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A pilot randomized controlled trial of a virtual peer-support exercise intervention for female older adults with cancer

BMC Geriatrics volume 24, Article number: 887 (2024) Cite this article

Abstract

Background

Regular exercise can mitigate side effects of cancer treatment. However, only a small proportion of adults with cancer meet exercise guidelines, and older adults (> 65 years) are underrepresented in cancer rehabilitation research. Peer support facilitates health-promoting behaviours in general populations, but interventions merging exercise and peer support for older adults with cancer are not examined. The purpose of this study was to determine the feasibility and preliminary effectiveness of a virtual partner-based peer support exercise intervention for older adult female cancer survivors.

Methods

Older adult female cancer survivors with internet access and currently participating in < 150 min of moderate-vigorous physical activity per week were included in this study. Participants were matched with a partner and given a peer support guide, exercise guidelines, and a Fitbit Inspire©. In addition, intervention group dyads (AgeMatchPLUS) had weekly 1-h virtual sessions with a qualified exercise professional for 10 weeks. Dyads randomized to the control group (AgeMatch) independently supported their partner around exercise for 10 weeks. The primary outcome was feasibility, measured using retention and adherence rates. Secondary outcomes included exercise volume, social support, quality of life, physical function, and physical activity enjoyment. Descriptive statistics were used to report feasibility and an ANCOVA was used to explore between group differences on secondary outcomes at post-intervention (10 weeks post baseline) and post-tapering timepoints (14 weeks post baseline).

Results

Eighteen participants (9 dyads; mean age 72 years (SD: 5.7 years)) were included in the pilot trial. Retention and adherence rates to the AgeMatchPLUS intervention were 100% and 95% respectively. All but one participant was satisfied with the quality of their peer match. Preliminary effects were seen between group, favouring AgeMatchPLUS for exercise-related social support post-intervention (effect size (d) = 0.27, 95% CI = 0,0.54) and physical activity enjoyment at post-tapering (d = 0.25, 95% CI = 0,0.52) and favouring the AgeMatch group for 30 s sit-to-stand repetitions at post-tapering (d = 0.31, 95% CI = 0.004, 0.57). No other effects were found.

Conclusions

A virtual partner-based exercise intervention for older adults with cancer is feasible and shows preliminary effect benefits. Findings inform future trials aimed at increasing exercise in older adults with cancer.

Trial registration

Clinicaltrials.gov (ID: NCT05549479, date: 22/09/22).

Peer Review reports

Background

By 2030, almost a quarter of the Canadian population will be over the age of 65 years [1]. Females have a longer life expectancy than males and will make up the majority of older Canadian adults [2]. As individuals age, they have increasing rates of functional decline and mobility limitations [3]. Two in five Canadian adults (43% of females) will be diagnosed with cancer [4], and most new cancers are diagnosed in those over 65 years [5]. Cancer and its associated treatments cause physical sequelae, which can accelerate the natural aging process [3, 6, 7]. These treatment-associated declines further compound limitations in function typically associated with aging and is a key survivorship issue faced by older adult survivors of cancer [6, 7].

Many of the physical effects of cancer treatment can be mitigated by participation in regular exercise [8,9,10,11,12]. However, less than 30% of all survivors meet current recommended exercise guidelines [13,14,15]. Further, older adult female cancer survivors are significantly less likely to meet current guidelines than males of all ages and their younger female counterparts [16]. While exercise is safe and effective in survivors of all ages [12, 17], older adults with cancer are significantly underrepresented in exercise oncology research [18]. Commonly reported barriers to participation in exercise programming include a lack of access to qualified health professionals to guide behavioural strategies and a lack of social support [14, 19, 20]. Further, the COVID-19 pandemic disproportionately affected older adults with chronic health issues such as cancer, with reports of decreased exercise levels, physical fitness, and quality of life [21,22,23,24,25].

