Background

There are now an estimated 2.5 million people living with cancer in the UK, with this figure projected to rise to 4 million by 2030.1 Cancer and its treatment can negatively impact physical and psychological well-being.2 Regular physical activity throughout the cancer journey can preserve or improve physical function, quality of life, cardiorespiratory fitness and weight management.3 That said, physical activity levels generally drop once a person has been diagnosed and ultimately remain low post-treatment unless they are given advice on how to be more active more often.4

Active Everyday (AE) is a physical activity referral programme for people living with and beyond cancer in Sheffield, UK (see supplementary file 1). The programme represents a new pragmatic approach to supporting patient’s physical activity needs throughout their cancer journey. The pathway connects clinical care with community physical activity provision. All patients referred to the programme receive personalised behaviour change support, enabling them to discuss their unique needs, aspirations and concerns regarding physical activity, healthy lifestyles and sport. Assistance is provided to promote realistic and incremental behavioural changes and appropriately signpost to PA opportunities that currently exist city-wide.

Why is this novel?

Scientific evidence for the beneficial effects of physical activity for people affected by cancer is building rapidly, yet the most effective way to deliver a physical activity service for patients with cancer is largely unknown. Recognising there is not a ‘one size fits all’ approach, AE provides easy access for physical activity support for all people affected by cancer and adopts a flexible and tailored approach to physical activity service provision. Enabling individuals to have choice is imperative in ensuring person-centred care. Often, when trying to increase physical activity levels, people affected by cancer are looking for reassurance and encouragement that what they are doing is safe and beneficial to their recovery. To help provide this support, the AE programme provides access to exercise and cancer specialists positioned in health and leisure facilities across Sheffield, to enable safe and structured support.

What are the successes?

AE has received referrals from over 250 people affected by cancer (mean age: 57 years old; 62% female, 38% male; 39% breast cancer, 7% colorectal, 7% lung, 11% prostate). Improvements have been observed in patient’s quality of life, measured through the EQ-5D5 with an average of 184 additional minutes per week spent being physically active to accrue a health benefit.6 In depth, qualitative interviews with programme participants have provided critical insight for future service delivery, as highlighted by the programme video.

The aim of AE is to create a culture of physical activity for people affected by cancer in Sheffield. Achieving this depends on the support and engagement from all strategic partners across the health and leisure and sport sectors. A critical success of this programme has been its ability to unite key strategic city partners to work collaboratively to achieve a shared goal: a holistic pathway of physical activity provision for people affected by cancer. This is highlighted through the successful integration of AE in Sheffield’s primary care, physical activity referral service. This marks the first time that cancer has been recognised as a condition within this scheme, and AE is now a core member of the executive management group.

Recognising the value of sport and its capability to attract and engage with communities, AE has formed relationships with professional sports teams. An example of this has been the development of Fans Fighting Cancer, a progressive physical activity programme for people affected by cancer centred on walking football, in association with Sheffield United Community Foundation.

Lessons learnt

The behavioural change component of AE is crucial. Delivery must be flexible, continually responding to patient need. This means delivering the intervention in locations appropriate for patients such as coffee shops, community venues and cancer support centres. Patients value the one-to-one support; they feel listened to and empowered to drive their own care.

Clinical endorsement of the importance of being physical activity during and after a cancer diagnosis is a powerful influence on an individual’s behaviour. Clinical champions are important for advocating a culture of physical activity. Champions can motivate colleagues to integrate AE referrals into their routine practice. It is important to have a simple and clear referral pathway not constrained to just clinical services, but all organisations that patients with cancer could come into contact with. A comprehensive marketing and communications strategy is required to optimise public and professional awareness of AE.