Participation and satisfaction of prostate cancer patients on androgen deprivation therapy participating in a virtual supervised group exercise service

Abstract

Objectives

To evaluate participation, satisfaction and selected health-related outcomes and to explore factors influencing engagement with a digitally delivered exercise programme among people with prostate cancer receiving androgen deprivation therapy (ADT) who took part in The Exercise Clinic® (TEC) component of the THRIVE service at The Royal Marsden NHS Foundation Trust.

Patients and methods

THRIVE was developed at The Royal Marsden NHS Foundation Trust in collaboration with a private exercise provider, TEC, to improve access to exercise services for prostate cancer (PCa) patients. Between November 2020 and December 2023, 148 men on ADT for more than 6 months were enrolled in the TEC component of THRIVE. Participants received a home exercise programme, weekly virtual supervised group exercise sessions and access to the TEC mobile phone application (app) to record activity. Primary outcomes were participation and satisfaction. Secondary outcomes included activity levels, physical performance and quality of life. Quantitative outcomes were measured at baseline and quarterly reviews; exploratory analyses examined changes between baseline and 12 months using paired t-tests. Qualitative data, collected via discussion groups and feedback questionnaires, was analysed using framework analysis to explore factors influencing engagement.

Results

Participants attended 14 exercise sessions during the first 6 months. 88%, 90% and 88% of eligible participants completed their 3-, 6- and 12-month review, respectively. Almost two-thirds of participants used TEC app. Overall experience was rated highly (median 10 out of 10). Virtual delivery and peer support were identified as key factors influencing engagement. Statistically significant changes were observed in EQ-5D index values between baseline and 12 months and in sit-to-stand performance and average daily step count from quarter one to four.

Conclusion

This service evaluation demonstrates high engagement and satisfaction among a selected group of men receiving long-term ADT participating in a virtually delivered, supervised exercise programme embedded within routine care. Factors such as social support and the accessible delivery format may contribute to engagement with exercise in this population. Observed changes in patient-reported and functional outcomes should be interpreted cautiously given potential selection bias and the lack of a comparator group. Findings support the feasibility and acceptability of digitally delivered exercise support extending beyond 3 months and provide further insight into the factors that may inform the design of future interventions. Future randomised controlled trials are needed to evaluate clinical effectiveness, cost-effectiveness and the feasibility of wider implementation.