Social support is multi-faceted and involves networks of individuals, groups, and the community available to individuals in times of need [26]. High levels of social support in adult survivors of cancer are beneficial for increasing physical activity behaviour [27,28,29,30]. Social support comes in various forms, including spousal support, caregiver support, and professional support. It can include providing information on a topic (e.g., informational support), material support (e.g., tangible assistance), encouragement towards a behaviour (e.g., esteem support), or empathy with a situation (e.g., emotional support) [31,32,33]. When considering the impact of COVID-19 on older cancer survivors and strategies to maximize well-being, peer support is recommended to alleviate feelings of isolation and maximize quality of life [34, 35]. Peer support facilitates health promotion as people share messages with members of their community and facilitate behaviour change in various areas via experience sharing, emotional support, and practical help [36,37,38]. Peer-based interventions in general adult populations are as effective as professionally delivered interventions to facilitate physical activity behaviour [39]. Peer support can naturally occur through a person’s existing social networks (e.g., friends, colleagues, family). However, peer-based supports that arise between individuals with similar circumstances, outside existing social networks, offer unique benefits by allowing peers to share lived experiences, challenges, and communicate with someone who can relate to specific life circumstances [39].

There is little research using peer-based interventions to promote exercise in older adults [40] or cancer populations [41],  and no literature on this issue in older adult cancer populations. Further, it is unknown whether exercise professional-guided virtual support provides additional benefits to peer matching alone, by cultivating a new and different type of support. This study builds on our previous work around physical activity and social support for survivors of cancer [42] by examining a virtual peer-matching exercise intervention specifically for older adults with cancer. In particular, the unique physical and social needs of this sub-group of survivors and their potential difficulty in using new technology were key factors underlining the importance of studying the feasibility of such an intervention in this population. The purpose of this study was to determine the feasibility and preliminary effectiveness of a novel peer support intervention related to exercise for older adult female cancer survivors. Our three specific research questions were 1) Is a virtually-delivered, peer matching intervention supported by qualified exercise professionals (QEP) feasible for older adult female survivors of cancer?; 2) Do older adult female survivors of cancer who participate in a virtually-delivered, peer-matching intervention with QEP support have improved exercise volume (weekly minutes of moderate-to-vigorous physical activity (MVPA)) compared to those receiving support from a peer only?; 3) Do older adult female survivors of cancer who participate in a virtually delivered peer matching intervention with QEP support have improved levels of social support, health-related quality of life, physical functioning, and physical activity enjoyment compared to those receiving support from a peer only? We hypothesized that 1) the intervention would demonstrate feasibility, 2) that both groups would show preliminary benefit of being matched with a peer, and 3) and those matched with a peer plus QEP support would demonstrate preliminary effect benefit compared to those receiving peer support only.

Methods

Study design

This study was a two-arm pilot randomized controlled trial with a blinded outcome assessment. The study methods adhered to the CONSORT extension for randomized pilot trials [43]. This trial was registered on Clinicaltrials.gov (ID: NCT05549479, date: 22/09/22) and the Hamilton Integrated Research Ethics Board approved this study (ID: 15,283). Participants were matched into dyads prior to randomization. Dyads were randomized (1:1) to the intervention (AgeMatchPLUS) or control (AgeMatch) groups. Group allocation was centrally randomized using a web platform (https://www.randomizer.org/) by a graduate student external to the research team. A Research Coordinator (RC) allocated participants in the order they completed the initial demographics questionnaire and were matched with a peer for the study.

Participants & recruitment

Eligible participants included: (1) English-speaking; (2) self-identified female older adults (> 65 years); (2) living with or beyond a cancer diagnosis (any type or stage of cancer at any stage of treatment); (3) living in Canada; who were (4) cleared to participate in exercise according to Canadian Society of Exercise Professional’s “Get Active Questionnaire”; [44] (5) had consistent access to the internet; and (6) took part in less than 150 min of MVPA per week. Participants were excluded from the study if they (1) self-reported any contraindications to exercise or (2) had recent (in the last 4 weeks) or planned surgery of any kind (including reconstructive surgery) in the ensuing 3 months.

We recruited for this project by sending out study ads using community association resources (i.e., retiree associations, aging councils’ websites, and social media) and placing ads in local newspapers to recruit participants. Interested potential participants were asked to contact study staff by email. A RC screened participants for eligibility before gaining consent and setting up the baseline assessment.

