Don't miss our upcoming webinars. Subscribe today! In this webinar: Attendees will learn about the role of exercise in the cancer care pathway, and the potential benefits from building a habit of moving more. We will also discuss the EXCEL study: EXercise for Cancer to Enhance Living Well, and how it is providing a sustainable exercise and behaviour change program to those living with cancer in rural and remote regions across Canada. Learn what is involved in this exercise research program and how to get involved online now! View the YouTube video: https://youtu.be/BIOviCzESwA Follow CCSN on social media: Twitter - https://twitter.com/survivornetca Facebook - https://www.facebook.com/CanadianSurvivorNet Instagram: https://www.instagram.com/survivornet_ca/ Pinterest - https://www.pinterest.com/survivornetwork

1. EXCEL: EXercise for Cancer to
Enhance Living Well
Presented by:
Dr. S. Nicole Culos-Reed
Health and Wellness Lab
wellnesslab@ucalgary.ca
February 25th, 2021, 1:00pm EST

2. First Nations Acknowledgement
• We acknowledge that we live and work within
the traditional territories of the Blackfoot
and the people of the Treaty 7 region in
Southern Alberta, which includes the Siksika,
the Piikuni, the Kainai, the Tsuut’ina and
the Stoney Nakoda First Nations (including the
Chiniki, Bearspaw, and Wesley First Nation).
The City of Calgary is also home to Metis
Nation of Alberta, Region III.

3. EDI Acknowledgement
• We acknowledge that Project EXCEL will
champion equity, diversity, and inclusivity
within our:
– Team Members
– Research Questions
– Training
– Programming
– Development of Resources

4. Agenda
• Cancer and Physical Activity
• Project EXCEL
– Overview
• The Exercise Program
– Referral to the program
– Online considerations
– Additional resources

5. Cancer Prevalence
43%
CANADA
225,800people will be
diagnosed with cancer
83,300 people will die
from the disease
1/4 Canadians are
estimated to die of cancer
2020
Will be diagnosed with cancer
during their lifetime (based on
2015 estimates)
45%

6. Statistics
Statistics highlight the need to:
• Provide supportive services to the
growing population of cancer
survivors
• Address the immediate and long-
term effects associated with
treatment
o Fatigue, myalgias, arthralgias,
functioning, physical and mental
side effects, and impact on overall
quality of life

7. Physical Activity
& Cancer

8. KEY TERMS
• Cancer Survivor: from the point of
diagnosis onward. Usually defined in
terms of on- or off-treatment. Also use
'individuals living with cancer'.
• Physical Activity: ‘any bodily movement
produced by skeletal muscle that results
in energy expenditure.’
• Exercise: ‘a subset of physical activity
defined as planned, structured, and
repetitive bodily movement done to
improve or maintain one or more
components of physical fitness.’
• Movement: not being sedentary!

9. THE ROLE OF EXERCISE
EXERCISE IS SAFE & BENEFICIAL FOR ALL CANCER
SURVIVORS, ACROSS THE ENTIRE CANCER
CONTINUUM.
PRE-TREATMENT
Including surgery,
chemotherapy, radiation
therapy, and palliative care as
needed
Rehabilitation and/ or
maintenance therapy as
needed
TREATMENT POST-TREATMENT
CANCER CONTINUUM
SURVIVORSHIP
ADVANCED CANCER
CARE
EXERCISE BENEFITS

10. EXERCISE AND CANCER BENEFITS
Exercise can be used to address:
DEPRESSION
AND/OR ANXIETY
LOW QUALITY OF
LIFE
EMOTIONAL
WELL-BEING
DECREASED
PHYSICAL
FUNCTIONING
CANCER-RELATED
FATIGUE
POOR BONE
HEALTH
LYMPHEDEMA

