Developing A Physical Activity Intervention For Adolescent And Young Adult Central Nervous System Tumor Survivors

Up to 45% of adolescent and young adult (AYA; 15-39 years old at diagnosis) central nervous system (CNS) tumor survivors experience cognitive impairment (CI). Physical activity (PA) is a promising approach to mitigate CI. However, <50% of AYA survivors meet recommended PA levels. Coping with CI while navigating developmental milestones with limited resources may impede AYAs’ engagement with PA interventions. PURPOSE: To design a feasible and engaging PA intervention (i.e., using active video games [AVG]) to improve survivorship outcomes for the AYA CNS population. METHODS: Guided by the Adaptome framework, we aimed to adapt the behavioral coaching materials and PA components of an existing virtual PA intervention using AVG for survivors of AYA CNS tumors. We recruited 16 survivors of AYA CNS tumors and 16 clinical providers to participate in online semi-structured focus groups, each with a minimum of four participants and lasting ~60 minutes each. Two research assistants conducted thematic analysis on feedback from focus groups; themes and subthemes were generated. RESULTS: AYA participants (n = 16) ranged from ages 19-38 (mean age: 25.8 ± 5.5) at the time of the focus group. The majority of participants (62.5%) were white, 25% were Hispanic or Latino, and 12.5% identified as “other race.” Thematic analysis resulted in 19 subthemes under five levels of adaptation based on the Adaptome framework The following top themes were identified under each level of adaptation: ‘target audience’: providing flexibility in the exergame intervention; ‘service setting’: 1) accounting for barriers and 2) screening for activity levels; ‘mode of delivery’: 1) inclusivity, 2) benefits of virtual delivery, and 3) social facilitation; ‘cultural adaptations’: 1) motivation, 2) careful selection of images and topics, 3) community building, and 4) mental health awareness; ‘core components’: 1) a variety of activities and 2) clinical integration. Each of the themes listed above was found in at least 10 participant quotes. CONCLUSIONS: Qualitative analysis findings indicate that program adaptation needs to occur at all five levels of the Adaptome framework. Key recommendations included maximizing program inclusivity, incorporating motivational techniques, and providing various exercise options.