CanSTEP: Effect of cognitive-motor step exergame training on chemotherapy-induced peripheral neuropathy (CIPN) symptoms in cancer survivors

Four-month cognitive-motor rehabilitation program involving step exergame training delivered through a home-based system (SmartStep). All intervention participants will receive the step exergame system (personal computer, software and instruction / safety booklet) and wireless step mat to interface with their television screen or provided computer monitor. The intervention involves unsupervised cognitive-motor training using the step exergame system. The intervention incorporates both stepping/balance exercises and cognitive training. The exergames require participants to make appropriately timed and accurate steps from both legs on the wireless floor step mat. The program of games is designed to train fast stepping responses in addition to cognitive functions of selective attention, response inhibition, working memory, visuo-spatial processing and task switching, Trained research assistants with experience working with balance-impaired clinical groups and trained in exercise physiology, physiotherapy, nursing, neurosciences or biomedical sciences will set up the equipment in participants' homes during a 60-90min initial home visit. The research assistant will instruct participants on how to safely use the program. Following the initial installation visit, intervention participants will receive a follow-up phone call (or online teleconference) after the first two weeks and again at eight weeks to ensure safe use and progression of training and to discuss any issues relating to system use. Additional phone calls (or home visits) during the intervention will be offered as needed. Emails will also be sent at 4 and 12 weeks to ascertain participant adherence to the program. At all points of contact with the study team, participants will be asked if they faced any difficulties using the program and appropriate measures will be taken to resolve any issues. Participants will be encouraged to undertake three to four 20-30 minute training sessions per week progressing to a target range of 80 to 120 minutes per week. We will initially encourage participants to undertake several short training sessions (e.g. 10 to 15min training sessions) per week to maximise confidence and long-term adherence. We will then progressively increase their training sessions duration (by 10% to 20% at a time, considering both physical function and personal preferences / other commitments). Participants’ intervention usage data (minutes of game play each week) will be collected locally on the personal computer and later transferred onto an online server at Neuroscience Research Australia.