Intervention

Peer matching

The RC matched all participants into dyads based on evidence-informed criteria [30, 45]. To be matched, females must have been within a 10-year age range and in the same time zone. Beyond these core criteria, we matched based on personal (family status and career stage) and cancer-related characteristics (cancer type, stage, treatment status) where possible. All participants were given a peer support guide that provided tips for supporting their study partner, an infographic on exercise guidelines for older adults with cancer, information on the Rate of Perceived Exertion scale (RPE; 10-point scale), and a Fitbit Inspire 2©. Matched peers were introduced to each other via Zoom after baseline data collection where they reviewed the study documents provided, discussed personal preferences for social support, and took part in icebreaker activities. IT support was available from the RC for all participants during the study to ensure that technical problems did not limit participation.

Partners in both groups independently communicated using the mode of their choice (i.e., phone, email, text messaging, video conferencing, in-person meeting, as chosen by the dyad) for the duration of the study. They were encouraged to support each other around exercise on a weekly basis (with chosen mode and frequency) for the duration of the study.

Intervention group (AgeMatchPLUS)

This group had dyads communicate and support each other around exercise, structuring their communication (mode and frequency) independently with their matched peer. Together, dyads also participated in weekly virtual sessions using zoom where they received support from a qualified exercise professional (QEP) for 10 weeks. Each session lasted up to 1 h. The QEP had advanced training in cancer rehabilitation and provided a tailored exercise program recommendation, focusing on aerobic activity (defined as dynamic activities that involve large muscles and result in increases in heart rate and energy expenditure; may include activities such as walking, swimming, and biking [12]), strength training (exercises designed to improve muscle strength using equipment like free weights, TheraBand’s and activities such as yoga and pilates [12]) and mobility (exercise designed to improve movement, can include activities like stretching and gait training [12]), with both individuals in the dyad based on personal circumstances, cancer-related characteristics, side effects, current fitness level (consistent with home-based exercise strategies [12]), and personal preferences. The QEP sessions were discussion-based only where exercise program recommendations were personalized for each individual in the dyad with the other participant supporting their partner in achieving their goals. A standardized piloted guide [42] was used to deliver specific sessions each week. Overall, the content discussed at the sessions included a review of the exercise program, barriers to exercise participation, goal setting, mindset, self-talk, motivation, achievement of goals, and adverse events. The overall goal was for each participant was to achieve exercise guidelines older adults and cancer survivors [12, 46]. For four weeks following the 10-week intervention (labelled “tapering” period), the QEP was available for consultation as needed by participants. During the tapering period, participants in this group also received two supportive emails from the QEP encouraging ongoing maintenance of exercise and social support. This tapering period was important to understand the strategies to taper older adults from an exercise trial successfully.

Control condition (AgeMatch)

Dyads in this group were asked to independently communicated and supported each other around exercise for the 10-week intervention period. They structured their communication and support (mode and frequency) independently with their matched peer and did not have additional contact or support provided by the QEP during the intervention or tapering period. After the final assessment time point, participant dyads in this group were offered a single virtual session with the study QEP to discuss exercise-related questions for older adults with cancer.

Outcomes

Outcome data were collected at baseline (T1), post-intervention (T2; 10 weeks post-baseline), and post-tapering (T3; 14 weeks post-baseline). Before baseline, a demographic survey collected personal (i.e., gender identity, culture) and-cancer specific characteristics (i.e., type, stage).

Primary outcome

The primary outcome of this pilot trial was feasibility. Feasibility was assessed by measuring retention and adherence rates to the intervention, number of participants requiring technical assistance, and satisfaction with peer support at T2. Retention was defined as a percentage of enrolled participants who completed the intervention and adherence was defined as percentage of total sessions attended. Based on the most recently published high quality systematic review data in this population and using similar methods, a priori we defined the intervention would be feasible with a retention rate of 70% [47]. Adherence was tracked using weekly logs by the QEP. Based on previously published data, a priori we defined the intervention would be feasible with an adherence rate of 70% [48]. Further, to determine the feasibility of this mode of study (distance based, virtual), the frequency (total number) of technical issues requiring assistance was tracked by the RC for the duration of the study, as was the needed response to each issue. A prior we defined the intervention would be feasible if < 50% of participants reported technical issues to the RC.

