The Feasibility of Implementing an Exercise Programme for Deconditioned Cancer Survivors

The primary outcome of this study will be its feasibility aspects including recruitment rates (percentage of eligible study population that consent to participation)

The primary outcome of this study will be its feasibility aspects including programme adherence (number of prescribed supervised and unsupervised sessions completed by participants)

The primary outcome of this study will be its feasibility aspects including programme retention rates (number of participants completing the programme and number of dropouts)

Acceptability of the intervention will be explored through qualitative interviews. Key stakeholders, namely participants in the exercise intervention and health professionals referring to the exercise programme will be invited to participate in semi-structured interviews. Health professionals (n=8-10) referring to the programme will be interviewed to examine their experience of referring to the FIXCAS programme to identify barriers and facilitators to referral and to determine areas for review and further development. Patients (n=10-15) will be asked to evaluate satisfaction with the intervention. Open-ended questions will be used to encourage reflection and elaboration on different aspects of the programme. The interviews will be recorded and transcribed, and data analysis of the interviews will occur through content analysis using simple descriptive thematic analyses.

Physical fitness will be measured by the 6 minute walk test (6MWT), a valid and reliable measure of physical fitness in people with cancer which will be performed according to the American Thoracic Society (ATS) Guidelines.

Self-reported physical activity will be collected using the International Physical Activity Questionnaire (IPAQ). The IPAQ is a self-report measure of physical activity on a 12-item scale. The total score will be summed within each physical activity domain to estimate the total time spent in occupational, transport, household, and leisure related physical activity, as well as total time reported sitting per week. The total score ranges from 0 to the highest number of time (hours) that the participants can spent on physical activity. A higher score means higher level of physical activity.

Physical performance will be measured by a Short Physical Performance Battery (SPPB). The SPPB is a simple test of standing balance, usual walking speed (4-metre gait speed) and ability to stand from a chair, which reflects global physical functioning and frailty. Each section is scored between 0 (worst) - 4 (best) and the total score ranges from 0 (worst performance) to 12 (best performance).

Leg extension 1 repetition maximum will be measured.

Quality of life is evaluated through the internationally established EORTC-QLQ-C30. The EORTC QLQ-C30 comprises 30 items (i.e. single questions), 24 of which are aggregated into nine multi-item scales, that is, five functioning scales (physical, role, cognitive, emotional and social), three symptom scales (fatigue, pain and nausea/vomiting) and one global health status scale. The remaining six single-item (dyspnoea, appetite loss, sleep disturbance, constipation, diarrhoea and the financial impact) scales assess symptoms.

All of the scales and single-item measures range in score from 0 to 100. Higher score for the functioning scales and global health status denote a better level of functioning (i.e. a better state of the patient), while higher scores on the symptom and single-item scales indicate a higher level of symptoms (i.e. a worse state of the patient).

EQ-5D-5L is a generic quality of life measure. The EQ 5D-5L includes 2 components: the EQ-5D-5L descriptive system and the visual analogue scale (VAS). The EQ-5D-5L descriptive system provides a profile of the participant's health state in 5 dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). For each dimension, the participant is instructed to choose one of 5 levels that best describes their health on that day: "no problem" (1), "slight" (2), "moderate" (3), "severe" (4), or "unable/extreme" (5). The VAS is the participant's rating of their health on a scale of 0 "worst health you can imagine" to 100 "best health you can imagine".

Fatigue will be assessed using the Brief Fatigue Inventory (BFI).The BFI is a 9-item, 11-point rating scale developed to assess subjective fatigue. The first three questions measure fatigue severity from 0, indicating "no fatigue," to 10, indicating "as bad as you can imagine," at current, usual, and worst levels. The following six questions assess fatigue interference with daily activities including general activity, mood, walking ability, normal work (both inside and outside the home), relations with other people, and enjoyment of life. Response options range from 0, indicating "does not interfere," to 10, indicating, "completely interferes." Higher scores on the BFI correspond to greater self-reported levels of fatigue.

Prostate cancer survivors will complete the International Consultation on Incontinence Questionnaire (ICIQ). The ICIQ is a self-reported survey and screening tool for incontinence and asks for rating of symptoms in the past 4 weeks. The sum score of items 3, 4, 5 is calculated for the actual score. Change in mean test scores range = 0 - 21; low score = mild symptoms, high score = significant impact on quality of life.

Prostate cancer survivors will complete the Brief Male Sexual Function Inventory (BSFI). The questions in the BSFI are evaluated on a series of 5-item Likert scales, from 0 or 1 points to 4 or 5 points. Scores are calculated for each of the 5 functional domains, along with a total BSFI score. Whilst there is no specific cut-off, the closer the score is to 1, the higher the lower urinary tract symptom severity and impairment to sexual function. Scores closer to 45 are considered to indicate less severe symptoms and little to no sexual dysfunction.