Multi-Region: Central West, Toronto Central LHIN, Central West Regional Cancer Program; Toronto Central Regional Cancer Program

Wellspring Cancer Support Centres (GTA) – Wellspring Cancer Exercise Program

1. Mission 

1. To promote safe and effective exercise for people living with cancer during or after treatment, and to ensure participants are meeting Cancer Care Ontario’s physical activity guidelines for people living with cancer. 
2. At a Glance

1. Location(s): 
   1. Brampton, Ontario
   2. Toronto (2), Ontario
   3. Oakville, Ontario
2. Program Site(s): 
   1. Wellspring Chinguacousy
   2. Wellspring Westerkirk House
   3. Wellspring Downtown Toronto
   4. Wellspring Birmingham Gilgan House
   5. Wellspring Niagara
   6. Wellspring London and Region
3. Program Launch Date: September, 2009
4. Key Stakeholders in Initiation 

1. Contact Information

1. Website: https://wellspring.ca 
2. Facebook: Wellspring Cancer Support Network @Wellspring CAN
3. Twitter: WellspringCAN @WellspringCAN
4. Email (sorted by location):

• Wellspring Chinguacousy: neal@wellspring.ca
• Wellspring Westerkirk House: alison@wellspring.ca
• Wellspring Downtown Toronto: dawn@wellspring.ca
• Wellspring Birmingham Gilgan House: lauren@wellspring.ca

1. Phone: 

• Wellspring Chinguacousy: 905-792-6480
• Wellspring Westerkirk House: 416-480-4440
• Wellspring Downtown Toronto: 416-961-1928
• Wellspring Birmingham Gilgan House: 905-257-1988

1. Community Partnerships and Affiliations 

1. Development and History

1. 1992: Wellspring was founded to offer psychological, emotional, social, spiritual and informational support to individuals and families living with cancer. 
2. 2005: Development of the Wellspring Cancer Exercise Program began in response to research regarding the benefits of exercise for the management of cancer treatment-related side effects.
3. 2007: Wellspring contracted Jodi Steele to design a comprehensive and safe exercise program for cancer survivors.  To meet leadership training needs, a professional rehab training program was developed in tandem with the exercise program for patients.
4. 2008: Wellspring launched a 10-week Cancer Exercise Program, offered 2 times per week, at Wellspring centres in the GTA.
5. 2010: Based on evaluation feedback and high program demand, the Wellspring Cancer Exercise Program transitioned from a 10-week program to a 30-week program, on a graduated model (twice a week for 10 weeks followed by once a week for 20 weeks).
6. 2013:  In collaboration with the University Health Network, Wellspring undertook a repeated measures research project to assess the impact of the program on various physical and psychosocial outcomes. 
7. 2015: Based on research results, the Wellspring Cancer Exercise Program transitioned from a 30-week program to a 20-week program, offered 2 times per week.  
8.  Barriers to Program Development

1. Perceived risk
   1. “One initial barrier was trying to get rid of the idea that people with a cancer diagnosis should rest and not do physical activity. That was a huge barrier right at the beginning.”
2. Infrequent physician referral
   1. “It has taken 8 years to build relationships with the regional cancer program to have referrals on a regular basis.”
3. Program awareness
   1. “The other thing was just awareness, being a community-based program, we are just starting to build relationships with our regional cancer program.”
4. Facilitators of Program Development

1. Staff training
   1. “We were looking for physiotherapists and kinesiologists that had a background with chronic disease in their clinical practice, and we had a full training of those leaders…so we were getting that consistent messaging from all of our leadership.”

1. Physician champions
   1. “We did have the support of physician champions in the cancer program, that either knew of Jodi and her expertise in this area, so that really helped.”
2. Targeted promotion
   1. “Jodi actually went to several of the [regional cancer] programs and did rounds, and discussed the program, what benefits it could have, and how to refer their patients to us.”
3. Current Staff Structure 

1. Core Practices

1. Facility 
   1. Multi-purpose rooms vary in size by location. 

1. Parking
   1. Parking is available at no cost at Birmingham Gilgan House and Wellspring Chinguacousy. 
   2. Parking at Wellspring Downtown and Wellspring Westerkirk House is available for approximately $10 -$15 (for a 1.5 hour visit) 

1. Cost Structure
   1. The Wellspring Cancer Exercise Program is free to program participants. However, a Wellspring membership is required to enrol in cancer exercise program. The membership is offered at no cost to program members. 

1. Funding and Support
   1. Donors (community foundations, corporate sponsors, individual donations)
   2. Fundraising Initiatives
   3. Grant Funding 
      1. Trillium Growth Fund

1. Participant Recruitment
   1. Referral Sources
      1. Health Care Provider (e.g., Family Physicians and Oncologists)
      2. Self-Referral
      3. Word of Mouth
   2. Awareness initiatives
      1. Wellspring has a communications specialist who actively investigates promotional events held each month by cancer-related organizations.
      2. Promotional presentations are delivered at conferences (e.g., Osteoporosis Canada).
      3. Wellspring engages in continual outreach initiatives to regional cancer programs and cancer organizations in the community (e.g., providing in-clinic peer support, being a part of patient-based presentations and outreach days).

