title: CanWalk: study protocol for a randomized feasibility trial of a walking intervention for people with recurrent or metastatic cancer.
abstract: BACKGROUND
  Increasing numbers of people in the UK are living with recurrent or metastatic cancer, many of whom experience reduced quality of life resulting from the physical and psychosocial consequences of cancer and its treatment. While drug treatments are important at alleviating some symptoms, there is increasing evidence of the benefits of exercise in enhancing quality of life and health outcomes. Walking is an inexpensive and accessible form of exercise. To our knowledge, no studies have investigated whether a walking intervention is sufficient to enhance quality of life and alleviate symptoms in people with recurrent or metastatic cancer across a range of tumor types. This paper describes the CanWalk study protocol, which aims to assess the feasibility and acceptability of undertaking a randomized controlled trial of a community-based walking program to enhance quality of life and well-being in people with recurrent or metastatic cancer.
  
  
  METHODS
  A mixed methods feasibility study includes an exploratory two-center randomized controlled trial and qualitative interviews. A minimum of 60 participants will be recruited from two London NHS Trusts and randomized 1:1 between the walking intervention and standard care using minimization. The walking intervention consists of the initial provision of written/online information followed by a short motivational interview. Participants are instructed to walk for 30 min on alternate days and attend an organized volunteer-led walk once a week. Half of all participants will be asked to use a pedometer. Postal questionnaires will be completed at baseline (pre-randomization) and at 6, 12 and 24 weeks. A subsample of participants and stakeholders will be interviewed at the end of the study.
  
  
  RESULTS
  Primary outcomes will be the acceptability and feasibility of the intervention and trial. A range of secondary outcome assessments needed to design a main study, including estimates of recruitment, adherence and variability in quality of life, will be evaluated.
  
  
  CONCLUSIONS
  Data from this study will be used to refine the walking intervention, investigate the acceptability of the intervention and study design, and determine the most appropriate outcome measures thereby providing estimates of the factors needed to design the main study.
  
  
  BACKGROUND
  ISRCTN42072606.
authors.affiliation: Kings College London, Kings Health Partners, Florence Nightingale Faculty of Nursing and Midwifery, London, UK.
authors.forename: Jenny
authors.initials: J
authors.lastname: Harris
authors.affiliation: Kings College London, Kings Health Partners, Florence Nightingale Faculty of Nursing and Midwifery, London, UK.
authors.forename: Vicki
authors.initials: V
authors.lastname: Tsianakas
authors.affiliation: University of Surrey, School of Health Sciences, Faculty of Health and Medical Sciences, Guildford, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Ream
authors.affiliation: King's College London, Kings Health Partners, Division of Cancer Studies, London, UK.
authors.forename: Mieke
authors.initials: M
authors.lastname: Van Hemelrijck
authors.affiliation: King's College London, Kings Health Partners, Division of Cancer Studies, London, UK.
authors.forename: Arnie
authors.initials: A
authors.lastname: Purushotham
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, USA.
authors.forename: Lorelei
authors.initials: L
authors.lastname: Mucci
authors.affiliation: Department of Urology and North London East Regional Urological Cancer Centre, Whipps Cross Hospital, London, UK ; Department of Health and Social Care, London South Bank University, London, UK.
authors.forename: James Sa
authors.initials: JS
authors.lastname: Green
authors.affiliation: NHS England, London, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Robb
authors.affiliation: Macmillan Cancer Support, London, UK.
authors.forename: Jacquetta
authors.initials: J
authors.lastname: Fewster
authors.affiliation: Kings College London, Kings Health Partners, Florence Nightingale Faculty of Nursing and Midwifery, London, UK.
authors.forename: Jo
authors.initials: J
authors.lastname: Armes
keywords: Feasibility studies; Metastatic cancer; Qualitative evaluation; Randomized controlled trial; Recurrent cancer; Secondary cancer; Walking