A hybrid effectiveness-implementation trial of an evidence-based exercise intervention for breast cancer survivors

Rinad S. Beidas, Breah Paciotti, Fran Barg, Andrea R. Branas, Justin C. Brown, Karen Glanz, Angela DeMichele, Laura DiGiovanni, Domenick Salvatore, Kathryn H. Schmitz

Research output: Contribution to journalArticlepeer-review

50 Scopus citations


Background: The primary aims of this hybrid Type 1 effectiveness-implementation trial were to quantitatively assess whether an evidence-based exercise intervention for breast cancer survivors, Strength After Breast Cancer, was safe and effective in a new setting and to qualitatively assess barriers to implementation. Methods: A cohort of 84 survivors completed measurements related to limb volume, muscle strength, and body image at baseline, 67 survivors completed measurements 12 months later. Qualitative methods were used to understand barriers to implementation experienced by referring oncology clinicians and physical therapists who delivered the program. Results: Similar to the efficacy trial, the revised intervention demonstrated safety with regard to lymphedema, and led to improvements in lymphedema symptoms, muscular strength, and body image. Comparison of effects in the effectiveness trial to effects in the efficacy trial revealed larger strength increases in the efficacy trial than in the effectiveness trial (P < .04), but few other differences were found. Qualitative implementation data suggested significant barriers around intervention characteristics, payment, eligibility criteria, the referral process, the need for champions (ie, advocates), and the need to adapt during implementation of the intervention, which should be considered in future dissemination and implementation efforts. Conclusions: This trial successfully demonstrated that a physical therapy led strength training program for breast cancer survivors can be implemented in a community setting while retaining the effectiveness and safety of the clinical trial. However, during the translation process, strategies to reduce barriers to implementation are required. This new program can inform larger scale dissemination and implementation efforts.

Original languageEnglish (US)
Pages (from-to)338-345
Number of pages8
JournalJournal of the National Cancer Institute - Monographs
Issue number50
StatePublished - Nov 2014

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research


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