Participant satisfaction with the quality of their peer match to support exercise was also collected as a component of feasibility via a self-report questionnaire collected at T2 (5-point Likert scale from very dissatisfied to very satisfied). We expected only a small number of participants (≤ 25%) would report being dissatisfied (i.e., dissatisfied or very dissatisfied) with the quality of their peer match. Participants were also asked to what extent they felt their exercise partner was a good match (5-point Likert scale from very good match to very poor match) and was similar to them (Likert scale from extremely similar to not at all similar). They were asked to elaborate on what characteristics they had in common with their partner in a multi-select question with the option to add additional information. At T2 and T3 participants were also asked how often they communicated with their exercise partner (number of times per week; open-ended question), for how long (in minutes; open-ended question), and how (i.e., mode; multi-select question) they communicated.

Secondary outcomes

Preliminary effectiveness outcomes included device-measured exercise volume, self-report exercise volume [49], social support [32, 50], health-related quality of life (HRQOL) [51], physical functioning [52, 53], and enjoyment of performing physical activity [54]. The outcomes were assessed at all three timepoints (T1, T2, and T3).

Device measured exercise volume was measured using a Fitbit Inspire 2©. The Fitbit device measured daily minutes of MVPA, sedentary minutes, total minutes of physical activity, and step count. Participants were only required to wear the Fitbit device for 7 days (7-day wear time) at each of the three assessment timepoints, and the daily counts were averaged into weekly values. Data were downloaded at the end of each 7-day wear time by a study team member via the online Fitbit database. In this study participants were only required to wear the Fitbit during activity assessments (not for the entire duration of the study). However, they were not restricted from using the Fitbit between assessment time points and use outside of the assessment time points was not tracked. Participants were able to keep them after the study was completed and use at their leisure. The Fitbit has been used successfully in other studies, including individuals with cancer, demonstrating high adherence [55, 56] and correlation with Actigraph measurement [55].

Self-report exercise volume was measured using The Godin Leisure Time Exercise Questionnaire [49, 57]. This self-report scale assesses weekly frequencies and duration of mild, moderate, and strenuous aerobic activity and has demonstrated reliability and validity in survivors of cancer [49, 57, 58]. Frequency and duration of resistance training were also self-reported within this form. Total scores were summarized for each of the three intensity levels for both the aerobic and resistance components to get a total aerobic and resistance activity score.

Overall social support was measured using the Social Support Survey (SSS) [32, 50]. This scale assesses the total amount of (number) and satisfaction with (on a five-point Likert scale from very dissatisfied to very satisfied) seven dimensions of social support (listening support, task challenge, emotional support, esteem support, tangible assistance, reality confirming, and understanding cancer support). The SSS is validated for individuals with cancer [59]. A modified Exercise-Related Social Support Survey, previously piloted by our team [32], was used to assess the total amount of and satisfaction with exercise-related social support associated with the same seven domains. Higher scores in both scales represent higher feelings of social support.

HRQOL was measured using the EQ-5D-Visual Analogue Scale (VAS) [51]. The EQ-5D-VAS uses a 10-point VAS to assess users’ perception of their current health status (from 0-worst imaginable health to 10-best imaginable health). This measure has demonstrated reliability and validity for those with cancer [51].

Physical functioning was assessed using the Patient-Specific Functional Scale (PSFS) [52], a virtually administered 6-Minute Walk Test (6MWT) [53], and virtually administered 30-s sit-to-stand (30STS) test [53]. The PSFS is a self-report measure where users identify up to five activities that are important to them, and they are having difficulty performing [52]. They rate their current level of difficulty level with each activity on an 11-point scale (from 0-unable to perform the activity to 10-able to perform an activity at the same level before the problem). It is valid and reliable in adults with various chronic conditions [60, 61]. The 6MWT is a sub-maximal test of functional capacity and measures how far participants can walk at a maximal comfortable speed in six minutes [62]. This test is a reliable and valid tool in adults with various chronic conditions [62, 63] and conducting this test remotely has demonstrated reliability in adult populations [53, 64]. The 30STS test is a test of physical function in older adults, specifically testing leg strength and endurance [65]. It assesses the number of times a person can go from a seated position to a standing position in 30 s and has age- and sex-matched norms. This test is valid and reliable in older adults [65], and remotely administered sit-to-stand tests have demonstrated feasibility and reliability in adult populations [53, 64].

