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Original article

Vol. 152 No. 1920 (2022)

Qualitative analysis of facilitators and barriers to centre- and home-based exercise training in breast cancer patients - a Swiss tertiary centre experience

  • Caroline Schneider
  • Sina Reimann
  • Julia Schmid
  • Jürg Bernhard
  • Manuela Rabaglio
  • Kristin L. Campbell
  • Matthias Wilhelm
  • Prisca Eser
DOI
https://doi.org/10.4414/SMW.2022.w30155
Cite this as:
Swiss Med Wkly. 2022;152:w30155
Published
12.05.2022

Summary

BACKGROUND: Exercise is an effective therapy for breast cancer patients to reduce fatigue and to improve health-related quality of life and physical function. Yet breast cancer patients often do not meet the recommended physical activity guidelines. To better understand why recommendations are not met and to improve long-term physical activity maintenance, this study aimed at identifying facilitators and barriers of breast cancer survivors to supervised, centre-based exercise within a cardio-oncological rehabilitation programme and to unsupervised, home-based exercise both during and after the completion of the programme, as well as strategies used to manage these barriers.

METHODS: Breast cancer patients who had previously completed a structured centre-based exercise programme at a Swiss tertiary centre were recruited by mailed invitation letter. Semi-structured telephone interviews were conducted with consenting patients and subsequent thematic analysis was performed to identify common themes.

RESULTS: Of the 37 eligible breast cancer patients, 19 patients (51%, mean age 48.9 ± 9.7 years) responded to our invitation. Baseline characteristics did not differ from the total eligible population. General facilitators for exercise were anticipated and experienced benefits on physical and mental health and enjoyment of exercise. Facilitators specific for supervised centre-based exercise were social support, accountability and the provision of structured exercise by the programme. Centre-based exercise barriers included physical, psychological and environmental barriers, whereby psychological barriers were reported predominantly in the context of home-based exercise. Strategies to manage these barriers were diverse and included the adaptation of training circumstances, behaviour change strategies and strategies to deal with side effects.

CONCLUSIONS: This first study on facilitators of and barriers to exercise in breast cancer patients in Switzerland identified more barriers, particularly psychological barriers, for unsupervised home-based exercise than for supervised centre-based exercise. These findings support the importance of providing structured supervised exercise programmes for breast cancer patients and suggest that a special focus should be directed at the transition from supervised to self-organized exercise in order to enhance and maintain long-term exercise participation.

