ACE pilot study takes cancer rehab to the community

UAlberta research team partners with UCalgary, AHS and YMCA to develop innovative community-based cancer exercise program.

(Edmonton and Calgary) Stage three breast cancer. Four words that, when uttered aloud, effectively put Laura Roberts' entire life on pause.

Faced with major surgery to remove a large tumour in her breast and 20 lymph nodes from her armpit, Roberts put on hold a budding career as a sociology and political science instructor at Keyano College in Fort McMurray to return to her hometown of Edmonton.

"It was pretty major surgery and it took a long time to recover from that. I didn't drive for almost a month and I could barely lift my arm," Roberts says.

She started physiotherapy to regain her strength but in December suffered another setback when a followup exam revealed her cancer hadn't gone away, and in fact required extensive chemotherapy.

An active person, Roberts, 36, was forced to adjust to the ebb and flow of treatment, alternating between having energy to go for walks or practise yoga and being bedridden for a week. She still tires out easily, but is making steady gains thanks to the Alberta Cancer Exercise (ACE) pilot study.

Making exercise more accessible in the community

A partnership between the University of Alberta, University of Calgary, Alberta Health Services and YMCA, ACE is exploring ways of improving the health and fitness of cancer survivors through a first-of-its-kind strategy to support transition to community-based exercise programming.

Despite existing evidence that exercise improves the health, fitness and energy levels of cancer survivors, there are very few community-based programs anywhere in North America, says study lead Margaret McNeely, an assistant professor of physical therapy in the U of A's Faculty of Rehabilitation Medicine.

"The goal of this pilot is to create more opportunities for cancer patients and survivors to exercise or get back into exercise in a setting that feels comfortable and welcoming," says McNeely. "Cancer survivors have told us they don't want a hospital-based program; they want exercise offered in a location that focuses on wellness, not illness, and where they can work on their recovery and getting better."

Over the course of 24 weeks, 80 cancer survivors in Edmonton and Calgary will take part in a pilot study to investigate the benefit of cancer-specific exercise classes and personal training, and the feasibility of offering such programming in the community.

In both cities, the research teams trained YMCA exercise specialists to understand the needs of survivors who've battled cancer and those still receiving chemotherapy or radiation treatments, using a cancer education program developed by Nicole Culos-Reed from the U of C's Faculty of Kinesiology.

"Improved access to programs is the key element of the ACE program. Eliminating barriers leads to improved adherence and better outcomes for cancer survivors, both physically and psychologically," explains Culos-Reed. "This work increases access to physical activity programming for cancer survivors within their own community."

Study participants will be split into two groups-one receiving standard care that will serve as a control, and one group that will be assigned to supervised group exercise training focusing on strength, balance, aerobic exercise and flexibility.

Two days a week, Roberts joins half a dozen cancer survivors at the Don Wheaton Family YMCA for an hour-long class overseen by instructors who understand her unique exercise needs and abilities, including cording and lymphedema that affects her arm movements. After just four classes, she says she's already noticed an increase in strength and feels energized upon leaving the downtown fitness facility.

"It feels like real life when I leave here. It feels kind of like I'm back in my normal life," she says.

Janice Yurick, manager with the Department of Rehabilitation Medicine at the Cross Cancer Institute, says the ACE program is important because it bridges the gap between CancerControl Alberta's physiotherapy services and the health and wellness of general exercise.

"Cancer survivors are provided with therapeutic, targeted exercise that is intended to address specific cancer-related physical impairments through ACE," says Yurick. "Making this available in community facilities will allow more cancer patients to have access to this important therapy."

Lorraine Gemmell, director of new program development with the YMCA of Northern Alberta, says the partnership fits perfectly with her organization's vision to participate in the health, well-being and physical activity of people dealing with a sudden life-changing event in their lives, including cancer.

"The goal is to introduce physical activity in a comfortable, safe, community environment that is specifically designed to assist and support participants in progressive physical activity, targeted to develop balance, cardiovascular endurance, muscle strength and endurance, as well as social interaction," Gemmell says. "It is believed that when people going through cancer treatment interact with other individuals facing the same experiences, their mental well-being is improved. This goes a long way in helping them to also improve their physical health."

McNeely says the study results could help determine whether it's feasible to offer similar community-based programming in other locations across Alberta. The team hopes to launch a much larger, three-year program starting next spring, pending available grant funding. With cancer rates and survivorship steadily on the rise, the need for this kind of programming will only grow, she says.

"Returning to activity, or becoming more active, can be a physical and mental obstacle for many cancer survivors, particularly after lengthy cancer treatment. If we can help them overcome these barriers and get back to the activities they enjoy, this type of initiative has the potential to have a long-term impact on their health and quality of life."