“Doing What Only I Can Do”

Abstract

BackgroundSparse evidence exists regarding the feasibility and patients’ experiences of exercise programs among older cancer populations.ObjectiveThe aim of this study was to explore the experiences of older patients with advanced cancer who participated in a 12-week supervised and multimodal exercise program in a hospital setting.MethodsIndividual interviews were conducted with 18 participants (≥65 years) with advanced cancer who completed the intervention program regardless of compliance rate. In addition, written evaluation questionnaires were collected. Data were analyzed using thematic analysis.ResultsThree main themes were identified: (1) Motivated to strengthen body and mind, with the subthemes “Doing what only I can do” and “Reaching goals with support from healthcare professionals and peers”; (2) Exercise as an integrated part of the treatment course; and (3) Overcoming undeniable physical limitations.ConclusionsThe participants experienced several benefits from participation, including physical improvements, increased energy, reduction of symptoms, and improved social engagement. Goal setting, being positively pushed and cheered on, and integration of fun games increased motivation. In contrast, being pushed beyond physical limitations and experiencing severe symptoms were experienced as barriers toward exercising. Adherence to the exercise program was facilitated by coordinating a tailored program with medical appointments and receiving comprehensive support and guidance.Implications for PracticeMultimodal exercise programs seem to be beneficial for older patients with advanced cancer and should be coordinated with oncological treatment in combination with targeted support and advice on symptom management.

A qualitative meta-synthesis of studies of patients' experience of exercise interventions in advanced cancer

“…Participants found the hospital environment to be practical as visits could be combined with other health care appointments and provide access to physiotherapists from whom feedback was appreciated ( 20 , 24 ). In addition, they were reassured by being in an environment where there was an understanding of illness and fluctuating performance from day to day.…”

“…In addition, they were reassured by being in an environment where there was an understanding of illness and fluctuating performance from day to day. Mikkelsen et al reported “some” of the 18 participants in their study appreciated the opportunity to co-ordinate visits for exercise programmes with medical appointments, positively influencingtheir capacity to take part because, even on their “bad days”, they had to attend hospital appointments ( 24 ). In Adamsen et al's study of a home and hospital-based exercise intervention participants reported that although the program was easily comprehended, several reasons existed for why they struggled to follow it ( 21 ).…”

“…Some participants in Mikkelsen et al's study described feeling that initial interactions with others in the group felt slightly confrontational yet, over time, this dissipated with accounts relating to the growing importance of sharing experiences and mutual support ( 24 ).…”

“…The support of the [teacher] was identified as important in four studies ( 20 , 23 , 24 , 26 ). Paltiel et al's study reported that all participants felt the exercise group should be led by a health professional with knowledge and training in physical activity in addition to a knowledge of cancer ( 20 ).…”

“…In addition, a patient's decision to participate was heavily influenced by their understanding that exercise would be individually tailored ( 20 ). Mikkelsen et al's study offered nurse-led support and counselling based on individual need ( 24 ), this was appreciated by participants. Some of the oldest and frailest participants found value in this.…”