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      Home-based cardio-oncology rehabilitation using a telerehabilitation platform in hematological cancer survivors: a feasibility study

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          Abstract

          Purpose

          Cardiovascular disease is a competing mortality cause in hematological cancer survivors due to toxic oncological treatment, accumulation of risk factors, and decline of cardiorespiratory fitness. Cardio-oncology rehabilitation (CORE) is an emerging treatment model to optimize the prognosis of hematological cancer patients and survivors; however, its accessibility during the COVID-19 pandemic is poor. The study aimed to evaluate the feasibility, safety, and effect of a 12-week home-based CORE intervention in telerehabilitation approach among hematological cancer survivors.

          Methods

          A prospective single-arm interventional study was conducted at a faculty hospital in Brno, Czech Republic. This study provided 12 weeks of the home-based CORE using a telerehabilitation approach that allows remote supervision by a clinician from a medical facility. The telerehabilitation approach consists of three components: a heart rate sensor (PolarM430, Kempele, Finland), a web platform compatible with the sensor, and telesupervising via telephone call (1 call per week). To improve adherence, a physiotherapist called participants to assess or address adverse effects, exercise feedback, and participant-related concerns. The anthropometry, body composition, and cardiorespiratory fitness were measured immediately after the intervention.

          Results

          Eleven hematological cancer survivors with an average age of 60.3 ± 10 years participated in the study. Most participants were diagnosed with Follicular lymphoma and received maintenance treatment. Participants had a significant (p < 0.05) increase in cardiorespiratory fitness by 2.6 ml/kg/min; and in peak workload, from 143.3 ± 60.6 W to 158.6 ± 67.5 W (p < 0.05). Improvement in anthropometry and body composition was observed but yielded no statistical significance. Most (80%) participants completed the three times/per week telesupervising exercise session for 12 weeks.No adverse event was identified.

          Conclusion

          Findings from this study suggest that home-based CORE may provide hematological cancer survivors with an increase in CRF during the rehabilitation period after hospital discharge. The telerehabilitation CORE model is effective, feasible, safe, and has demonstrated good adherence. Further randomized controlled efficacy study with larger sample size is needed before clinical implementation.

          Clinical trial registration

          Clinical trial registration number NCT04822389 (30/03/2021).

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s13102-023-00650-2.

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          Most cited references46

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          Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda

          An unresolved issue in the field of implementation research is how to conceptualize and evaluate successful implementation. This paper advances the concept of “implementation outcomes” distinct from service system and clinical treatment outcomes. This paper proposes a heuristic, working “taxonomy” of eight conceptually distinct implementation outcomes—acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability—along with their nominal definitions. We propose a two-pronged agenda for research on implementation outcomes. Conceptualizing and measuring implementation outcomes will advance understanding of implementation processes, enhance efficiency in implementation research, and pave the way for studies of the comparative effectiveness of implementation strategies.
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            Exercise Guidelines for Cancer Survivors

            The number of cancer survivors worldwide is growing, with over 15.5 million cancer survivors in the United States alone-a figure expected to double in the coming decades. Cancer survivors face unique health challenges as a result of their cancer diagnosis and the impact of treatments on their physical and mental well-being. For example, cancer survivors often experience declines in physical functioning and quality of life while facing an increased risk of cancer recurrence and all-cause mortality compared with persons without cancer. The 2010 American College of Sports Medicine Roundtable was among the first reports to conclude that cancer survivors could safely engage in enough exercise training to improve physical fitness and restore physical functioning, enhance quality of life, and mitigate cancer-related fatigue.
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              Sample size of 12 per group rule of thumb for a pilot study

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                Author and article information

                Contributors
                batalik.ladislav@fnbrno.cz
                Journal
                BMC Sports Sci Med Rehabil
                BMC Sports Sci Med Rehabil
                BMC Sports Science, Medicine and Rehabilitation
                BioMed Central (London )
                2052-1847
                23 March 2023
                23 March 2023
                2023
                : 15
                : 38
                Affiliations
                [1 ]GRID grid.412554.3, ISNI 0000 0004 0609 2751, Department of Rehabilitation, , University Hospital Brno, ; Brno, Czech Republic
                [2 ]GRID grid.4491.8, ISNI 0000 0004 1937 116X, Department of Rehabilitation and Sports Medicine, 2nd Faculty of Medicine, , Charles University, University Hospital Motol, ; Prague, Czech Republic
                [3 ]GRID grid.412554.3, ISNI 0000 0004 0609 2751, Department of Internal Medicine–Hematology and Oncology, , University Hospital Brno, ; Brno, Czech Republic
                [4 ]GRID grid.412554.3, ISNI 0000 0004 0609 2751, Department of Internal Medicine and Cardiology, , University Hospital Brno, ; Brno, Czech Republic
                [5 ]GRID grid.16890.36, ISNI 0000 0004 1764 6123, School of Nursing, , The Hong Kong Polytechnic University, ; Hong Kong, China
                [6 ]GRID grid.410558.d, ISNI 0000 0001 0035 6670, Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, School of Health Sciences, , University of Thessaly, ; Lamia, Greece
                [7 ]GRID grid.10267.32, ISNI 0000 0001 2194 0956, Department of Public Health, Faculty of Medicine, , Masaryk University, ; Brno, Czech Republic
                Author information
                http://orcid.org/0000-0002-4202-3564
                http://orcid.org/0000-0002-2647-7769
                http://orcid.org/0000-0002-3829-0467
                http://orcid.org/0000-0002-8105-1744
                http://orcid.org/0000-0002-8242-811X
                http://orcid.org/0000-0001-8012-0325
                http://orcid.org/0000-0003-2147-1541
                Article
                650
                10.1186/s13102-023-00650-2
                10034898
                36959613
                67b82556-c1c8-4385-84a1-79704c79db68
                © The Author(s) 2023

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 4 October 2022
                : 14 March 2023
                Funding
                Funded by: This research was funded by the Ministry of Health, Czech Republic; conceptual development of research organization (FNBr, 65269705).
                Categories
                Research
                Custom metadata
                © The Author(s) 2023

                cardio-oncology rehabilitation,telerehabilitation,home-based exercise,cardiorespiratory fitness,telemonitoring

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