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Trinity Exercise Oncology Research Group



L to R: Jeremy Towns, Programme Manager Clinical Research Facility, Kate Devenney, postdoctoral research fellow, Dr Suzanne Doyle, Assistant Professor, Dr Emer Guinan, Assistant Professor, Dr Deirdre Connolly, Associate Professor, Professor Juliette Hussey, Professor in Physiotherapy, Professor Jacintha O’Sullivan, Professor in Translational Oncology, Dr Grainne Sheill, postdoctoral research fellow, Dr Linda O’Neill, postdoctoral research fellow

The Trinity Exercise Oncology Research Group is a multidisciplinary group conducting research into the role of exercise in cancer care. The research programme, which has been in existence since 2009, brings together expertise in physiotherapy, occupational therapy, surgery, translational oncology and clinical nutrition and dietetics to conduct clinical trials and exploratory studies across a range of cancer types. Core team members from the Discipline of Physiotherapy bring together experience in clinical practice, research methodology and higher-level education to deliver a programme that values patients, promotes advanced practice and supports ongoing education as part of the Trinity St James’s Cancer Institute. 

In 2018/2019, the Trinity Exercise Oncology Research Group was awarded approximately €1.3 million in funding by the Health Research Board (HRB), Medical Research Charities Group (MRCG), the Irish Cancer Society and the All-Ireland Institute of Hospice and Palliative Care to allow expansion of the cancer survivorship programme. This funding is being used to deliver key projects in cancer prehabilitation, post-treatment rehabilitation and palliative care which are described below. Implementation is supported through our established collaboration with the dedicated research facilitates provided at the Wellcome Trust-Health Research Board Clinical Research Facility.  

The core value of the research programme is to conduct patient-centred, interprofessional, clinically pragmatic research that has the potential to positively benefit patient care. We work with patient-representatives and their families, a multidisciplinary network of health-care professions and patient advocacy groups to inform the design, implementation, dissemination and future directions of our research programme. Patient and public representations are encouraged to get involved by contacting exerciseoncology@tcd.ie.  

Why Is Exercise Important in Cancer Care?


Over the past two decades research interest in exercise oncology has increased dramatically with a resultant recognition of the importance of exercise as a supportive intervention for patients with cancer. Considerable evidence establishes the efficacy of exercise to both mitigate treatment side-effects and to optimise quality-of-life, with emerging literature suggesting association with cancer survival.  With cancer survival rates improving across a range of cancers, it follows that the National Cancer Strategy 2017-2026, places cancer survivorship at the centre of the national cancer agenda. Exercise rehabilitation is a key part of survivorship care with the potential to optimise patient outcome at each step on the continuum of cancer care. The Trinity Exercise Oncology Research Group prioritises research in complex cancer presentations, particularly upper gastrointestinal cancers, which require specialist rehabilitation expertise and multidisciplinary collaboration.    

Patient Centred Multidisciplinary Cancer Care Model

 

Core Team Members

Home Exercise Video's

Exercise is safe, possible and helpful for many people with cancer.

There are very good reasons for exercising. It can improve your quality of life and physical function. Regular exercise can reduce symptoms of anxiety and depression and help to manage cancer related fatigue.

The videos below have been created by the Trinity Exercise Oncology Team to provide guidance on getting active at home.

If you are not currently exercising or do not exercise often, start slowly using the ‘easy’ videos. Once you are more comfortable, you can begin harder videos. If you need help getting started or want to make a plan tailored to your needs, please contact your local physiotherapist.

INTRO

 

                    My Fitness Plan

My fitness levels

WARM-UP

EASY

HARDER

STRENGTH

STRETCHES

New to exercise or low fitness levels

Complete the warm-up exercises before every exercise session

Aim to complete these exercises 3-5 times per week

 

Aim to complete these exercises twice per week

Stretch and cool down after every exercise session

Comfortable with EASY exercises and ready to progress exercise intensity

Complete the warm-up exercises before every exercise session

 

Aim to complete these exercises 3-5 times per week

Aim to complete these exercises twice per week

Stretch and cool down after every exercise session

WARM UP


EASY

HARDER

STRENGTH

STRETCHES

Public and Patient Involvement

Public and Patient Involvement (PPI) has been described as research being carried out with or by members of the public rather than to, about, or for them. This approach to research is encouraged as it is felt that those affected by research should have a say in how it is carried out . There is also evolving evidence that PPI can increase the rate of recruitment to research and improve its quality and impact. The Exercise Oncology Research Group values a PPI approach to research and accordingly has embedded a number of PPI strategies in our current research portfolio including the inclusion of patient collaborators, patient led support for research participants, and involving patients and members of the public in the development of trial documentation.

Of note as part of the HRB-DIFA ReStOre II trial the group will undertake a Study Within a Trial (SWAT) in which we will examine the impact of patient and family co-developed participant information on recruitment, retention and understanding of the trial. The SWAT is supported by the Health Research Board Trials Methodology Research Network (HRB-TMRN) and is aligned with the HRB TMRN, PRioRiTy I question 16, does involvement of (i) members of the public and/or (ii) members of the public participating in a randomised trial, in designing trial information improve recruitment?
If you are a patient or family member and are interested in getting involved in our PPI programme we would be delighted to hear from you. You can contact us on exerciseoncology@tcd.ie.

