Effectiveness of a Home-Based and Group-Based Tele-Exercise Program for Breast Cancer Survivors: Pilot Randomized Controlled Trial
Clinical Snapshot
PICO Framework
| P — Population | Adult female breast cancer survivors in Hong Kong who have completed primary treatment and remain insufficiently physically active |
| I — Intervention | 7-week theory-informed tele-exercise program comprising progressively supervised group-based sessions transitioning to unsupervised home-based exercise, combined with psychological counselling |
| C — Comparator | Control group (nature of control condition — e.g., usual care, waitlist — not fully specified in abstract) |
| O — Outcomes | Primary: cardiorespiratory fitness. Secondary: lower-extremity strength, balance, affected-side shoulder range of motion, health-related quality of life. Feasibility outcomes: recruitment rate, retention, attendance, compliance, acceptability (RE-AIM framework) |
Bottom Line
This pilot RCT provides encouraging feasibility and acceptability data for a theory-informed tele-exercise programme in breast cancer survivors, demonstrating a 100% retention rate, 87.7% attendance, and 85.3% compliance over 7 weeks in a Hong Kong Chinese cohort. Preliminary signals of improvement were observed across cardiorespiratory fitness, lower-extremity strength, balance, shoulder range of motion, and health-related quality of life. However, the study's small sample (n=12 per group), absence of reported effect sizes or confidence intervals, unclear randomisation and allocation concealment procedures, lack of blinded outcome assessment, and undefined control condition substantially limit the strength of conclusions that can be drawn. This is appropriately framed as a feasibility pilot — it is not designed nor powered to confirm clinical effectiveness. For Australian clinicians, the tele-exercise model is conceptually well-aligned with existing telehealth infrastructure and exercise oncology guidelines, but direct applicability is constrained by the single-cultural context. The results justify investment in a fully powered, multi-centre RCT with longer follow-up, blinded outcome assessment, and rigorous reporting of adverse events before this programme can be recommended for routine clinical implementation.
Key Findings
P Value: Not reported in abstract
Effect Size: Not reported in abstract; described qualitatively as 'preliminary signals of improvement' across all measured domains
Primary Outcome: Cardiorespiratory fitness — preliminary signals of improvement reported in the intervention group; no quantitative values provided in the abstract
Nnt Or Sensitivity: Not calculable from available data; pilot study was not powered for hypothesis testing. Feasibility metrics: recruitment 79.4%, retention 100%, attendance 87.7%, compliance 85.3%
Confidence Interval: Not reported
Clinical Application
The tele-exercise delivery model is feasible from an implementation standpoint, with high retention and compliance metrics. However, clinicians should note this is a 7-week pilot with n=12 in the intervention arm. Clinical adoption should await results of a fully powered definitive RCT. The progressive supervised-to-unsupervised model aligns with principles of supported self-management. In Australia, breast cancer is the most commonly diagnosed cancer in women, with over 20,000 new cases annually (AIHW). Exercise oncology is increasingly supported by RACGP and Cancer Australia guidelines, which recommend structured exercise for cancer survivors to improve fitness, fatigue, and quality of life. Telehealth services expanded significantly under Medicare during and post-COVID-19, with ongoing MBS telehealth item numbers supporting remote consultations. Exercise physiology services are accessible via Medicare Chronic Disease Management plans (up to 5 allied health visits per year), though group tele-exercise programmes of this nature are not currently PBS-subsidised as a standalone intervention. The TGA does not regulate exercise programmes. Australian physiotherapists and accredited exercise physiologists (AEPs) could feasibly deliver this model. Cultural adaptation would be required given the Hong Kong Chinese study population. The COSA (Clinical Oncology Society of Australia) position statement on exercise in cancer care provides a relevant local framework for implementation. Adult female breast cancer survivors who have completed primary treatment, are insufficiently physically active, and have access to internet-enabled devices for telehealth participation. Most applicable to those with early-stage breast cancer in the post-treatment rehabilitation phase.
Abstract
BACKGROUND: Breast cancer remains the most prevalent cancer among women globally. Adjuvant therapies can cause adverse effects that compromise physical and mental health. Exercise may mitigate these effects; however, many breast cancer survivors remain insufficiently active. OBJECTIVE: This pilot study aimed to test the effectiveness of a 7-week theory-informed tele-exercise intervention for breast cancer survivors in Hong Kong. METHODS: We developed a 12-week theory-informed tele-exercise intervention for breast cancer survivors in Hong Kong; this pilot tested a 7-week abbreviated version. In this 2-group randomized controlled pilot trial, 34 individuals were assessed for eligibility, and 27 were randomized; 24 completed baseline and were included in the modified intention-to-treat analyses (12 per group). The intervention comprised a progressively supervised group-based tele-exercise intervention transitioning to unsupervised sessions, combined with psychological counseling. Outcomes were guided by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework, with emphasis on feasibility, acceptability, and preliminary effects. RESULTS: Recruitment was 79.4% (27/34) and baseline-to-post retention was 100% (24/24), with satisfactory attendance (87.7%) and compliance (85.3%) in the intervention group. Acceptability was high. Preliminary signals of improvement were observed in cardiorespiratory fitness (primary outcome), lower-extremity strength, balance, affected-side shoulder range of motion, and health-related quality of life. CONCLUSIONS: This pilot supports the feasibility and acceptability of tele-exercise for breast cancer rehabilitation and provides preliminary evidence to justify a larger trial with longer follow-up to assess sustained effects and broader applicability.
References
- 1.Gao, Y., Sun, Y., Wang, X., Chun, O. K., Fung, B. K. Y., & Fung, W. W. S. (2026). Effectiveness of a home-based and group-based tele-exercise program for breast cancer survivors: Pilot randomized controlled trial. Journal of Medical Internet Research. https://doi.org/10.2196/79564
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