Motivational coaching following supervised cancer rehabilitation.

Due to improved diagnosis and treatment modalities, cancer survival rates are increasing. Consequently, the population of cancer-survivors is growing and there is an urgent need for evidence-based survivorship-care to mitigate or prevent side-effects. It has been well-established that a supervised cancer rehabilitation program that contains exercise training, positively affects these side-effects, but less is known about the long-term effects.Current guidelines advise cancer patients and survivors to perform at least 150 minutes of moderate- to- vigorous physical activity per week and to perform bone and muscle strengthening exercises two times per week. In a cohort of breast cancer survivors, 79% of the patients did not meet these exercise criteria, six months after finishing a rehabilitation program. Another study on the follow-up of exercise behaviour in cancer patients showed that 30% of the participants did not engage in any exercise 12
months after completing a cancer rehabilitation program. These findings indicate that short-term rehabilitation might not be enough for cancer patients to reach recommended physical activity levels. A qualitative study showed that patients experience the transition from hospital-based supervised exercise to unsupervised exercise in the community as a confrontation with the real world which could be improved through a more structured transition, accessibility of transferable tools, sustained peer support and on going monitoring. Motivational coaching could be effective to improve physical activity behaviour and other outcomes in participants after completing oncological rehabilitation. Positive effects have been found for motivational coaching following rehabilitation in other populations, but not for cancer patients. Therefore, this study will focus on the effect of motivational coaching following oncological rehabilitation on physical activity behaviour in cancer patients.

Motivational coaching following exercise rehabilitation will improve physical activity behaviour (minutes of moderate- to- vigorous physical activity spent per week), measured six months after completing the exercise program.

Measurements are performed at baseline and at 6 months follow-up

The intervention group will receive motivational coaching to improve physical activity behaviour following the 10-week exercise program. This coaching program is called ‘Beweeg Bewust’ and is guided by the organization ‘Maastricht Sport’. In this motivational coaching program, each patient will be linked to an individual coach, who is a trained sports college student and will guide them to stay physically active. During an intake assessment in Maastricht UMC+, the coach will give individually tailored exercise advice, based on performance tests, personal motivation and personal preferences. The coach will help them to choose a sports activity that personally fits. Participants are offered the possibilities to attend to the groups sessions of the organisation, to go to other sports clubs or to perform exercise independently (like walking, cycling etc.). After the intake, the program contains electronic coaching (e-coaching). Motivational coaching will be based on the COM-B model. This model is developed for behaviour change in which capability, opportunity and motivation are seen as the drivers of behaviour. Coaches will identify moderators and barriers for behaviour change in these three constructs, to personalize the coaching strategy. In the first twelve weeks, the coach will approach the participant weekly, by e-mail or telephone. After an evaluation, the frequency of the contact will be reduced.