Exercise is an evidence-based strategy shown to reduce the negative side effects associated with cancer treatment for individuals living with and beyond cancer (LWBC). Healthcare providers (HCPs) play a critical role in promoting exercise for these individuals. Notwithstanding, several barriers hinder HCPs’ ability to discuss and support exercise in clinical practice. EXCEL is an exercise intervention designed to address health disparities in access to exercise oncology resources for rural/remote individuals LWBC, including a referral pathway for HCPs to use. The purpose of this study was to evaluate HCP experiences using the EXCEL exercise referral pathway. We employed an interpretive description methodology, using semi-structured interviews to assess HCP experiences with EXCEL. Overall, HCPs felt empowered to refer to exercise when they were supported in doing so. The findings highlighted (1) a need for a better understanding of the role of exercise professionals and their integration into cancer care; (2) the need for efficient referral systems including embedding referrals into existing health care electronic record systems; and (3) sharing patient feedback with exercise oncology programs back to the HCPs to drive continued referrals.

Despite being key partners in the supportive care of the cancer patient, family caregivers are often inadequately prepared for or supported to take on this critical role, subsequently putting their own wellbeing at risk and, by extension, that of the patient. Exercise interventions show promise in mitigating caregiver burden and improving health outcomes for both caregivers and patients; however, the interrelationship between family caregiver and care recipient has gone largely unexplored. Thus, we conducted a single-group pilot study to examine the feasibility and preliminary effectiveness of a 12-week dyadic exercise intervention. Of the 27 caregiver–patient dyads who consented, 21 (77.8%) completed the study, with participants completing an average of 23.1 (96.3%) of the prescribed exercise sessions, suggesting good adherence and study retention. All participants reported higher post-intervention levels of strenuous physical activity (p = 0.017), improved sit-to-stand repetitions (p = 0.004), and social functioning (p = 0.030) compared to baseline. Of note, caregivers reported higher post-intervention scores on the burden in relationship subscale of the Zarit Burden Interview relative to baseline (p = 0.043), suggesting an increase in perceived caregiver burden following the intervention. Overall, dyadic exercise interventions appear feasible and may confer certain physical and psychosocial benefits for both family caregivers and care recipients. However, such programs may also unintentionally exacerbate certain aspects of caregiver burden. Future research should aim to identify factors within dyadic exercise interventions that may contribute to increased caregiver burden, as well as strategies to help mitigate these effects.