Physical activity enjoyment was measured using the Physical Activity Enjoyment Scale [54]. This 18-item scale assesses enjoyment of the physical activity respondents are currently doing on a 7-point Likert scale from 1 (I enjoy it) to 7 (I hate it). Higher scores represent greater levels of enjoyment. The scale has demonstrated validity and reliability in adults and those with functional limitations [54].

Sample size

Sample size calculation was completed based on suggestions for pilot RCT calculations [66]. Specifically, alpha was set to 0.05 and power 0.8. With a possible attrition of 30%, the required sample size for a full RCT is N = 108. The one-sided CI approach for calculating sample sizes for pilot RCTs [66] suggested using 9% of the total sample size. So, with a possible 30% [30] dropout, the sample size for this trial is at least 14 participants. We rounded this to at least 16 participants (8 total dyads across both groups).

Analysis

Research Question 1: Descriptive statistics were used to measure feasibility. Retention rates were calculated as the percentage of enrolled AgeMatchPLUS participants who completed the intervention and tapering period. Adherence rates for the AgeMatchPLUS group was calculated as a percentage of the total virtual QEP sessions attended and tracked using weekly logs. Reasons for non-participation in scheduled sessions were documented by the QEP using these logs. Satisfaction scores were measured by calculating descriptive statistics (frequencies, percentages) as appropriate.

Research questions 2–3: Descriptive statistics were computed for all measures at all time points. An analysis of covariance (ANCOVA) was used to explore the preliminary between group differences for each secondary outcome using baseline outcome score and group as covariates. An intention-to-treat analysis was used for these analyses using the last observation carried forward. Effect sizes, using Cohen’s d, and confidence intervals were calculated based on ANCOVA results. Stata v15 [67] was used for these exploratory analyses with significance at p < 0.05.

Results

Participants

Eighteen participants were included in this pilot trial. Figure 1 demonstrates participant flow across the study. The mean age of participants was 72 years (SD = 5.7 years), all but one identified as a woman (n = 17; 94%) and 16 (89%) self-identified as white/Caucasian. Most (n = 13; 72%) were highly educated (having completed post-secondary education) and the majority were retired (n = 13; 72%). Breast cancer was the most common cancer diagnosis (n = 11; 61%), and half were diagnosed with stage 1 or 2 cancer (n = 9; 50%). All but four participants (n = 14; 78%) were post treatment. The top three reasons for taking part in this exercise intervention were to increase strength (n = 16; 89%), increase mobility (n = 15; 83%), and improve fitness level (n = 14; 78%). Table 1 provides more information on participant characteristics at baseline. Table 2 provides information on dyad matching characteristics.

Fig. 1
figure 1

CONSORT diagram of patient flow across study

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Table 1 Participant characteristics
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Table 2 Dyad matching characteristics
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Feasibility

Table 3 provides an overview of feasibility benchmarks and outcomes of this study’s intervention.

Table 3 Summary statistics for feasibility outcomes
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Retention rate

The retention rate of the intervention was 100%. All consented participants in the AgeMatchPLUS group completed the intervention. All but one (94%) participant completed the T2 (10-week) follow-up assessment, and all participants (100%) completed the T3 (14-week) follow-up assessment. All participants completed the 7-day Fitbit wear time at all timepoints.

Adherence rate

Adherence to the AgeMatchPLUS intervention was 95%. One participant missed two sessions and three participants missed two sessions. Missed sessions were due to technical issues (no Wi-Fi; n = 1), vacation (n = 1), and family emergency (n = 1). Two sessions were missed for unknown reasons.

Technical issues

Throughout this study, seven participants (39%) had technical issues needing assistance from the RC. These all related to setting up and pairing the Fitbit to their device at the beginning of the study. In response to these issues, the RC made a home visit to resolve these issues with five participants, a phone call with one participant, and a FaceTime call with one participant. After the initial setup of the Fitbits, no technical assistance was needed for the duration of the study.