1. Participants
   1. Eligibility criteria: The program is open to adult individuals of any age, with any type of cancer, and any stage (individuals must have been diagnosed <5 years). Physician referral is required. 
   2. Participants per session: 10
   3. Staff to participant ratio: 10:2 leader to participant ratio
   4. Total number of participants in program: 30-80 participants (varies by location)

1. Initial intake session
   1. Client intake sessions are performed by an exercise leader at the Wellspring Cancer Exercise Program. 
      1. Intake Assessment Measures (these measures are repeated at 10-weeks (midpoint) and 20-weeks (end of program))
         1. Anthropometric Measurements
            1. Weight
            2. Waist circumference
         2. Physical Fitness Measurements
            1. Grip strength
            2. Aerobic assessment 
            3. Balance assessment
         3. Brief fatigue index
         4. Functional scale inventory

1. Program Schedule 
   1. Session duration: 1 hour 
   2. Frequency: 2 sessions per week
   3. Length: 20 weeks 
   4. Session schedule (subject to change based on members’ needs and leader availability)
      1. Downtown Toronto: 
         1. Monday and Wednesday: 
            1. 9:00-10:00am
            2. 10:00-11:00am
            3. 11:00-12:00pm
         2. Tuesday and Thursday
            1. 6:00-7:00pm

1. 1. Westerkirk House at Sunnybrook
      1. Monday and Wednesday
         1. 6:00-7:00pm
      2. Tuesday and Thursday
         1. 10:00-11:00am
         2. 11:00-12:00pm
         3. 12:00-1:00pm
         4. 1:00-2:00pm

1. 1. Birmingham Gilgan House
      1. Monday and Wednesday
         1. 9:00-10:00am
         2. 10:00-11:00am
         3. 11:00-12:00pm
         4. 12:00pm-1:00pm
         5. 1:00-2:00pm
         6. 2:00-3:00pm
      2. Tuesday and Thursday
         1. 6:00-7:00pm

1. 1. Chinguacousy 
      1. Tuesday and Thursday
         1. 12:00-1:00pm
         2. 1:00-2:00pm
         3. 2:00-3:00pm

1. Program Design 
   1. The Wellspring Cancer Exercise Program was designed to meet the ACSM guidelines for people living with cancer.
   2. Individualized exercise prescription
      1. Fitness components include aerobic, strength and flexibility.
   3. Equipment
      1. Treadmills, recumbent bikes, upright bikes, steps, arm ergometers, trampoline, elliptical, free weights, bands, stability balls, bosu balls, foam balance, leg machine, reclining bench

1. Educational Components
   1. Informal education (optional): Exercise leaders provide education within their scope of practice regarding health and wellness management (e.g., lymphedema management/prevention).
   2. Formal education (optional): Staff encourage participants to attend educational talks delivered within the Wellspring organization (‘Well Talks’)
      1. ‘Well Talks’ occur on a regular basis wherein professionals in the community are invited to discuss cancer related topics of interest to the Wellspring members.

1. Program Evaluation
   1. Experiential and outcome data are collected by survey twice yearly.  All participants who participated are invited to provide feedback.  Reports are pooled, reviewed, and shared with program leaders and Wellspring governance bodies.  

1. Additional Exercise Programming
   1. A variety of additional exercise programs are delivered at Wellspring (e.g., yoga, tai chi, and qi gong). See location website for further details.
2. Current Barriers to Participation

1. Program length
   1. “The program is twenty weeks in length, so they are with us for three to four months, which is a large investment of time.”
2. Program schedule 
   1. “At some of our centers we only run the program at certain times during the week, so it might not fit into their schedule.”
3. Perceived risk
   1. “Sometimes there is a little bit of inhibition and fear coming in to an exercise program, people thinking that it might be something that they won’t be able to accomplish, or that it might be too difficult for them if they are not feeling well.”
4. Treatment-related side effects 
   1. “Health status is also a barrier, it is a catch twenty two where exercise can help you feel better, but you have to have a certain level of wellness to even start.”
5. Location 
   1. “Until we are able to offer an equally impactful exercise program online… it means that sick people have to come to us.”
6. Facilitators of Participation

1. Social program atmosphere
   1. “There may be a group of people exercising that are new [to the program], with people who have been there for ten, fifteen, twenty weeks, so we find that group kind of camaraderie really helps.”
2. Benefits of physical activity
   1. “A lot of people who are at the ten-week point say, ‘you know when I started I wasn’t able to do the elliptical for three minutes, and now I am doing six’. That is a really motivating factor for our other members coming in for the first time which is really nice.”
3. Future Directions

1. To increase program access to participants by offering more exercise sessions at various times. 
2. To improve relationships with regional cancer programs to encourage direct participant referral.
3. Pending the success of the YMCA Oakville transition program, to create similar programs to assist patients in transitioning into the community to promote life-long exercise and permanent behavioural changes in regards to physical activity