11. Physical Activity for Fatigue
2018 Oberoi et al. Review
• Results: n=123 RCTs
– PA reduced fatigue severity
– Effect didn’t differ based upon patient or intervention characteristics
Fatigue (CRF) is the #1 reported side effect by cancer patients and has been
found to be the most distressing treatment-related symptom.
• 94% of oncologists treat pain, only 5% treat fatigue
-National Cancer Institute, 2007

12. Evidence Summary
Improvements after treatment
Research shows benefits of exercise –
physical and psychosocial
No significant negative impacts
o Exercise does NOT undermine
treatment efficacy
Differences may depend where on
cancer trajectory individual is
Maintenance and less decline than normal
during treatment

13. Exercise Guidelines & Recommendations
1. Campbell et al., 2019. Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Med Sci Sport
Exer. 51, 2375-2390Rock et al., 2012. Nutrition and Physical Activity Guidelines for Cancer Survivors. CA Cancer J Clin. 62, 242-274.
ACSM GUIDELINES
ACSM Exercise Guidelines for Cancer Survivors1

14. Flexibility training on
most days of the week
AEROBIC STRENGTH FLEXIBILTY
RECOMMENDATIONS:
90 min. of moderate
intensity aerobic
exercise per week
or 75 min vigorous
intensity per week
2 days of strength
training

15. CANCER & EXERCISE GUIDELINES
Exercise is safe and feasible during treatment
• Improves physical functioning, fatigue and QOL
• Avoid inactivity and return to normal daily activities as soon as possible following
diagnosis
After treatment, exercise is essential for recovery and fitness
• Improves some physical side-effects, and growing evidence for others
• Enhances overall well-being and QOL
Individualization and tailoring are necessary
• Fitness levels, gender, age, disease status
• Social support
• Access to resources/programs, exercise preferences, consideration of barriers

16. CCS/CIHR Cancer Survivorship Team
Grant

17. Project EXCEL Team

18. Research Coordinator: Calgary Central CEP: Edmonton Central CEP:
Ms. Julianna Dreger Ms. Nicole Struthers Ms. Corrie Effa
Halifax Central CEP: Toronto Central CEP:
Ms. Joy Chiekwe Mr. Daniel Sibley
Project EXCEL Team

19. Alberta Cancer Exercise (ACE)
For all cancer survivors in urban AB
N=2500
Hybrid implementation and effectiveness
study
Exercise as standard cancer care
Still recruiting in urban settings

20. EXCEL Objective
• Improve access to exercise programs for those
living with cancer in rural/remote locations
• Result in improved PA levels – participant
reported, objective tracking
Make exercise part of standard cancer care

21. Exercise Oncology Survivorship (EOS)
Model
1. Hub-and-spoke framework
2. Clinic to community system – build referral
pathways
3. Train fitness professionals
4. Deliver evidence-based exercise oncology
program, tailored to rural cancer survivor
needs

22. 1. Hub n Spoke Model
HUB
• CEP
Central Team(s)
for Support
Support
network of
HCPs
SPOKE
QEPs
Surrounding
communities

24. 2. Clinic to Community
Recruitment into the program facilitated by connecting
with:
• Cancer centres across Canada
• 3CTN
• Primary Care Networks and family physicians
• Fitness and recreation centres
• Support groups/networks, like CCSN

25. Recruitment
FOR PATIENTS THAT:
Have/had a cancer diagnosis
Pre-, on, or within 3 years of treatment
18 years and older
Able to participate in mild/moderate
physical activity
Have access to reliable internet
Live in remote or rural areas
 Patients can SELF REFER
 Healthcare providers can refer by
directing patients to
wellnesslab@ucalgary.ca
 Our team of exercise physiologists
will SCREEN AND TRIAGE

26. Onboarding Process
Referral
Hub CEP screening
Physician/Oncologist
Clearance Provided
PROs and Fitness Ax
Require medical clearance
PROs and Fitness Ax
Exercise Class
Exercise Class led by CEP