Satisfaction with peer support and communication characteristics

Most participants (n = 12; 67%) reported being satisfied (n = 7; 39% of all participants) or very satisfied (n = 5; 28%) with the quality of their exercise partner match to support exercise in this project. Only one participant (6%) reported being dissatisfied with the quality of their peer match. Most (n = 13; 72%) felt their assigned exercise partner was a good match for them (n = 6, 33% selected ‘very good’; n = 7, 39% selected ‘good’). When asked how similar they were to their exercise partner, most (n = 12; 67%) felt they were either ‘extremely similar’ (n = 4; 22%) or ‘similar’ (n = 8; 44%) to their partner. When asked what characteristics they had in common with their partner, age (n = 15, 83%) and current physical activity level (n = 11, 61%) were the most common responses.

The median number of times participants communicated each week within the intervention period (between T1-baseline assessment and T2) was once (range 0–3; AgeMatchPLUS median = 1 (outside of QEP session) (range 0–3), AgeMatch median = 2 (range 1–3)). On average, those who connected during this time communicated for 28.88 min (SD = 35.17) (AgeMatchPLUS group mean = 33min (SD = 31.28); AgeMatch mean = 24.75min (SD = 40.42)). Between T1 and T2, most communicated by email (n = 7; 39%) and text messaging (n = 7, 39%). Only four (22%) communicated using video calls, and three (17%) met in person. Twelve participants (67%) said they communicated with their partner during the tapering period (between T2 and T3). The median number of times participants communicated each week during the tapering period was once (range 0–4; AgeMatchPLUS median = 0.5 (range 0–3, AgeMatch median = 1 (range 0–4)). For those who did communicate with their partner during this time, the average duration of the interaction was 22.6 min (SD = 23) (AgeMatchPLUS group mean = 29min (SD = 28.67); AgeMatch mean = 18min (SD = 18.96)). During this time, participants most often communicated by email or text messaging (both n = 6, 33%), however, three participants (17%) said they did continue to meet their partner in person during this time.

Preliminary effectiveness outcomes

Table 4 provides a detailed overview of the results of the analysis of effectiveness outcomes.

Table 4 Summary statistics and exploratory ancova results
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Overall, preliminary estimates of effect found that group allocation had a small effect on exercise-related social support at T2 (t = 2.34, p = 0.03, d = 0.27, 95% CI = 0, 0.54) and physical activity enjoyment at T3 (t = 2.24, p = 0.04, d = 0.25, 95% CI = 0, 0.52), favouring the AgeMatchPLUS intervention group. A group effect was also found on 30STS scores at T3 (t = -2.57, p = 0.02, d = 0.31, 95% CI = 0.004, 0.57), favouring the AgeMatch control group. No other effect of group allocation was found for any outcome at T2 or T3. Figure 2 provides margin plots demonstrating changes in outcome by group over time for selected outcomes.

Fig. 2
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Margins plots demonstrating changes in outcome by group over time (mean, 95% CI) for A) Self-Reported Physical Activity Level (Godin Leisure Time Exercise Questionnaire), B) Exercise Related Social Support (Exercise-Related Social Support Survey), and C) Physical Functioning (Patient Specific Functional Scale)

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Discussion

This study assessed the feasibility and preliminary effectiveness of a virtually delivered peer support exercise intervention for older adult female survivors of cancer. A high adherence rate (95%), retention rate (100%), and satisfaction scores support the feasibility of the intervention and future exploration in a full-scale trial. In an exploratory analysis, beneficial effects of the AgeMatchPLUS intervention were seen for exercise-related social support, and PA enjoyment. Together, the results of this study provide a foundation to support future trials of virtually delivered partner-based interventions for older adults with cancer on a larger scale.

However, technical issues arose for seven participants, all related to setting up the Fitbit device used during assessment procedures, which required assistance from the RC. This observation highlights the need for improved informational resources (such as videos or detailed written instructions) on how to set up and sync the Fitbit devices for older adults in future research trials. We suggest addressing processes for setting up the Fitbit during the initial participant meeting in future trials using similar methods or choosing a device that is simpler for users to set up. No other technical issues arose during the intervention, supporting its feasibility.

