JMIR Publications

ABSTRACT

Background:

Strong evidence supports the benefits of exercise following both cardiovascular disease and cancer diagnosis. However, less than one third of Australians who are referred to exercise rehabilitation complete a program following a cardiac diagnosis. Technological advances make it increasingly possible to embed real-time supervision, tailored exercise prescription, behaviour change, and social support into home-based programs.

Objective:

This study aimed to explore demographic and health characteristics associated with the likelihood of breast cancer survivors uptaking a digitally-delivered cardiac exercise rehabilitation program and to determine whether this differed according to intervention timing (that is, offered generally, before, during, or after treatment). Secondary aims were to explore knowledge of cardiac-related treatment side-effects, exercise behaviour, additional intervention interests (e.g., diet, fatigue management), and service fee capabilities.

Methods:

This cross-sectional study involved a convenience sample of breast cancer survivors recruited via social media. A participant-completed questionnaire was used to collect outcomes of interests, including likelihood of uptaking a digitally-delivered cardiac exercise rehabilitation program, and demographic and health characteristics. Descriptive statistics were used to summarise sample characteristics and outcomes. Ordered logistic regression models were used to examine associations between demographic and health characteristics and likelihood of intervention uptake generally, before, during, and after treatment, with odds ratios <0.67 or >1.5 defined as clinically meaningful and statistical significance a priori set at ≤0.5.

Results:

A high proportion (93%) of the sample (n=208; mean (SD) age of 57 (11) years, median (IQR) BMI of 26 (23–31) kg/m2) met recommended physical activity levels at the time of the survey. Living in an outer regional area was associated with higher odds of uptake in each model (OR=3.86–8.57; p=0.01–0.04). Receiving more cardiotoxic treatments was also associated with higher odds of general uptake (OR=1.42; p=0.04). There was some evidence that a higher BMI, more comorbid conditions, and lower education were associated with lower odds of intervention uptake, but findings differed according to intervention timing. Respondents identified the need for better education about cardiotoxic effects of breast cancer treatment, and the desire for multifaceted rehabilitation interventions that are free or low cost (median AUD, IQR=10, (10-15) per session).

Conclusions:

These findings can be used to better inform future research and the development of intervention techniques that are critical to improve the delivery of a digital service model that is effective, equitable, and accessible. Specifically, by enhancing digital inclusion, addressing general exercise barriers experienced by chronic disease populations, incorporating multidisciplinary care, and developing affordable delivery models.