Rethinking exercise identity: a qualitative study of physically inactive cancer patients’ transforming process while undergoing chemotherapy

Abstract

ObjectiveTo explore physically inactive breast and colon cancer patients’ prediagnosis exercise history and attitudes to physical activity (PA) and experiences in initiating PA while undergoing adjuvant chemotherapy.DesignAn explorative qualitative study guided the interpretive analysis of semistructured, open-ended interviews conducted at initiation of chemotherapy and after 12 weeks. The study was embedded in a pilot randomised controlled trial.SettingParticipants were recruited from the Oncological Department at a hospital in Copenhagen, Denmark.Participants33 patients with cancer, median age 49 years: 25 patients with breast cancer and 8 with colon cancer, 72% with a low cardiac respiratory fitness level and the majority with a high level of education. Patients received adjuvant chemotherapy, oncologist’s PA recommendation and exercise, cancer nurse specialist’s counselling prior to allocation to PA interventions or waitlist control group.ResultsPrediagnosis exercise had been excluded from patients’ daily lives due to perceptions of exercise as boring, lack of discipline and stressful work conditions for both genders. Recommendations from oncologists and nurses inspired the patients to reconsider their attitudes and behaviour by accepting recruitment and participation in PA interventions during chemotherapy. Despite extensive side effects, most patients adhered to their PA commitment due to their perception of the bodily, emotional and social benefits and support of healthcare professionals, peers and family.ConclusionThe patients’ attitude towards exercise transformed from having no priority in patients’ daily lives prediagnosis to being highly prioritised. This study identified four important phases in the exercise transformation process during the patients’ treatment trajectory of relevance to clinicians in identifying, motivating and supporting physically inactive patients with cancer at long-term risk. Clinicians should address young, highly educated patients with cancer at onset of adjuvant chemotherapy due to their specific risk of a sedentary lifestyle resulting from being in stressful, ambitious careers.Trial registration numberCurrent Controlled Trials (ISRCTN24901641), Stage: Qualitative results.

Healthcare professionals’ perspectives of barriers and facilitators in implementing physical activity programmes delivered to cancer survivors in a shared-care model: a qualitative study

“…This network helps patients in understanding information, provides support and manages overall care that patients would otherwise not receive from their HCPs [28]. Most patients start and continue to do physical activities due to the emotional and practical support of their social network [30,31]. One should note that physical activity is still rarely a topic in daily clinical practice and patients may seek support from their social network.…”

Physical deterioration and adaptive recovery in physically inactive breast cancer patients during adjuvant chemotherapy: a randomised controlled trial

“…Patients in both interventions received individual test feedback and health counselling and symptom guidance at baseline and at weeks 6, 12 and 39 to help counteract barriers and to support individual motivational aspects to initiate and prioritise leisure time PA 27,38 . The theoretical framework for initiating and adopting behavioural change at onset and during adjuvant chemotherapy focused on recognising pre-exercise history, individual goal planning, family resources and the immediate pitfalls during anticancer treatment as crucial determinants for the individual to rethink regular exercise as pivotal for their health and post-cancer life priorities 36 .…”

A sense of understanding and belonging when life is at stake—Operable lung cancer patients' lived experiences of participation in exercise

“…The questions for future research on the social challenges as a side effect of cancer and the social benefits illuminated in this study and other literature involve whether the family or close relatives of cancer patients should be included in the shared community explored in the present study. A study by Adamsen et al () described how relatives of patients with breast cancer or prostate cancer were included in a physical activity intervention, which helped strengthen the relationship between the participating relatives and the patients as a basis for their shared social life. Research is required to explore the potential social benefits or challenges of including relatives in programmes facilitating human interaction and sharing of illness experiences.…”

“…However, it is also reported how the relationship might be ambiguous (Andersen, Larsen, & Birkelund, ; Birkelund & Larsen, ; Borregaard & Ludvigsen, ; Larsen, Larsen, & Birkelund, ). Studies on exercise for patients with cancer have also reported social benefits of participating in group‐based interventions (Adamsen, Andersen, Lillelund, Bloomquist, & Moller, ; Backman, Browall, Sundberg, & Wengstrom, ; Missel et al, b); however, the meaning of participating in group‐based exercise for patients after lung cancer surgery is sparsely investigated. The objective of this qualitative study was to explore the lived experiences and social benefits among patients with operable NSCLC who participated in an exercise programme.…”