Interim Implementation and Effectiveness Results from the IMplementation of Physical Activity for Children and Adolescents on Treatment (IMPACT) Intervention and Trial

Emma McLaughlin¹Nicole Culos-Reed^1,2,3Carolina Chamorro^1,4Beverly Wilson^5,6Sara Fisher⁶Gregory MT Guilcher⁷Bridget Penney⁸Mira Penney⁸Laura Wich⁸Janine Wich⁸Colleen Cuthbert^10,2,9Amanda Wurz^1,11,12*

• ¹Faculty of Kinesiology, University of Calgary, Calgary, Canada
• ²Department of Oncology, University of Calgary Cumming School of Medicine, Calgary, Canada
• ³Department of Psychosocial Resources, Arthur J.E. Child Comprehensive Cancer Centre, Calgary, Canada
• ⁴Kids Cancer Care Foundation of Alberta, Calgary, Canada
• ⁵Department of Pediatrics, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Canada
• ⁶Stollery Children's Hospital, Edmonton, Canada
• ⁷Hematology/Oncology/BMT Clinic, Alberta Children's Hospital, Calgary, Canada
• ⁸Participant Advisory Board, Calgary, Canada
• ⁹Faculty of Nursing, University of Calgary, Calgary, Canada
• ¹⁰University of Calgary, Department of Community Health Sciences, Calgary, Canada
• ¹¹University of the Fraser Valley, School of Kinesiology, Chilliwack, Canada
• ¹²BC Children's Hospital Research Institute, Vancouver, Canada

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), awaiting, on-, or <3 months off-treatment are referred or self-referred to the IMPACT. 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 (e.g.,posters, brochures, videos, 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.