27. 3. QEP Network
• Training in exercise oncology
• Moderating provides on the job training
• Ongoing training
– Bi-monthly webinars delivered by hub sites

28. 4. The Exercise Oncology Program
• Assessments
• Timeline:
– Baseline, Post-program; 24-wk follow-up, 1-year
follow-up
• Questionnaires to assess physical activity levels
and quality of life
• Objective PA levels - accelerometers
• Fitness assessment conducted online

29. EXCEL
• 8 to 12-week program, classes 2x per week
• 60 mins of exercise, plus 15 mins post-class “social”
• Cardio, resistance training, balance, flexibility
Instructors will MEET YOU
where you are at:
• Equipment can be minimal
• Exercises can be modified
• We create a safe, inclusive,
and positive class
environment

30. Exercise Program – Online Delivery
• ZOOM platform is used for classes
• Safety precautions:
– Moderators for eyes on all screens
– Physical address
– Stable internet access important
• Support for those who need set-up assistance
30

31. Additional Resources
• Education topics – in-class delivery and
webinars
• ZoeInsights app
– Journaling to track
behaviour change
31

32. Education Topics
• Principles of Exercise & Cancer
• Goal Setting
• Behaviour Change Relapse Prevention & Motivation
• Cancer-Related Fatigue & Stress Management
• Social Support and Long-Term Motivation
32
• Topics reviewed in class
• FREE education webinars to
focus on small group
discussion

33. Online Community
• Education Webinars
– Breakout room discussion
between participants
– Fostering community
“[The webinars] give me permission to focus on
myself...for some this may be the only conversation all
week, or the only chance to really focus on themselves
and something positive.” – Anonymous

34. EXCEL - Spring 2021
• Next round of classes starting in early April
2021
• Hubs in Calgary, Edmonton, Halifax, and
Toronto
• Online: can join a class from anywhere in
Canada!

35. Further Outreach
• Quebec outreach
• Indigenous populations
– Discussions with community oncology program
(AB) and aboriginal cancer nurse navigator
• Under-served ethnic populations
– Addressing issues of inclusivity, and language
barriers to participation

36. Adolescent & Young Adult Yoga
• Yoga for young adults affected by cancer:
exploring implementation and effectiveness of an
online program
• Objectives:
– Assess implementation markers throughout
program delivery.
• Participants: diagnosed with cancer between the
ages of 18-39
• Program: 8-weeks, 60-minute weekly yoga class
– Includes 15-min of behaviour change and
mindfulness education

37. Quality Improvement Cycles
• Six-month feedback loops
• Networks – QEP, clinical, community partners,
others (administration)
• Participant feedback
– Improvements in content
– Improvements in delivery
– Update resources
– Regional tailoring
• Implementation tracking of changes to practice

39. EXCEL Participant Testimonials
"Living in a rural location, the EXCEL Program has
provided a lifeline for me. The benefits of
exercise and cancer recovery are
well documented, and the network of support is
an added benefit. I truly believe that it is making
a difference for all of us cancer survivors!" -
Janice
"I hope to see this study offered as a permanent
program to all Canadian cancer patients as it has
made a world of difference for me." - Shirley

40. THANK YOU
Dr. Nicole Culos-Reed
EXCEL Principle Investigator
nculosre@ucalgary.ca
Julianna Dreger
EXCEL Research Coordinator
jdreger@ucalgary.ca
wellnesslab@ucalgary.ca

41. Canadian Cancer Survivor Network
Contact Info
1750 Courtwood Crescent, Suite 210
Ottawa, ON K2C 2B5
Telephone / Téléphone : 613-898-1871
E-mail: jmanthorne@survivornet.ca or info@survivornet.ca
Website: www.survivornet.ca
Twitter: @survivornetca
Facebook: www.facebook.com/CanadianSurvivorNet
Instagram: @survivornet_ca
Pinterest: http://pinterest.com/survivornetwork/