Interestingly, improvements in exercise-related social support were seen in both the AgeMatchPLUS and AgeMatch groups over time. The greatest change in the AgeMatchPLUS group occurred between T1 and T2 and then remained unchanged from T2 to T3, whereas in the AgeMatch group, improvements occurred from T1 to T2 and again from T2 to T3. This improvement over time in the AgeMatch group demonstrates the potential benefit of peer matching alone to facilitate exercise-related social support, which is a novel finding for older adult survivors of cancer. This finding is consistent with peer-based exercise interventions for general adult populations, which have demonstrated that peer matching alone is as effective at improving PA level as professionally delivered interventions [39]. Further, in younger adult survivors of cancer (i.e., < 65 years of age), partner-based exercise interventions have demonstrated improved outcomes when peers are matched into a mentor–mentee relationship (i.e., one partner acting as an exercise mentor to the other partner) [41, 68], and when matched as equals to support and facilitate exercise performance [30, 69]. For example, Pinto and colleagues paired participants into mentor/mentee dyads and after 12-weeks found that physical activity level and well-being increased significantly from baseline to post-intervention [68, 70, 71]. Murray and colleagues conducted an ecological momentary assessment to examine whether different forms of social support from a matched peer of equal physical activity level were associated with increased levels of exercise [30]. They reported higher levels of exercise-related tangible support (i.e., materials that help facilitate exercise) which were associated with increased daily steps and light physical activity minutes [30]. It is important to note that in our study there was a significant difference between groups at T2 in exercise-related social support scores, favouring the AgeMatchPLUS group. This observation demonstrates the potential additional benefit of informational support specifically provided by the QEP for this population. Together, these findings support further exploration of this intervention in a larger scale trial to determine the effectiveness of this intervention and to evaluate different methods of facilitating continued support from an exercise partner over time.

While the previous studies by Pinto and colleagues [68] and Murray et al [30] demonstrate increases in physical activity levels over time with the support of a partner, no significant differences were found in physical activity levels between groups over time in this study. We did see trends for increased total physical activity level and decreased sedentary time within all participants (favoring the AgeMatchPLUS group); however, minutes of MVPA did not change significantly. While previous research has demonstrated that ‘some (exercise) is better than none’, [72] that lower levels of sedentary minutes improve health-related quality of life in survivors of cancer, [73] and that light physical activity improves strength, flexibility, balance, and depressive symptoms in older adults, [74] current exercise guidelines for individuals with cancer [12, 75] and older adults [76] highlight the need for regular MVPAto gain associated benefits. While associated recommendations from leading health organizations suggest a slow introduction of exercise [77], current guidelines are ignoring a big part of activity that may be very beneficial. Future studies evaluating the benefits of light physical activity and reduced sedentary time would also benefit the older adult population. Information on how to track exercise, self-manage possible impairment sequelae, and evaluate outcomes during survivorship phases of the cancer trajectory would further be beneficial for older adults with cancer.

Finally, this study assessed the frequency, duration, and mode of communication between partners over the intervention and tapering periods. We found a trend for decreased communication (i.e., number of connections and total time connecting each week) between partners over time, which is an important finding because total time connecting is linked to physical activity and those connecting more have higher levels of physical activity [30]. A recent study by Peck and colleagues [69] evaluated social support in female survivors of cancer and demonstrated that esteem support (i.e., exercise encouragement) was the most frequent type of social support provided by peers and that those who felt they were in a ‘good match’ were more likely to receive more support (i.e., various levels of support and total time) compared to those who felt they were in a ‘neutral’ or ‘poor match’. Most (72%) of the participants in our study felt they were in a good match and appreciated having similar characteristics to their partner (primarily age and current physical activity level). A recent study by Sabiston and colleagues [78] exploring women’s perception of preferred characteristics in a peer found personal characteristics (e.g., age, sex, life stage, work status), physical activity characteristics (e.g., activity level), and cancer characteristics (e.g., stage, type) were all important in an exercise peer for adult cancer survivors. Due to the small sample size in the current pilot study, we were only able to match based on age and geographical location; however, future work should explore how to facilitate the ‘best’ peer match to facilitate feelings of support and physical activity behaviour and the characteristics most important in an exercise partner for older adults. Finally, future research should explore encouraging and facilitating sustained communication in exercise partners to prolong social benefits. Some possible approaches could include regularly scheduled video calls (only a small portion of participants in this study met using video and face-to-face visual contact has been found to increase cooperation [79]) or setting up mutual goals and/or activity challenges to facilitate ongoing connection.

