Table 3

Barriers to and facilitators for physical activity in patients with head and neck cancer

	PA barriers*	f/n*	PA facilitators*	f/n*
Personal factors	Characteristics
	Older age50	1/22
	Feelings/Emotions
	Low emotional well-being/distress44 49 53	3/485	Feeling mentally/physically better and more normal47 48 51 53	4/63
	Lack of confidence: fear of injury and making the condition worse45 48	2/457	Positive feelings (contentment, power and control, confidence, self-esteem)35 51 53	3/31
	Not feeling comfortable: pressured by coaching approach 53 ; intimidation by group format42	2/74	Enjoyment of being outdoors48	1/20
	Attitude
	Lack of time42 46 49 50 53	5/142	Returning to normal life and better function as motivators40 48 ;	2/31
	Lack of motivation/ interest/enjoyment39 42 46	3/173	Not feeling anxious and having experienced the benefits (after intervention)42	1/60
	Not having a preference concerning the source of counselling and exercise variability38	1/90	Making you feel better, improved attitude50	1/22
	Overestimation of own PA levels48	1/20	Using terms “movement” or “physical activity” rather than “exercise”47	1/20
	Lack of intention, no interest or aversion towards more PA51	1/9	After exercise participation decreased barrier: “lack of interest” and “exercise is boring”40	1/11
	Behaviour
	Laziness48 50	2/42	Enjoyment by social environment and accountability to instructors and group42	1/60
	Missing structure and accountability after intervention42	1/60	Structured programme42	1/60
	Lacking prior experiences/sporty attitude, loss of self-control53	1/14	Prior experiences/sporty attitude53	1/14
	Being sedentary, but confident to have adequate PA level51	1/9	Most important motivator to continue exercise: beneficial, motivated, controllability52	1/9
	Beliefs/Expectations
	No need to increase PA levels, PA was considered irrelevant or pre-existing PA habits were considered sufficient.51	1/9	Outcome expectations: improvement of overall physical health, giving a higher energy level, increasing flexibility, improving overall health39	1/101
Social factors	Lack of company45	1/437	Emotional and practical support from social network,35 48 50 51 53	5/73
			Group setting and instructors created a positive atmosphere and a possibility to exchange and discuss experiences42 46	2/72
			Social aspect of PA48 50	2/42
			Hobbies48	1/20
			Commitment to study programme,53	1/14
			Personal coaching and empowerment with clear instruction, personalised intervention53	1/14
Environmental factors	Work and family responsibilities38 42 46 48 51	5/191	External incentive, chemo dog53	1/14
	Distance to training facility, lack of transportation or too time consuming45 51 53	3/460	Structure of daily life activities, home-based, simplicity of the intervention53	1/14
	Weather condition38 48 51	3/119
	No or little advice on PA44 51	2/446
	A hostile exercise environment38 48	2/110
	Financial problems/constraints48 51	2/29
	HCPs approach and focus on prevention rather than on resuming function44	1/437
	Content of exercise programme unclear53	1/14
Health- or treatment related factors	Fatigue or loss of energy42 44 45 48 50–53	8/1008	Experienced or perceived general health benefits44 48 50 53	4/493
	General pain,44 45 48 51 53or pain specified to head, neck or shoulder50 52	7/948	Building up strength and fitness44 48 50	3/479
	Other physical complaints42 49 50 52 53	5/762	Reducing risk of disease44	1/437
	Problems with eating/feeding38 42 45 50 53	5/623	Increased energy levels, less fatigue42	1/60
	Dry mouth or throat38 44 45 50	4/1105	Psychological benefits48	1/20
	General treatment toxicity40 42 49 53	4/119
	Pre-existing health problems, comorbidities45 50 51	3/468
	General weakness44 48	2/457
	Shoulder weakness,44 45	2/874
	Difficulties with breathing44 45 ; experience of choking feeling during exercise50	3/500
	Weight loss53	1/14
	Hospital admittance53	1/14

*f: frequency=number of publications in which this factor is stated; n: number of participants within these publications
HCPs, healthcare professionals; PA, physical activity.