Telehealth Exercise Program Evaluating Fatigue and Physical Function in Rural Cancer Survivors

Effects of a Telehealth Exercise Program for Rural Cancer Survivors With Cancer-related Fatigue Including Integrated Longitudinal Assessments of Objective Physical Function and Fatty Acid Oxidation

This study investigates the efficacy of a telehealth exercise program designed specifically for rural cancer survivors with cancer-related fatigue (CRF). Small dried blood samples and measures of physical function will be collected throughout the program. The main questions it aims to answer are:

• Does the exercise program improve CRF in rural cancer survivors?
• How do CRF, metabolism, and physical function change during the exercise program? Researchers will compare the program to a wait-list control group. This group will complete all study measures without without changing current physical activity before receiving the full exercise program.

Participants will:

• Complete a virtual physical assessment before and after the program.
• Complete brief virtual assessments and collect dried blood samples (at home and mailed in) every two weeks during the program.
• Receive a personalized exercise program including virtual sessions and remote exercise programming with a cancer exercise specialist (after a 12-week wait period in the wait-list control group).
• Optional: Willing participants will visit a study site for a laboratory-based exercise assessment before and after the program.

This study investigates the efficacy of a telehealth exercise program designed specifically for rural cancer survivors with cancer-related fatigue (CRF). The 12-week program is designed to be delivered completely via remote methods including: telehealth exercise sessions with cancer exercise specialists, additional exercise programming delivered through a personal training smartphone/internet application, and regular symptom monitoring via emailed surveys. Symptoms (CRF) are plotted against a reference chart of anticipated changes during the program, with additional telehealth sessions initiated if symptoms do not improve as predicted. Program efficacy is investigated using a randomized controlled trial with a wait-list control group (N=134, Aim 1). The control group will receive the exercise program following a 12-week wait period.

Possible mechanisms of action are assessed throughout the program (every two weeks) using accessible methods (Aim 2). Fatty acid oxidation is measured via dried blood spots collected remoted and mailed to the primary study site. Physical function is measured via brief telehealth assessments.

Changes in molecular responses to acute exercise and changes in body composition will be explored in a controlled laboratory assessment in participants able and willing to travel to participating sites (N=40, Aim 3). Small blood samples are collected before and after a standardized treadmill exercise session. Body composition is measured non-invasively in a small chamber using air displacement. This laboratory assessment occurs before and after the program (or wait period).

Inclusion Criteria:

1. Age ≥ 18 and < 90 years of age. 2. Diagnosis of breast or prostate cancer. 3. Cancer treatment criteria: 3a. Completion of treatment with curative intent > 3 months prior to and < 5 years from study initiation.

3b. Treatment must include hormonal, radiation, chemotherapy, and/or immunotherapy. Those who have received only surgery are not eligible.

3c. Individuals diagnosed with breast cancer currently receiving maintenance hormonal therapy, with no planned treatment changes in the next six months, are eligible.

4. Home zip code meeting Health Resources & Services Administration (HRSA) definition of rural (data.hrsa.gov/tools/rural-health).

5. Presence of at least moderate fatigue (>3/10 per National Comprehensive Cancer Network guidelines).

6. Access to high-speed home internet. 7. Possession of smartphone or laptop with front-facing camera. 8. Capable and willing to give informed consent. 9. Willing to participate in a 12-week telehealth exercise intervention or 12-week waiting period prior to intervention with brief remote physical assessments and dried blood spot collection every 2 weeks.

10. Able and willing to provide contact information for a local support individual to assist with any possible adverse events.

11. Able and willing to provide contact information for a local primary care provider to address medical issues potentially arising during study activities.

12. Able to provide signed physician clearance for exercise if indicated by the Physical Activity Readiness Questionnaire (PAR-Q+) or National Comprehensive Cancer Network exercise safety screening questions.

Exclusion Criteria:

1. Eastern Cooperative Oncology Group (ECOG) Performance Status Grade ≥ 2.
2. Current or planned cancer-related treatments (except maintenance hormonal therapies) in the next six months.

2a. For individuals with a prostate cancer diagnosis, those currently receiving androgen deprivation therapy (ADT), or those who have previously received ≥ 12 months of ADT, are not eligible.

3. Plans to relocate to a non-rural location in the next six months. 4. Presence of a disease or condition that affects the ability of an individual to safely participate in an exercise intervention (e.g. recent cardiac event or chronic obstructive pulmonary disease).

4a. These conditions are identified in the PAR-Q+. 5. Presence or history of metabolic disease (e.g. diabetes or uncontrolled hyper- or hypothyroidism).

5a. Participants with pre-diabetes, metabolic syndrome, or diabetes managed with metformin only will be eligible, with this variable tracked for later analysis.

6. Current participation in another exercise oncology program.