The Development and Evaluation of ExerciseGuide – A Web-Based Exercise and Behaviour Change Intervention to Support Individuals with Metastatic Prostate Cancer

Abstract

Prostate cancer is the second most commonly diagnosed cancer in Australian men. Onethird of these individuals will progress to the locally advanced or metastatic stage. Emerging evidence suggests that exercise can play a supportive care role in the management of metastatic prostate cancer, and recently, the safety of individualised faceto- face exercise has been demonstrated. Despite this, many individuals do not engage in sufficient exercise to gain the benefits. Many barriers limit the uptake of face-to-face exercise in this population, including lack of suitable facilities, access to experts, significant fatigue, and motivation. Technological advances and adoption make it possible to deliver web-based individualised exercise prescription economically and automatically using algorithms. However, acceptability and safety has not been ascertained in this population. The overarching aim of this thesis by publication is to systematically develop and pilot a web-based computer-tailored exercise and behavioural change tool (ExerciseGuide) designed for individuals with metastatic prostate cancer. Consideration of users' needs and preferences is essential for enhancing web-based intervention effectiveness and adherence. Semi-structured interviews with individuals with metastatic prostate cancer (Chapter 3) explored individuals' lifestyle, understanding of their disease, exercise levels, exercise advice received from health care providers, and acceptability of and suggested content for the web-based exercise tool. Results indicated that individuals had a limited understanding of the benefits of prostate cancer-specific exercise but viewed a potential web-based computer-tailored intervention as an acceptable vehicle for exercise prescription and education due to accessibility and convenience. Web-based intervention development should involve a patient-centred process of intervention evaluation and modification to ensure acceptability and usability in the target population. A mixed-methods approach (Chapter 4) was used to examine and iteratively refine ExerciseGuide, the web-based computer-tailored exercise intervention for men with metastatic prostate cancer. After the first iteration, testing found the program acceptable, usable and resistance training algorithms were shown to provide individualised content safely. An eight-week pilot two-armed randomised controlled trial was used to evaluate a webbased computer-tailored exercise and behavioural change tool (ExerciseGuide) in individuals with metastatic prostate cancer. Publication of the protocol aimed to ensure transparency around pre-specified criteria for success (chapter 5). Study findings (chapter 6) indicated that the ExerciseGuide intervention is acceptable, improves meaningful participation in moderate to vigorous physical exercise (MVPA) and is safe (no grade three or more adverse events). However, website usability was just below the cut-point for success. The recruitment goal was not met, but behavioural change and physical functioning data were collected in greater than 75% of suitable participants indicating the feasibility of conducting a larger-scale evaluation if recruitment concerns can be addressed. Collectively, the results of this thesis add important knowledge to the literature about enhancing the engagement and efficacy of web-based exercise interventions for people with metastatic prostate cancer. In particular, the findings suggest that web-based individualised exercise prescription and behaviour change support facilitated by technology provides a safe, acceptable, and potentially efficacious scalable alternative to face-to-face exercise programs. Future research is needed to examine efficacy further, and if warranted, optimise implementation in clinical practice.