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.