Exercise Interventions for Women with Ovarian Cancer: A Realist Review
Deirdre McGrath, Peter O’Halloran, Gillian Prue, Malcolm Brown, Joanne Millar, Adrina O’Donnell, Lisa McWilliams, Claire Murphy, Gwyneth Hinds, Joanne Reid
Abstract
BACKGROUND: Despite evidence indicating the benefits of exercise interventions for women with ovarian cancer both during and following treatment, uptake is poor. There is limited research exploring the implementation of such interventions for this cohort of women. The purpose of this review was to identify implementation theories in relation to exercise interventions for women with stages I-IV ovarian cancer, both during and following treatment; to explain positive and negative contextual factors, which may help or hinder implementation; and to develop a theory on how exercise interventions for women with ovarian cancer may be implemented. METHODS: This realist review sourced literature from five electronic databases: CINAHL plus, Medline, Embase, PsycINFO and Google Scholar. Methodological rigour was assessed using the relevant critical appraisal skills programme tools. RESULTS: Nine papers were included. Two intervention stages were identified: first, optimising uptake by providing education to patients on the benefits of exercise, approaching patients when symptoms are adequately managed and offering a personalised exercise programme; second, adherence and retention are influenced by the provision of an "autoregulated" exercise programme with additional supportive infrastructure, individualised goal setting and symptom management support where required. CONCLUSION: Women with ovarian cancer are reluctant to engage in exercise interventions, despite the supporting evidence in terms of positive clinical outcomes. This realist review elucidates underlying mechanisms and important contextual factors that will support and guide the implementation of exercise interventions for this cohort of women.