Videoconference Physical Activity Interventions Transform Pediatric Cancer Care Delivery

Are Videoconference-Delivered PA Interventions the Future for Pediatric Cancer Care?

Videoconference-delivered physical activity (PA) interventions represent a promising approach to addressing the unique challenges faced by pediatric cancer patients during treatment. The IMplementation of Physical Activity for Children and adolescents on Treatment (IMPACT) trial offers valuable insights into this emerging modality of supportive care. Despite the relatively rare occurrence of pediatric cancer, with approximately 400,000 children and adolescents diagnosed globally each year (less than 3% of all cancer diagnoses), the disease remains a significant cause of morbidity and mortality. While survival rates are encouraging—with nearly 90% surviving 5 or more years and over 70% surviving 10 or more years—children undergoing cancer treatment experience substantial negative effects across physical, psychological, social, and cognitive domains. These challenges often persist into survivorship, with pediatric cancer survivors facing increased risks of secondary cancers, morbidity, and premature mortality. Physical activity has emerged as a potential strategy to mitigate these adverse effects and improve quality of life during and after treatment, but barriers to engagement remain substantial for this vulnerable population.

The IMPACT trial addresses a critical gap in pediatric exercise oncology by evaluating a 12-week, individualized PA intervention delivered via videoconference to children and adolescents with cancer or blood disorders. This single-arm, mixed-methods, type II hybrid effectiveness-implementation trial aims to assess both the effectiveness of the intervention on device-measured PA (primary outcome: steps per day) and implementation factors such as recruitment, feasibility, delivery time, expertise, cost, fidelity, and adverse events. The intervention consists of three weekly sessions (15-45 minutes each) of tailored aerobic, resistance, balance, core, and flexibility exercises, delivered by trained exercise professionals regardless of whether participants are at home or in the hospital. This approach represents a significant departure from traditional hospital-based PA programs, potentially overcoming barriers related to treatment side effects, isolation periods, variable treatment timelines, and geographical constraints. The trial's broad eligibility criteria (ages 5-18, any cancer or blood disorder diagnosis, currently receiving or recently completed treatment) and recruitment from two major children's hospitals in Alberta enhance its potential to generate meaningful evidence about the role of videoconference-delivered PA in pediatric oncology care.

How Does the Trial Ensure Robust Assessment and Safe Intervention Delivery?

The comprehensive assessment protocol includes device-measured PA via Fitbit, participant- and caregiver-reported outcomes (PA, quality of life, symptoms, cognitive function, resource use), and physical function tests (aerobic endurance, flexibility, range of motion, balance, mobility) conducted via videoconference at baseline, post-intervention, and 6- and 12-month follow-ups. Qualitative data from semi-structured interviews with participants, caregivers, healthcare providers, and exercise professionals provide deeper insights into experiences, barriers, facilitators, and sustainability. This mixed-methods approach, guided by the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance), offers a holistic understanding of both intervention effectiveness and implementation factors. Safety measures include medical clearance, caregiver presence during sessions, trained exercise professionals, regular fidelity checks, and established emergency protocols. The intervention development followed a patient-oriented approach, integrating relevant literature, existing resources, pediatric PA guidelines, and perspectives from international experts and local healthcare providers, ensuring its alignment with evidence-based practices and contextual needs.

The trial's exercise professionals undergo rigorous training, completing a comprehensive 30-hour program covering both educational components (cancer and treatment protocols) and practical elements (exercise prescription, delivery, behavior change support, motivational communication skills). This includes specific training in the Thrive Health Cancer and Exercise program, pediatric cancer and exercise modules, and adolescent and young adult-specific content. Additionally, they receive trial-specific training on oncology treatments and side effects, exercise modifications, and intervention processes. To ensure competency, they complete scenario-based training, shadow existing group-based PA programs, and practice delivering PA via videoconference to children without a history of cancer. This extensive preparation ensures that exercise professionals can safely and effectively deliver tailored PA sessions while addressing the unique needs and challenges of pediatric cancer patients.

Can Remote Assessments Accurately Measure Pediatric Physical Function?

The physical function assessments conducted via videoconference represent an innovative approach to remote evaluation. These include the 2-minute step test for aerobic endurance, sit-and-reach test for lower body flexibility, shoulder flexion test for range of motion, flamingo balance test, and functional mobility assessments (30-second sit-to-stand test and timed up and go test). Each test has been selected or adapted for videoconference delivery, with detailed protocols to ensure standardization and safety. Two trained assessors are present during each assessment, with caregivers required to be present for additional safety. This remote assessment methodology could have implications beyond the current trial, offering a model for telehealth-based functional evaluations in pediatric populations with chronic conditions.

