# Interim implementation and effectiveness results from the IMplementation of Physical Activity for Children and adolescents on Treatment (IMPACT) intervention and trial

## TL;DR

The IMPACT intervention aims to increase physical activity in children and adolescents undergoing cancer treatment through a 12-week videoconference-based program, but faces challenges with low participation and adherence.

## Contribution

The study introduces a novel, supervised physical activity intervention for pediatric cancer patients delivered via videoconference and evaluates its implementation and effectiveness.

## Key findings

- Referral rates are high, but participation and retention rates are low at 39% and 33%, respectively.
- Adherence to physical activity sessions is moderate at 57%, with 54% missing data reported.
- Intervention delivery fidelity is high at 95.2%, and quality improvement efforts led to new recruitment materials.

## Abstract

To support physical activity (PA) among pediatric cancer patients, the IMPACT (IMplementation of Physical Activity for Children and adolescents on Treatment) PA intervention was developed. IMPACT is a 1:1, supervised, PA intervention delivered by exercise professionals over videoconference. It is being evaluated in a hybrid effectiveness–implementation trial. This interim report: (1) examines implementation, (2) explores changes in select secondary effectiveness outcomes, and (3) reviews quality improvement data and documents refinements to date.

Children and adolescents affected by cancer and blood disorders (5–18 years old), awaiting, on-, or <3 months off-treatment are referred or self-referred to the IMPACT intervention and trial. IMPACT is a 12-week, 1:1, supervised, PA intervention delivered by videoconference by a trained exercise professional. Interim IMPACT implementation covers reach (referral rates, participation rate, participant demographics), adoption (sources of referrals, difference in referrals across referring sites), and implementation (trial retention, adherence to PA sessions, percentage of missing data, intervention delivery time, expertise, PA session fidelity, trial delivery time, adverse events) metrics collected throughout trial delivery. Interim effectiveness data includes a subset of secondary effectiveness outcomes (quality of life via PedsQL, physical fitness) collected pre- and post-intervention. Additional quality improvement cycle data were collated and reviewed every 6 months. All data were analyzed with descriptive statistics and individual change scores.

Between 1 March 2022 and 12 December 2024, 93 patients were referred (84 = healthcare provider referral; 9 = self-referred), 36 expressed interest, 14 consented and enrolled, and 12 completed the intervention (participation rate = 39%). Retention to the trial was 33%, adherence to PA sessions was 57%, no adverse events were reported, and missing data was 54%. Visual analysis of individual change scores suggests no significant changes in select secondary outcomes. Over 300 intervention and trial delivery hours were accrued, and intervention delivery fidelity was high (95.2 ± 3.83%). Data from quality improvement cycles informed refined and novel recruitment and outreach resources, including posters, brochures, videos, and presentations.

Although levels of referral are high, participation, retention, and adherence rates are low. Results highlight critical areas for improvement to facilitate enrollment, improve adherence, and support data collection for the remaining months of intervention and trial delivery.