The feasibility of Fit ABCS: A web-based resource that trains community instructors to lead a group exercise program for pediatric brain tumor survivors

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Abstract Background To address the cognitive difficulties that pediatric brain tumor survivors (PBTS) experience and the potential for exercise to ameliorate these challenges, we evaluated the feasibility of a hospital-led group exercise program for PBTS. Following promising preliminary cognitive outcomes, we developed a web resource (Fitness to Aid the Brain and Cognitive Skills [Fit ABCS]) that trains community fitness instructors to deliver the same program. This study evaluated the feasibility of a community-led group exercise program for PBTS using Fit ABCS. Methods Fitness instructors were recruited through Wellspring, a community network of cancer support programs and services with varying levels of experience. They completed the FitABCS Training Module, which taught them about the exercise program content, the ways to modify exercises for PBTS, and how to use the online platform to plan for and document exercise sessions. PBTS (6-17 years old) were recruited through the Neuro-oncology program at the Hospital for Sick Children (Toronto, Canada). Eligible PBTS completed the 12-week exercise program (3 sessions/week) with assessments at baseline, post-intervention, and 3-month follow-up. At least two instructors were present for each exercise session. Prior to the exercise session, the instructors used Fit ABCS to plan the exercises, games, and/or sports that would take place in the session. The instructors also used FitABCS to document attendance and the challenges/successes encountered in each session. Feasibility indicators (participant recruitment, attendance, adherence, instructor adherence [2], acceptability [2]) were evaluated with Bayesian statistics. Results Ten fitness instructors facilitated 5 program cohorts involving 16 PBTS. Posterior means for participant recruitment (14%), adherence (33%), and attendance (78%) fell below a priori mean targets (20%, 80%, 80%, respectively), and instructor adherence (95%, 97%) and acceptability ratings (81%, 82%) surpassed a priori mean targets (80%). Posterior probabilities fell below our 80% target for all indicators except instructor adherence. Conclusions Based on instructor feedback and study team observations, we developed recommendations to increase the success of future exercise trials for PBTS: provide consistent, comprehensive instructor training, document and reflect on exercise sessions, conduct multi-site research involving more diagnostic groups, minimize participant burden, and obtain program-specific feedback from instructors and participants.

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