Can Live-Remote Delivery of Supervised Group Exercise Reduce Cancer Health Disparities? Insights from a Community Readiness Assessment and Feasibility Trial of the Exercising Together Program in Underserved Oregon Counties

Background : Rural cancer survivors living with poverty and their partners have poorer health outcomes than their urban-dwelling counterparts and encounter barriers to implementing health behaviors that can improve quality of life. We investigated the readiness of geographically underserved (rural with high or persistent poverty) counties in Oregon to engage in health-related research to inform the subsequent conduct of a pilot study to assess the feasibility, acceptability, and preliminary efficacy of a live-remote, supervised dyadic exercise program (Exercising Together ^Ó (ET)) in couples coping with cancer in those counties. Methods: We conducted a Community Readiness Assessment in 5 geographically underserved Oregon counties and calculated their readiness scores on a scale from 1 (No awareness) to 9 (Professionalization). The pilot study recruited breast, prostate, and colorectal cancer survivors and their intimate partners living in these 5 counties. Participants were assigned to one of two resistance training programs (ET or unsupervised home-based exercise) for 6 months. Feasibility was assessed by study accrual and retention, completion of surveys and testing visits, intervention adherence, and safety. Participants completed a post-intervention acceptability survey and performance testing and patient-reported outcomes at 0, 6, and 12 months. Results: Readiness for health-related research varied but was low overall (2.7, Denial/Resistance to 5.2, Preparation). The pilot study enrolled 11 couples (31% accrual), with 73% residing in the highest readiness county. The study had high retention in the ET arm (93%) and high data completeness (surveys, 98%; performance testing visits, 96%), intervention adherence (ET, 93%; unsupervised, home-based exercise, 83%), and safety in both the ET and unsupervised, home-based exercise arms. ET received higher overall experience ratings than unsupervised, home-based exercise, and both survivors and partners in ET experienced large effect-size improvements in physical performance and smaller improvements in some patient-reported outcomes after the exercise program. Conclusion: Delivering exercise via live-remote classes could address health disparities for rural cancer survivors by increasing access to supervised, evidence-based programs. Since readiness scores were aligned with pilot study enrollment, future studies should prioritize activating low-readiness counties to increase participation in exercise interventions for couples coping with cancer. Implications for Cancer Survivors: Live-remote exercise classes may increase access to supervised, evidence-based programs for rural cancer survivors.