References

  1. Jones LW, Peddle CJ, Eves ND, Haykowsky MJ, Courneya KS, Mackey JR, et al. Effects of presurgical exercise training on cardiorespiratory fitness among patients undergoing thoracic surgery for malignant lung lesions. Cancer. 2007 Aug;110(3):590–8. https://doi.org/10.1002/cncr.22830
  2. Campbell KL, Winters-Stone KM, Wiskemann J, May AM, Schwartz AL, Courneya KS, et al. Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Med Sci Sports Exerc. 2019 Nov;51(11):2375–90. https://doi.org/10.1249/MSS.0000000000002116
  3. Bower JE. Management of cancer-related fatigue. Clin Adv Hematol Oncol. 2006 Nov;4(11):828–9.
  4. Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvão DA, Pinto BM, et al.; American College of Sports Medicine. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010 Jul;42(7):1409–26. https://doi.org/10.1249/MSS.0b013e3181e0c112
  5. Buffart LM, Kalter J, Sweegers MG, Courneya KS, Newton RU, Aaronson NK, et al. Effects and moderators of exercise on quality of life and physical function in patients with cancer: an individual patient data meta-analysis of 34 RCTs. Cancer Treat Rev. 2017 Jan;52:91–104. https://doi.org/10.1016/j.ctrv.2016.11.010
  6. Gilchrist SC, Barac A, Ades PA, Alfano CM, Franklin BA, Jones LW, et al.; American Heart Association Exercise, Cardiac Rehabilitation, and Secondary Prevention Committee of the Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; and Council on Peripheral Vascular Disease. Cardio-Oncology Rehabilitation to Manage Cardiovascular Outcomes in Cancer Patients and Survivors: A Scientific Statement From the American Heart Association. Circulation. 2019 May;139(21):e997–1012. https://doi.org/10.1161/CIR.0000000000000679
  7. Blanchard CM, Courneya KS, Stein K ; American Cancer Society’s SCS-II. Cancer survivors’ adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American Cancer Society’s SCS-II. J Clin Oncol. 2008 May;26(13):2198–204. https://doi.org/10.1200/JCO.2007.14.6217
  8. Irwin ML, McTiernan A, Bernstein L, Gilliland FD, Baumgartner R, Baumgartner K, et al. Physical activity levels among breast cancer survivors. Med Sci Sports Exerc. 2004 Sep;36(9):1484–91.
  9. Emery CF, Yang HC, Frierson GM, Peterson LJ, Suh S. Determinants of physical activity among women treated for breast cancer in a 5-year longitudinal follow-up investigation. Psychooncology. 2009 Apr;18(4):377–86. https://doi.org/10.1002/pon.1519
  10. Clifford BK, Mizrahi D, Sandler CX, Barry BK, Simar D, Wakefield CE, et al. Barriers and facilitators of exercise experienced by cancer survivors: a mixed methods systematic review. Support Care Cancer. 2018 Mar;26(3):685–700. https://doi.org/10.1007/s00520-017-3964-5
  11. Browall M, Mijwel S, Rundqvist H, Wengström Y. Physical Activity During and After Adjuvant Treatment for Breast Cancer: An Integrative Review of Women’s Experiences. Integr Cancer Ther. 2018 Mar;17(1):16–30. https://doi.org/10.1177/1534735416683807
  12. Courneya KS, McKenzie DC, Reid RD, Mackey JR, Gelmon K, Friedenreich CM, et al. Barriers to supervised exercise training in a randomized controlled trial of breast cancer patients receiving chemotherapy. Ann Behav Med. 2008 Feb;35(1):116–22. https://doi.org/10.1007/s12160-007-9009-4
  13. Hefferon K, Murphy H, McLeod J, Mutrie N, Campbell A. Understanding barriers to exercise implementation 5-year post-breast cancer diagnosis: a large-scale qualitative study. Health Educ Res. 2013 Oct;28(5):843–56. https://doi.org/10.1093/her/cyt083
  14. Ferri A, Gane EM, Smith MD, Pinkham EP, Gomersall SR, Johnston V. Experiences of people with cancer who have participated in a hospital-based exercise program: a qualitative study. Support Care Cancer. 2021 Mar;29(3):1575–83. https://doi.org/10.1007/s00520-020-05647-y
  15. Braun V, Clarke V. Thematic analysis: APA handbook of research methods in psychology. 2012; 2: 57–71. ISBN-139781433810039.
  16. Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020 Dec;54(24):1451–62. https://doi.org/10.1136/bjsports-2020-102955
  17. Armstrong T, Bull F. Development of the world health organization global physical activity questionnaire (GPAQ). Z Gesundhwiss. 2006;14(2):66–70. https://doi.org/10.1007/s10389-006-0024-x
  18. Balneaves LG, Van Patten C, Truant TL, Kelly MT, Neil SE, Campbell KL. Breast cancer survivors’ perspectives on a weight loss and physical activity lifestyle intervention. Support Care Cancer. 2014 Aug;22(8):2057–65. https://doi.org/10.1007/s00520-014-2185-4
