Aim:
Supervised exercise has demonstrated greater efficacy than independent home-based exercise programs in improving functional capacity in people with cancer. However, between January and March 2026, only 8.3% of moderate- and high-risk patients participating in the prehabilitation program at a tertiary cancer centre met the recommended model of care of two supervised exercise sessions per week. Patient- and clinician-reported barriers included appointment-burden, symptom-burden, session times, geographical isolation, and technological challenges. This physiotherapy-led quality improvement initiative aimed to increase the proportion of patients meeting the recommended model of care to 50% by August 2026.
Methods:
The project leads undertook a nine-month improvement coaching program between November 2025 and August 2026, using the Institute for Healthcare Improvement Model as a framework. Change ideas were tested through iterative Plan-Do-Study-Act (PDSA) cycles. PDSA 1 assessed the implementation of stratified exercise programming and PDSA 2 assessed the uptake of individualised supervised exercise. Run charts were used to track performance and distinguish meaningful trends from random variation.
Results:
From March to July 2026, 74 moderate- or high-risk patients participated in the exercise prehabilitation service. Change idea 1 (March-April 2026) involved implementing concurrent seated and standing exercise programs to provide clinicians with a standardised structure for virtual exercise classes. During the six-week PDSA cycle, the proportion of patients meeting the model of care increased from 8.3% to 15.6%. Change idea 2 (June-July 2026) involved offering individual one-on-one exercise sessions with prehabilitation exercise clinicians in addition to the usual group exercise class structure. Results from this cycle are pending analysis.
Conclusion:
This project has highlighted the complexity of implementing exercise prehabilitation within a tertiary cancer setting for a heterogenous patient population, including regional, rural, and interstate locations. Early findings indicate that improving uptake will require continued testing and refinement of flexible, patient-centred models of supervised exercise delivery.