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 factorsCharacteristics
Older age501/22
Feelings/Emotions
Low emotional well-being/distress44 49 533/485Feeling mentally/physically better and more normal47 48 51 534/63
Lack of confidence: fear of injury and making the condition worse45 482/457Positive feelings (contentment, power and control, confidence, self-esteem)35 51 533/31
Not feeling comfortable: pressured by coaching approach 53 ; intimidation by group format422/74Enjoyment of being outdoors481/20
Attitude
Lack of time42 46 49 50 535/142Returning to normal life and better function as motivators40 48 ;2/31
Lack of motivation/ interest/enjoyment39 42 463/173Not feeling anxious and having experienced the benefits (after intervention)421/60
Not having a preference concerning the source of counselling and exercise variability381/90Making you feel better, improved attitude501/22
Overestimation of own PA levels481/20Using terms “movement” or “physical activity” rather than “exercise”471/20
Lack of intention, no interest or aversion towards more PA511/9After exercise participation decreased barrier: “lack of interest” and “exercise is boring”401/11
Behaviour
Laziness48 502/42Enjoyment by social environment and accountability to instructors and group421/60
Missing structure and accountability after intervention421/60Structured programme421/60
Lacking prior experiences/sporty attitude, loss of self-control531/14Prior experiences/sporty attitude531/14
Being sedentary, but confident to have adequate PA level511/9Most important motivator to continue exercise: beneficial, motivated, controllability521/9
Beliefs/Expectations
No need to increase PA levels, PA was considered irrelevant or pre-existing PA habits were considered sufficient.511/9Outcome expectations: improvement of overall physical health, giving a higher energy level, increasing flexibility, improving overall health391/101
Social factorsLack of company451/437Emotional and practical support from social network,35 48 50 51 535/73
Group setting and instructors created a positive atmosphere and a possibility to exchange and discuss experiences42 462/72
Social aspect of PA48 502/42
Hobbies481/20
Commitment to study programme,531/14
Personal coaching and empowerment with clear instruction, personalised intervention531/14
Environmental factorsWork and family responsibilities38 42 46 48 515/191External incentive, chemo dog531/14
Distance to training facility, lack of transportation or too time consuming45 51 533/460Structure of daily life activities, home-based, simplicity of the intervention531/14
Weather condition38 48 513/119
No or little advice on PA44 512/446
A hostile exercise environment38 482/110
Financial problems/constraints48 512/29
HCPs approach and focus on prevention rather than on resuming function441/437
Content of exercise programme unclear531/14
Health- or treatment related factorsFatigue or loss of energy42 44 45 48 50–538/1008Experienced or perceived general health benefits44 48 50 534/493
General pain,44 45 48 51 53or pain specified to head, neck or shoulder50 527/948Building up strength and fitness44 48 503/479
Other physical complaints42 49 50 52 535/762Reducing risk of disease441/437
Problems with eating/feeding38 42 45 50 535/623Increased energy levels, less fatigue421/60
Dry mouth or throat38 44 45 504/1105Psychological benefits481/20
General treatment toxicity40 42 49 534/119
Pre-existing health problems, comorbidities45 50 513/468
General weakness44 482/457
Shoulder weakness,44 452/874
Difficulties with breathing44 45 ; experience of choking feeling during exercise503/500
Weight loss531/14
Hospital admittance531/14
  • *f: frequency=number of publications in which this factor is stated; n: number of participants within these publications

  • HCPs, healthcare professionals; PA, physical activity.