Integrating Exercise Within Neuro-Oncology Care

Neuro-oncology patients are underserved in the field of exercise oncology. With growing evidence on the role of exercise for this patient population, there is a need to develop and evaluate accessible and tailored exercise interventions within standard supportive neuro-oncology care. The purpose of this PhD thesis was thus to develop, deliver, and evaluate the feasibility and effectiveness of tailored 12-week exercise intervention for neuro-oncology patients across Alberta, Canada – the Alberta Cancer Exercise-Neuro-Oncology (i.e., ACE-Neuro) study. A type II effectiveness-implementation study design was used along with a mixed-methods and patient-oriented research approach. A series of five studies were conducted, including (1) building the protocol, (2) evaluating feasibility, (3) evaluating effectiveness, (4) gathering patient and caregiver perspectives of participation, and (5) gathering clinical team member perspectives of referring to and delivering ACE-Neuro. Adult neuro-oncology patients either self-referred or were referred via the electronic medical record to a tailored exercise intervention that screened for neurological impairment and exercise readiness prior to twice-weekly exercise and health coaching sessions. Quantitative measures included patient-reported outcomes, functional fitness, and objective physical activity. Qualitative measures included semi-structured interviews with patients, caregivers, and the clinical team. Analyses included descriptive statistics, linear mixed models, and interpretive description. The ACE-Neuro study was created in August 2020 and delivered until December 2024. A total of n=70 patients enrolled into ACE-Neuro. N=37 patients and caregivers and n=10 clinical team members participated in interviews. ACE-Neuro was deemed feasible, improved select patient outcomes, and was valued by patients, caregivers, and the clinical team. Key areas of success included the tailored delivery approach, engagement of end-users across the research process, and adoption of the referral pathway during the study into the neuro-oncology clinical workflow. The ACE-Neuro study is a novel addition to the limited evidence base on exercise in neuro-oncology. Findings highlight the potential for exercise to be integrated into neuro-oncology supportive care. Opportunities for future work include exploring strategies for long-term program delivery, such as optimizing referral pathways and championing exercise specialists as part of the transdisciplinary care team, to build towards sustained access to exercise for individuals living with brain cancer.

Name thesis:degree_name

Doctor of Philosophy (PhD)

Discipline thesis:degree_discipline

Kinesiology

Grantor dc:publisher.institution

Graduate Studies

Year dc:date.issued

2025

Author dc:creator

• Daun, Julia Teresa

Advisor dc:contributor.advisor

• Culos-Reed, S. Nicole

Committee members dc:contributor.committeemember

• McDonough, Meghan Heather
• Roldan Urgoiti, Gloria
• Sauro, Khara Marissa
• Winters-Stone, Kerri M.

• Neuro-Oncology
• Exercise Oncology
• Tailored Exercise Interventions
• Supportive Cancer Care
• Implementation
• Feasibility
• Effectiveness
• Mixed Methods
• Patient-Oriented Research

Statement dc:rights

• University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission. This thesis includes seven chapters, five of which are manuscripts that have been published or are prepared for submission to a peer-reviewed journal. Chapters one and seven are original, unpublished work. All co-authors of the manuscripts presented in chapters two through six have provided written consent for their inclusion in this thesis. The authors retain copyright for all manuscript content. The manuscripts in chapters two, three, and five are shared under a Creative Commons Attribution (CC-BY) 4.0 License.

Language dc:language.iso

en

DOI

https://dx.doi.org/10.11575/PRISM/48869

OAI identifier oai:identifier

oai:ucalgary.scholaris.ca:1880/121279