Background: Alberta Cancer Exercise (ACE) is a hybrid effectiveness–implementation study evaluating a cancer-specific community-based exercise program across urban sites in Alberta, Canada. The purpose of this paper is to describe the baseline characteristics of participants. Methods: Adults with any type and stage of cancer, who were undergoing cancer treatment or up to three years post treatment completion, were eligible. ACE was delivered in person at 18 sites across 7 cities in Alberta, with video conferencing introduced during the COVID-19 pandemic. Participants took part in 60 min of mild-to-moderate intensity exercise twice weekly for a 12-week period and were encouraged to increase overall physical activity. Results: From January 2017 to February 2023, 2570 individuals enrolled. Participants were a mean age of 57.8 years, 71.3% were female, 45.4% had breast cancer, and 49.4% were undergoing cancer treatment. At baseline, only 22.4% of participants self-reported meeting recommended physical activity levels, 66.0% were overweight/obese, and 71.4% reported one or more comorbidities. Most participants were below normative levels for the six-minute walk and 30 s sit-to-stand tests, and 75.9% reported fatigue. Conclusion: Participants were largely inactive, unfit, and symptomatic. ACE attracted more females and individuals with breast cancer but was otherwise representative of the Alberta cancer population.

Background: Current guidelines endorse the integration of exercise into cancer care. The diagnosis of cancer and its treatment, however, may introduce factors that make exercise engagement difficult, especially for individuals with advanced stages of disease. In this paper, we describe the baseline screening and triage process implemented for the Alberta Cancer Exercise (ACE) hybrid effectiveness-implementation study and share findings that highlight the multifaceted complexity of the process and the direct role of the clinical exercise physiologist (CEP). Methods: ACE was a hybrid effectiveness-implementation study examining the benefit of 12-week cancer-specific community-based exercise program. The ACE screening process was developed by integrating evidence-based guidelines with oncology rehabilitation expertise to ensure safe and standardized participation across cancer populations. The screening process involved four steps: (1) a pre-screen for high-risk cancers, (2) completion of a cancer-specific intake form and the Physical Activity Readiness Questionnaire for Everyone (PAR-Q+), (3) a CEP-led interview to further evaluate cancer status, cancer-related symptoms and other health issues (performed in-person or by phone), and (4) a baseline fitness assessment that included measurement of vital signs. Results: A total of 2596 individuals registered and underwent prescreening for ACE with 2570 (86.6%) consenting to participate. After full screening including the baseline fitness testing, 209 participants (8.1%) were identified as requiring further medical clearance. Of these, 191 (91.4%) had either a high-risk cancer, metastatic disease or were in the palliative end-stage of cancer, and 161 (84.3%) reported cancer-related symptoms potentially affecting their ability to exercise. In total, 806 (31.4%) participants were triaged to CEP-supervised in-person programming, 1754 (68.2%) participants to ACE community programming, and 8 (0.3%) specifically to virtual programming (post-COVID-19 option). Conclusions: The findings highlight the complexity and challenges of the screening and triage process, and the value of a highly trained CEP-led iterative approach that included the application of clinical reasoning.

Background/Objectives: Despite recommendations to exercise, many individuals living with and beyond cancer do not achieve or sustain recommended physical activity levels because access to structured exercise support remains limited. We evaluated the real-world delivery of a scalable, community-based exercise model designed to address this gap. Methods: We conducted a hybrid effectiveness–implementation study of a 12-week supervised exercise intervention delivered in community settings across Alberta, Canada (in person or virtual). The primary outcome was the proportion of participants meeting physical activity guidelines at one year. Secondary outcomes included physical fitness and patient-reported outcomes. Results: Among 2570 participants, completion (90.6%) and attendance (77.1%) were high. At one year, the proportion meeting physical activity guidelines increased from 24.1% to 38.9% (p < 0.001), exceeding the prespecified target. At 12 weeks, participants demonstrated clinically meaningful gains in physical fitness, including sit-to-stand performance (+2.8 repetitions; 95% CI, 2.6, 3.9) and six-minute walk distance (+39.9 m; 95% CI, 36.9, 42.8), along with improvements in patient-reported outcomes. Improvements in fatigue and quality of life were smaller among participants receiving chemotherapy. Adverse events were rare (0.5%), with all serious events occurring among participants receiving active cancer treatment. Conclusions: This study demonstrates that structured supervision and behavioural support can be delivered through scalable, community-based models integrated with cancer care and may help patients achieve and sustain recommended physical activity levels. These findings support the translation of established exercise evidence into real-world models of care while highlighting the need for additional strategies to support long-term behaviour change.

Exercise has been found to be safe and beneficial for people with advanced cancers, but more research is needed to understand how best to design and implement exercise programming. The Alberta Cancer Exercise (ACE) study examines the effectiveness and implementation of a 12-week community-based exercise program in Alberta, Canada, for people diagnosed with cancer. Here, we describe the characteristics of individuals with metastatic cancer enrolled in the ACE program and report 12-week changes in self-reported and objective outcomes. Of 306 participants, 274 (89.5%) completed the 12-week study. Many participants were female (65.4%), with ≥1 comorbidity (71.9%), and on active cancer treatment (74.8%). Common cancer types included breast (33.7%), genitourinary (16.7%), and digestive (15.0%). Frequent sites of metastasis were bone (44.8%), liver (28.8%), and lung (25.8%). The mean exercise attendance rate was 73.6%. One exercise-related adverse event (0.3%) and one non-exercise-related adverse event (0.3%) occurred, both in individuals with brain metastases. Participants demonstrated strong interest and engagement in exercise, with significant improvements in weekly physical activity, symptoms, quality of life, and physical fitness. Greater benefits were found among subgroups of male participants, those not undergoing chemotherapy, and those receiving group personal training or virtual circuit training. A low rate of adverse events is anticipated.