RIVERS Study

For cancer survivors living in rural communities, access to evidence-based supportive care remains a persistent challenge. Limited access to specialized care, long travel distances, and fewer community resources can make it difficult to find structured support after treatment ends. At the CU Anschutz Health and Wellness Center (AHWC), researchers are addressing this gap through RIVERs, an ongoing virtual exercise study designed to improve recovery outcomes for rural cancer survivors. 

RIVERS, short for Response-Driven Individualized Virtual Exercise for Rural Survivors, is led by Ryan Marker, PhD, PT, a researcher at AHWC and Director of BfitBwell, the Center’s longstanding program supporting exercise for individuals impacted by cancer. The study builds upon years of clinical and research experience showing that personalized exercise can play a meaningful role in improving recovery after cancer treatment, particularly for individuals experiencing persistent fatigue. 

BfitBwell, housed within AHWC, provides individualized, supervised exercise programming for people undergoing cancer treatment or recently completing it. Clinical experience and early research efforts demonstrated the effectiveness of this personalized approach, while also underscoring the need for delivery models that extend beyond in-person care. RIVERS was developed to rigorously evaluate whether that same individualized framework can be delivered virtually while maintaining effectiveness for survivors in rural settings. 

The study enrolls adults living in federally designated rural areas who have been diagnosed with breast or prostate cancer and are between three months and five years post-treatment. Participation is entirely virtual, allowing individuals to complete all assessments and exercise sessions from home. Equipment needed for exercise is shipped directly to participants, with live assessments and coaching sessions conducted through secure video platforms. 

Over the 12-week intervention period, participants complete biweekly assessments of physical function and cancer-related fatigue, along with dried blood spot collections. These samples, collected at home and returned to AHWC for analysis, enable the research team to examine changes in metabolic processes, specifically fatty acid oxidation, and how those changes may relate to fatigue and functional outcomes. Jake Dawson, BfitBwell Exercise Specialist and RIVERS Study Coordinator, explains, "While we know cancer-related fatigue is often a direct result of treatment, the mechanism(s) that cause it are not well understood. We hope the combination of these assessments and the outcomes they measure allows us to better understand not just how an exercise program impacts fatigue in a general sense, but a physiological one as well."

Following baseline testing, participants are randomized to either an immediate exercise intervention group or a waitlist group. Those in the intervention group receive individualized exercise programming developed and adjusted by AHWC exercise specialists, with ongoing monitoring and response-driven adaptations throughout the program. Participants assigned to the waitlist group complete the same assessment schedule and later receive the full exercise intervention, ensuring all enrolled individuals benefit from the program. 

A defining feature of RIVERS is its repeated, within-program data collection. By assessing outcomes every two weeks, the study captures dynamic changes over time rather than relying solely on pre- and post-intervention measures. During a recent project overview, Dawson explained that the goal is to track progress throughout the program. “We’re collecting those outcomes not just baseline to final, but also within the program as well, which is kind of unique to our study."

Recruitment for the RIVERS study is currently underway, with enrollment and data collection expected to continue over the next two to three years. Ultimately, the goal is to better understand how accessible, individualized, virtual exercise programs can improve quality of life for cancer survivors, especially those living in rural communities where support services are harder to reach. The findings will also help inform how programs developed at the CU Anschutz Health and Wellness Center can be adapted and delivered beyond traditional clinical settings.