Exercise has been shown to improve the health and well-being of people who have survived cancer. Yet, less than 40% of cancer survivors in Australia meet the recommended 150 minutes of moderate-intensity physical activity per week. Our objective was to systematically review the literature regarding barriers, facilitators and preferences for exercise for survivors of cancer.
MEDLINE, EMBASE, CINAHL, PsychINFO and SCOPUS were searched for qualitative or quantitative articles addressing barriers, facilitators and preferences for exercise in cancer survivors. Quality assessment was performed by two independent reviewers using the Mixed Methods Appraisal Tool (1). Thomas and Harden’s method of thematic synthesis (2) was used to amalgamate qualitative data while descriptive statistics were used to collate quantitative data. Higher-order interpretive constructs were developed by combining like themes within qualitative and quantitative literature. Narrative synthesis was used to integrate evidence across studies.
Twenty-one studies were included, of which 9 were qualitative and 12 were quantitative. Fatigue was the most commonly reported barrier to initiating or maintaining exercise, followed by lack of time, and treatment-related physical barriers such as loss of physical strength and function. The most common facilitators of exercise were gaining a feeling of control over their health as well as managing emotions and mental wellbeing. Survivors indicated that they would prefer to receive face-to-face exercise counselling from an exercise specialist at a cancer centre, with the option of carrying out an exercise program at home. Overwhelmingly, the preferred method of exercise was walking. The study also highlighted a significant proportion of survivors receiving incorrect or insufficient information regarding exercise.
A breadth of factors affects exercise participation for cancer survivors. The lack of useful information provided for survivors suggests the need for improved patient education as well as highlighting the need for exercise professionals working in multidisciplinary cancer settings.