Barriers and facilitators to exercise among adult cancer survivors in Singapore

Abstract

Purpose Exercise can help cancer survivors manage sequela, treatment side effects, improve overall quality of life, and is recommended for most. The purpose of this study was to investigate exercise behavior and factors influencing exercise engagement among cancer survivors at the National Cancer Centre, Singapore (NCCS). Methods This cross-sectional study was inclusive of survivors of all cancer types and stages who were at least 21 years of age and had undergone chemotherapy at the NCCS. Surveys were utilized to assess survivor barriers and facilitators to exercise and to retrospectively assess physical activity and exercise behaviors at 4 cancer-related time periods (pre-diagnosis and post-diagnosis before, during, or after chemotherapy). Results A total of 102 cancer survivors were enrolled; 60% were diagnosed with stage IV cancer. Predominant cancer types included lower gastrointestinal tract (25.5%) and breast cancer (21.6%). Prior to cancer diagnosis, 90.2% of participants reported aerobic activity satisfying NCCN guidelines. Significant reductions in reported exercise, and physical activity, were observed following cancer diagnosis that persisted during chemotherapy. Key exercise facilitators included the desire to remain healthy (86.3%) and to improve sleep and mental well-being (73.5%). Key barriers included side effects of treatment (52.0%). Only 46.1% of survivors reported receiving exercise guidance from healthcare professionals following diagnosis. Conclusion Overall, even among this notably active cohort of Singaporean survivors, opportunities for increased exercise engagement throughout the survivorship continuum remain. Increased education regarding the benefits of exercise to survivors as well as guidance regarding exercise modalities including resistance training is greatly needed as well.

Exercise counselling and referral in cancer care: an international scoping survey of health care practitioners’ knowledge, practices, barriers, and facilitators

“…Estimates of cancer survivors who meet PA guidelines range from about 10 to 30% [ 17 ]. Research has identified that barriers to exercise include cancer-related symptoms, low mood, time limitations, low exercise literacy, low awareness of exercise benefits, and lack of advice or referral from a health care practitioner (HCP) [ 18 – 21 ]. Other influential factors include sociodemographic and clinical variables, obesity, smoking, alcohol consumption, attitudes towards exercise, self-efficacy, and intentions [ 22 – 24 ].…”

Barriers and facilitators to the engagement of physical activity among Black and African American cancer survivors during and after treatments

“…Notably, the medical system is not trustworthy for Black/AA patients due to centuries of neglect and abuse [ 4 , 29 ]. Thus, while research has indicated that oncology healthcare providers are a preferred source of PA encouragement among cancer survivors, this research has been largely conducted with White [ 30 , 31 ] and Asian participants [ 9 ]. Findings from this study indicate that the role of family members may be especially important in PA interventions for Black/AA cancer survivors.…”

“…Physical activity (PA) is widely recommended for cancer survivors to ameliorate many of these adverse effects [ 7 ]. However, most survivors do not engage in PA at recommended levels [ 8 , 9 ]; furthermore, Black/AA survivors are less physically active than White survivors [ 10 , 11 ]. To achieve health equity for Black/AA cancer survivors, focused efforts are needed to increase PA among this population.…”

Evaluation of a city-wide physical activity pathway for people affected by cancer: the Active Everyday service

“…For example, self-managed physical activity options were the second most favourable option. Costs of gym memberships have previously been identified as a barrier for people affected by cancer [58][59][60], and home-based programmes provide a no-cost option.…”