 1. Collaborating with the participant to define realistic goals that are specific, achievable and measurable. As the individual successfully reaches those goals (performance accomplishment), this in turn promotes optimism and willingness to persist despite set-backs. 2. Providing information about success of others (vicarious experience), which instils the notion of “If they can do it, so can I”. 3. Encouragement by the AEPP (verbal persuasion), which is demonstrated to increase motivation. 4. Attention to emotional arousal including cognitive distortions, and challenging preconceived ideas or misperceptions about exercise that can otherwise pose a barrier. Intervention training for AEPPs will be multimodal. First, a self-directed training manual will describe the common physical and psychological consequences of the diagnosis and treatment of reproductive cancer. This will be supplemented by a day-long skills development session that will focus on empathic engagement, the principles of chronic disease self-management, motivational interviewing, encouraging exercise self-efficacy and techniques to challenge cognitive distortions. Third, clinical supervision from experienced psycho-oncology clinicians and specialist oncology AEPPs will be available for AEPPs as our previous research has demonstrated that this is a central aspect of promoting the confidence of health professionals to deliver this type of intervention. Duration and intensity of daily physical activities will be tracked during the monitoring period. All participants will be required to wear a FitBit throughout their maintenance period to accurately track the intensity of daily physical activities, including the unsupervised exercise sessions.