  19. Creswell JW, Poth CN. Qualitative inquiry and research design: Choosing among five approaches: Sage publications; 2016.
  20. Achtziger A, Gollwitzer PM. Dorsch Lexikon der Psychologie; 2021 [updated 8 March 2021; cited 14 July 2021]. Available from: https://dorsch.hogrefe.com/stichwort/volition
  21. Schwarzer R. Modeling health behavior change: how to predict and modify the adoption and maintenance of health behaviors. Appl Psychol. 2008;57(1):1–29. https://doi.org/10.1111/j.1464-0597.2007.00325.x
  22. Schmid J, Gut V, Conzelmann A, Sudeck G. Bernese motive and goal inventory in exercise and sport: validation of an updated version of the questionnaire. PLoS One. 2018 Feb;13(2):e0193214. https://doi.org/10.1371/journal.pone.0193214
  23. Jekauc D. Enjoyment during exercise mediates the effects of an intervention on exercise adherence. Psychology (Irvine). 2015;6(01):48–54. https://doi.org/10.4236/psych.2015.61005
  24. Rhodes RE, Fiala B, Conner M. A review and meta-analysis of affective judgments and physical activity in adult populations. Ann Behav Med. 2009 Dec;38(3):180–204. https://doi.org/10.1007/s12160-009-9147-y
  25. Backman M, Browall M, Sundberg CJ, Wengström Y. Experiencing health - Physical activity during adjuvant chemotherapy treatment for women with breast cancer. European journal of oncology nursing : the official journal of European Oncology Nursing Society. 2016;21:160-7.
  26. Lavallée JF, Abdin S, Faulkner J, Husted M. Barriers and facilitators to participating in physical activity for adults with breast cancer receiving adjuvant treatment: A qualitative metasynthesis. Psychooncology. 2019 Mar;28(3):468–76. https://doi.org/10.1002/pon.4980
  27. Ee C, Cave AE, Naidoo D, Bilinski K, Boyages J. Weight management barriers and facilitators after breast cancer in Australian women: a national survey. BMC Womens Health. 2020 Jul;20(1):140. https://doi.org/10.1186/s12905-020-01002-9
  28. Ottenbacher AJ, Day RS, Taylor WC, Sharma SV, Sloane R, Snyder DC, et al. Exercise among breast and prostate cancer survivors—what are their barriers? J Cancer Surviv. 2011 Dec;5(4):413–9. https://doi.org/10.1007/s11764-011-0184-8
  29. Sweegers MG, Altenburg TM, Chinapaw MJ, Kalter J, Verdonck-de Leeuw IM, Courneya KS, et al. Which exercise prescriptions improve quality of life and physical function in patients with cancer during and following treatment? A systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2018 Apr;52(8):505–13. https://doi.org/10.1136/bjsports-2017-097891
  30. Zhang CQ, Zhang R, Schwarzer R, Hagger MS. A meta-analysis of the health action process approach. Health Psychol. 2019 Jul;38(7):623–37. https://doi.org/10.1037/hea0000728
  31. Hattar A, Pal S, Hagger MS. Predicting physical activity‐related outcomes in overweight and obese adults: A health action process approach. Appl Psychol Health Well-Being. 2016 Mar;8(1):127–51. https://doi.org/10.1111/aphw.12065
  32. Scholz U, Sniehotta FF, Schwarzer R. Predicting physical exercise in cardiac rehabilitation: the role of phase-specific self-efficacy beliefs. J Sport Exerc Psychol. 2005;27(2):135–51. https://doi.org/10.1123/jsep.27.2.135
  33. Frost H, Campbell P, Maxwell M, O’Carroll RE, Dombrowski SU, Williams B, et al. Effectiveness of Motivational Interviewing on adult behaviour change in health and social care settings: A systematic review of reviews. PLoS One. 2018 Oct;13(10):e0204890. https://doi.org/10.1371/journal.pone.0204890
  34. Spencer JC, Wheeler SB. A systematic review of Motivational Interviewing interventions in cancer patients and survivors. Patient Educ Couns. 2016 Jul;99(7):1099–105. https://doi.org/10.1016/j.pec.2016.02.003
  35. Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020 Dec;54(24):1451–62. https://doi.org/10.1136/bjsports-2020-102955
  36. Demark-Wahnefried W, Peterson B, McBride C, Lipkus I, Clipp E. Current health behaviors and readiness to pursue life-style changes among men and women diagnosed with early stage prostate and breast carcinomas. Cancer. 2000 Feb;88(3):674–84. https://doi.org/10.1002/(SICI)1097-0142(20000201)88:3<674::AID-CNCR26>3.0.CO;2-R
  37. Balneaves LG, Truant TL, Van Patten C, Kirkham AA, Waters E, Campbell KL. Patient and Medical Oncologists’ Perspectives on Prescribed Lifestyle Intervention-Experiences of Women with Breast Cancer and Providers. J Clin Med. 2020 Aug;9(9):E2815. https://doi.org/10.3390/jcm9092815

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