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Interim implementation and effectiveness results from the IMplementation of Physical Activity for Children and
Emma McLaughlin1,2, S Nicole Culos-Reed1,3,4, Carolina Chamorro-Viña1,5
1Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
Insights
Referral rates are high for the IMPACT intervention supporting pediatric cancer patients, but participation, retention, and adherence remain low. Improvements are needed to enhance patient enrollment and engagement in physical activity programs.
Area of Science:
- Oncology
- Pediatrics
- Public Health
- Exercise Science
Background:
- The IMPACT (IMplementation of Physical Activity for Children and adolescents on Treatment) intervention was developed to support physical activity in pediatric cancer patients.
- This intervention is a 1:1 supervised program delivered via videoconference by exercise professionals.
- It is currently being evaluated in a hybrid effectiveness-implementation trial.
Purpose of the Study:
- To examine the implementation of the IMPACT intervention.
- To explore changes in select secondary effectiveness outcomes.
- To review quality improvement data and document refinements.
Main Methods:
- The study included children and adolescents (5-18 years) with cancer or blood disorders.
- Implementation metrics included reach, adoption, and adherence to the 12-week intervention.
- Effectiveness outcomes included quality of life and physical fitness, assessed pre- and post-intervention.
Main Results:
- 39% participation rate, with 33% retention and 57% adherence to physical activity sessions.
- High intervention delivery fidelity (95.2%) with no reported adverse events.
- Quality improvement cycles led to refined recruitment and outreach materials.
Conclusions:
- Despite high referral rates, participation, retention, and adherence to the IMPACT intervention are low.
- Critical areas for improvement include facilitating enrollment and enhancing adherence.
- Findings highlight the need for modifications to support ongoing intervention and trial delivery.
Background:
To support physical activity (PA) among pediatric cancer patients, the IMPACT (IMplementation of Physical Activity for Children and adolescents on Treatment) PA intervention was developed. IMPACT is a 1:1, supervised, PA intervention delivered by exercise professionals over videoconference. It is being evaluated in a hybrid effectiveness-implementation trial. This interim report: (1) examines implementation, (2) explores changes in select secondary effectiveness outcomes, and (3) reviews quality improvement data and documents refinements to date.
Methods:
Children and adolescents affected by cancer and blood disorders (5-18 years old), awaiting, on-, or <3 months off-treatment are referred or self-referred to the IMPACT intervention and trial. IMPACT is a 12-week, 1:1, supervised, PA intervention delivered by videoconference by a trained exercise professional. Interim IMPACT implementation covers reach (referral rates, participation rate, participant demographics), adoption (sources of referrals, difference in referrals across referring sites), and implementation (trial retention, adherence to PA sessions, percentage of missing data, intervention delivery time, expertise, PA session fidelity, trial delivery time, adverse events) metrics collected throughout trial delivery. Interim effectiveness data includes a subset of secondary effectiveness outcomes (quality of life via PedsQL, physical fitness) collected pre- and post-intervention. Additional quality improvement cycle data were collated and reviewed every 6 months. All data were analyzed with descriptive statistics and individual change scores.
Results:
Between 1 March 2022 and 12 December 2024, 93 patients were referred (84 = healthcare provider referral; 9 = self-referred), 36 expressed interest, 14 consented and enrolled, and 12 completed the intervention (participation rate = 39%). Retention to the trial was 33%, adherence to PA sessions was 57%, no adverse events were reported, and missing data was 54%. Visual analysis of individual change scores suggests no significant changes in select secondary outcomes. Over 300 intervention and trial delivery hours were accrued, and intervention delivery fidelity was high (95.2 ± 3.83%). Data from quality improvement cycles informed refined and novel recruitment and outreach resources, including posters, brochures, videos, and presentations.
Conclusions:
Although levels of referral are high, participation, retention, and adherence rates are low. Results highlight critical areas for improvement to facilitate enrollment, improve adherence, and support data collection for the remaining months of intervention and trial delivery.