What Role Do Quality Improvement Cycles Play in Enhancing Implementation?

Quality improvement cycles conducted every six months are a key feature of the trial's implementation strategy. During these cycles, the trial team reviews participant and caregiver data, intervention fidelity, and recruitment strategies. Health care providers and exercise professionals involved in the trial participate in semi-structured interviews to identify potential improvements or additional resources needed. The Consolidated Framework for Implementation Research guides this process, helping to categorize and analyze the data collected. Any modifications identified during these cycles are carefully considered by the trial team and advisory board before implementation. This continuous improvement approach ensures that the intervention and trial procedures can be optimized over time, enhancing both effectiveness and implementation outcomes.

What Insights Do Interim Findings Provide on Recruitment and Implementation?

Interim results from the IMPACT trial indicate both opportunities and challenges in implementing videoconference-delivered PA for pediatric cancer patients. As of October 2025, 105 patients had been referred (85.7% via healthcare provider referral, 14.3% via self-referral), with 42 scheduling information calls, 26 providing informed consent, 16 completing the intervention, and 1 actively participating. These numbers suggest potential barriers to recruitment and retention that warrant further exploration. The trial's funding has been extended until March 2026 to address slower-than-anticipated recruitment, highlighting the challenges of conducting intervention research with this specialized population. Despite these limitations, the trial's pragmatic nature, broad eligibility criteria, mixed-methods approach, and focus on both effectiveness and implementation position it to make significant contributions to the field of pediatric exercise oncology. The inclusion of both cancer and blood disorder patients, who are typically treated on the same wards, may support a cultural shift toward greater integration of movement during treatment.

Could Telehealth-Delivered PA Interventions Redefine Pediatric Oncology Care Pathways?

The IMPACT trial's findings could have substantial implications for pediatric oncology care pathways, potentially supporting the integration of exercise professionals into routine care and offering a scalable approach to providing PA support for geographically dispersed populations. By addressing common barriers to PA engagement during cancer treatment, videoconference delivery may help more children and adolescents access the benefits of physical activity, including improved physical function, reduced symptom burden, enhanced quality of life, and potentially improved long-term outcomes. The trial's continuous quality improvement cycles, involving regular reviews of implementation data and input from an advisory board comprising participants, caregivers, healthcare providers, and community partners, further strengthen its potential for translation to practice. As healthcare systems increasingly recognize the importance of supportive care in pediatric oncology, evidence from trials like IMPACT will be crucial in informing the development of accessible, effective PA interventions that can be integrated into standard care protocols and sustained beyond the research context.

Could the findings from this trial influence how healthcare systems approach supportive care for pediatric cancer patients, particularly in rural or underserved areas where access to specialized programs may be limited? What role might telehealth-delivered physical activity interventions play in addressing health disparities and ensuring equitable access to supportive care across diverse populations of pediatric cancer patients? How might the integration of physical activity professionals into pediatric oncology care teams reshape the multidisciplinary approach to treatment and recovery? These questions highlight the potential broader impacts of this research beyond its immediate findings on effectiveness and implementation. As healthcare continues to evolve toward more patient-centered, accessible models of care, the lessons learned from the IMPACT trial could inform not only physical activity interventions but also broader approaches to supportive care delivery for children and adolescents with cancer and blood disorders.

Summary

The IMPACT trial evaluates a 12-week videoconference-delivered physical activity intervention for children and adolescents with cancer or blood disorders, addressing critical barriers to exercise engagement during treatment. This hybrid effectiveness-implementation study assesses device-measured physical activity outcomes alongside implementation factors including recruitment, feasibility, cost, and safety. The intervention comprises three weekly individualized exercise sessions delivered by trained professionals, whether participants are at home or hospitalized. Comprehensive assessments include Fitbit-measured activity, patient-reported outcomes, remote physical function tests, and qualitative interviews guided by the RE-AIM framework. Exercise professionals complete 30 hours of specialized training covering oncology protocols, exercise prescription, and behavior change strategies. Quality improvement cycles every six months optimize intervention delivery based on stakeholder feedback. Interim results show 105 patient referrals with 16 completing the intervention, revealing recruitment and retention challenges that led to funding extension through March 2026. The trial's pragmatic design and mixed-methods approach position it to generate evidence on telehealth-delivered physical activity as a scalable solution for geographically dispersed pediatric oncology populations. Findings could inform integration of exercise professionals into routine care pathways and address health disparities in access to supportive care services.