Limitations

While there are numerous strengths to this study, including the novelty of the multi-component intervention used, the control intervention, and recruitment success, results of this study should be viewed with an understanding of its limitations. First, most participants were recruited from Southwestern Ontario, Canada, which limits the generalizability of these findings to populations outside of this region. Further, due to the pilot nature of this trial, we had a small sample size, and while this project demonstrated feasibility, all analysis of secondary outcomes is exploratory due to the sample size, requiring confirmation in a larger scale trial. Additionally, while we explored effects over the short term, longer-term follow-up is needed in future studies to determine if any sustained effects are associated with participation in a study of this sort. Also, we provided participants with a Fitbit to assess their activity level at the assessment time points; however, participants were also able to wear it at their leisure in between assessment time points and this was not tracked by the research team. Those who chose to use the Fitbit between assessment timepoints may have had additional motivation to exercise, which was not accounted for in the analysis. Finally, Fitbit’s data has been shown to underestimate actual activity levels in older adults and the algorithms used by Fitbit have not been validated in older adult populations [80]. Therefore, they may be less accurate for this population, and results of this data should be viewed with caution.

Conclusions

Older adult female survivors of cancer are at risk of physical decline, reduced mobility, and psychological burden due to low levels of activity and inadequate social interactions. This study demonstrated that a virtually delivered partner-based exercise intervention with QEP support is feasible for older adults with cancer and has potential benefits on levels of physical activity, social support, and health-related quality of life. Future research is needed to confirm these results in a larger scale trial with longer follow-up and should evaluate what specific types of support is most effective to facilitate the benefits of physical activity for older adults with cancer.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author (JST) upon reasonable request.

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Acknowledgements

The authors would like to thank Myanca Rodrigues for her assistance with statistical analysis.

Funding

This project was funded by the McMaster Institute for Research on Aging (MIRA) Labarge Catalyst Grant. The funder had no role in the conceptualization, design, data collection, analysis, decision to publish, or preparation of the manuscript. MB is supported by a tier 2 Canada Research Chair in Mobility, Aging, and Chronic Disease. CMS holds a Tier 2 Canada Research Chair in physical activity and mental health.

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Authors and Affiliations

  1. School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada

    Jenna Smith-Turchyn, Susanne Sinclair, Marla Beauchamp & Julie Richardson

  2. Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON, M5S 2W6, Canada

    Erin K. O’Loughlin, Madison F. Vani & Catherine M. Sabiston

  3. Department of Health, Aging, and Society, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 1C7, Canada

    Anthea Innes

  4. Department of Kinesiology, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 1C7, Canada

    Stuart M. Phillips

  5. Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 1C7, Canada

    Lehana Thabane

Authors
  1. Jenna Smith-Turchyn
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  10. Catherine M. Sabiston
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Contributions

JST: conceptualization, methodology, validation, formal analysis, investigation, writing original draft, supervision, funding acquisition; SS: investigation, data curation, writing – review and editing, project administration; EO: conceptualization, methodology, investigation, writing – review and editing; AI: conceptualization, methodology, writing – review and editing, funding acquisition; MV: conceptualization, methodology, writing – review and editing; MB: conceptualization, methodology, writing – review and editing, funding acquisition; SP: conceptualization, methodology, writing – review and editing, funding acquisition; JR: conceptualization, methodology, writing – review and editing, funding acquisition; LT: methodology, writing – review and editing; CMS: conceptualization, methodology, writing – review and editing, supervision, funding acquisition.

Corresponding author

Correspondence to Jenna Smith-Turchyn.

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Ethics approval and consent to participate

The Hamilton Integrated Research Ethics Board approved this study (ID: 15283). All participants provided written informed consent prior to enrollment in the study.

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Not applicable.

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The authors declare no competing interests.

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Smith-Turchyn, J., Sinclair, S., O’Loughlin, E.K. et al. A pilot randomized controlled trial of a virtual peer-support exercise intervention for female older adults with cancer. BMC Geriatr 24, 887 (2024). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12877-024-05495-z

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BMC Geriatrics

ISSN: 1471-2318

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