Patient Information
Watch this short-animated video to learn more about the benefits of exercising across a wide range of chronic disease.

Listen to our patient experience of participating in an exercise study after treatment for cancer.

Key Projects

PRE-HIIT: Preoperative Exercise to Improve Fitness in Patients Undergoing Complex Surgery for Cancer of the Lung or Oesophagus

Funder: MRCG/HRB Joint Funding Scheme 2018 €284,150
Patients with cancer of the lung or oesophagus, undergoing curative treatment, usually require a thoracotomy and a complex oncological resection. These surgeries carry a risk of major morbidity and mortality, and risk assessment, preoperative optimisation, and enhanced recovery after surgery (ERAS) pathways are modern approaches to optimise outcomes. Pre-operative fitness is an established predictor of postoperative outcome, accordingly targeting pre-operative fitness through exercise prehabilitation has logical appeal.  Exercise prehabilitation is challenging to implement however due to the short opportunity for intervention between diagnosis and surgery. Therefore, individually prescribed, intensive exercise training protocols which convey clinically meaningful improvements in cardiopulmonary fitness over a short period need to be investigated.  This project will examine the influence of exercise prehabilitation on physiological outcomes and postoperative recovery and, through evaluation of health economics, the impact of the programme on hospital costs.

ReStOre: Rehabilitation Strategies in Oesophago-gastric and Hepatopancreatibociliary Cancer

Funder: Health Research Board Definitive Interventions and Feasibility Awards 2018 (€934,859)
Curative treatment for upper gastrointestinal (UGI) cancers is associated with numerous side-effects including sarcopenia and nutritional compromise, increasing morbidity, compromising functional capacity and decreasing health-related quality of life (HR-QOL) in survivorship. As survival improves in UGI cancer, there is increasing focus on optimising survivorship, however research examining rehabilitation programmes in this newly-emergent complex clinical cohort is lacking. We recently designed, implemented, and evaluated the Rehabilitation Strategies following Oesophagogastric Cancer (ReStOre) programme, a novel multidisciplinary rehabilitation programme tailored for oesophagogastric cancer survivorship. We established the feasibility and preliminary efficacy of the ReStOre programme and recognise the need to further examine programme efficacy in a definitive trial.
Using a convergent parallel mixed-methods design, ReStOre II, implemented as a 2-armed randomised controlled trial, will examine if multidisciplinary rehabilitation can improve functional capacity and HR-QOL in UGI cancer survivors. ReStOre II will prescribe a 12-week programme of supervised aerobic and resistance training, self-directed unsupervised exercise, individualised dietetic counselling and multidisciplinary education for patients who are >3 months following oesophagectomy, gastrectomy, pancreaticoduodenectomy, or major liver resection.

Ex-MET: Exercise prescription in patients with bone metastases: Identifying clinical tools to overcome clinician concerns regarding skeletal related events
Funder: All Ireland Institute of Hospice and Palliative Care and the Irish Cancer Society 2018 (€31,400)

It remains unclear if being physically active increases the risk of skeletal-related events in patients with bone metastases. Clinician concerns were highlighted through our recent work with medical, radiation and palliative care consultant oncologists and chartered physiotherapists working in oncology in Ireland, who cited fracture risk as the primary concern with exercise prescription, despite a recognition of the importance of exercise participation. Consequently, health professionals can be hesitant to offer exercise advice and many patients are physically inactive. With increasing evidence supporting the benefits of exercise in metastatic bone disease, there is a need to address exercise-related concerns. Clinical scoring systems such as Mirel’s classification, are predictive of pathological fracture risk. Scoring algorithms have considerable potential to inform exercise eligibility in this population, however to date the applicability of such clinical measures for exercise prescription have been inadequately studied. This longitudinal study will examine the relationship between habitual physical activity, captured objectively by accelerometry, and skeletal related events, (e.g. pathological fracture) in patients with metastatic disease (n=100) over 12-months.

Further information on this study can be found on The Palliative Hub Professional Website

Implementing an Exercise Programme for Deconditioned Cancer Survivors

 
FIXCAS: The Feasibility of Implementing an Exercise Programme for Deconditioned Cancer Survivors in a National Cancer Centre

Funder: Irish Cancer Society Stimulus Award (€29,950)

As both the number of cancer survivors and the length of survival time are increasing, long-term health issues related to cancer and its treatment are becoming more prevalent. Research suggests that exercise can mitigate a number of negative health consequences in cancer survivors and improve physical function and quality of life. Multi-modal exercise interventions have been proposed as a cornerstone for survivorship care. However, studies evaluating exercise programmes within the Irish population are lacking. This study will evaluate the introduction, implementation and acceptability of a multi-modal exercise rehabilitation programme for deconditioned cancer survivors in a real-world, standard practice setting. Cancer survivors (n=40) will undergo a 10-week multi-modal exercise programme. The study population will comprise of cancer survivors attending outpatient services in St James’s Hospital, Ireland. Participants will be aged 18 or older and have completed treatment with curative intent. Feasibility will be evaluated in terms of recruitment, adherence and compliance to the programme. Secondary outcomes will examine physical function and quality of life measures. In addition, the acceptability of the programme will be assessed. The study results will be used to optimise the intervention content, and may serve as the foundation for a larger definitive trial.

 

Contact Details
E: exerciseoncology@tcd.ie