Patient Perceptions of the Benefits of Physical Activity Throughout the Cancer Continuum in Cancer Survivor Populations

Patient Perceptions of the Benefits of Physical Activity Throughout the Cancer Continuum in Cancer Survivor Populations | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Patient Perceptions of the Benefits of Physical Activity Throughout the Cancer Continuum in Cancer Survivor Populations Kristin Dean, Elizabeth Stamp, Mhairi Morris This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3870757/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose Physical activity (PA) and exercise have multiple benefits throughout the cancer continuum, including alleviating treatment side effects, improving quality of life, and preventing secondary recurrence. Despite these benefits being well-documented, most cancer survivors do not meet the minimum exercise guidelines. Method To assess cancer survivors’ beliefs and experiences surrounding exercise during treatment, a 12-question survey was disseminated to a range of cancer survivors. Free-form comments were reviewed to identify common themes. Results Out of the 275 initial respondents, 198 male and female cancer survivors completed the questionnaire, upon which qualitative and quantitative analysis was conducted revealing a reduction in feelings of depression and anxiety in 83.36% of respondents. Physical barriers were the most common reported theme, followed by healthcare-related barriers due to lack of knowledge and guidance, with 99% of respondents agreeing a greater emphasis on this aspect is needed. Stretching/yoga-based activities were the most favoured type of exercise amongst respondents. Conclusions The findings presented herein comprehensively demonstrate the benefits of and barriers to participating in PA throughout the cancer continuum. Healthcare practitioners working with cancer survivors need to be cognisant of these barriers when designing interventions aimed at improving PA adherence. Implications for Cancer Survivors: Individualised exercise programmes that consider all aspects of an individual’s cancer journey (cancer type, treatment modalities, etc.) may be able to correct the disconnect between knowledge of the benefits of PA and adherence to current guidelines amongst cancer survivors. physical activity exercise cancer survivors benefits patient perceptions Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Introduction In 2020, an estimated 19.3 million new cancer diagnoses and 10 million cancer-related deaths occurred worldwide ( 1 ). Cancer survival rates in the UK have doubled in the last 40 years ( 2 ), primarily due to improvements in early detection, available treatments and cutting-edge research advances ( 3 , 4 ). The survivorship period, defined as an individual with a history of cancer ( 5 ), has its own set of unique, varied challenges, dependent upon an individual’s experience, emphasising the need to reflect on the cancer continuum as a whole, from initial diagnosis up to the final active treatment ( 6 ). One of the key issues facing cancer survivors is ongoing treatment-related problems, including cancer-related fatigue ( 7 ), pain ( 8 ), psychological distress ( 9 ), decreased physical fitness and functioning ( 10 ), and a weakened immune system ( 11 ). Together, these problems impact a survivor’s quality of life (QoL) post-treatment ( 3 , 12 ). Moreover, cancer survivors are commonly at an increased vulnerability of cancer reoccurrence and other chronic health issues (e.g., diabetes, osteoporosis, cardiovascular disease) ( 9 , 13 , 14 ). These physical and psychological side effects, coupled with the sudden absence of their healthcare specialists (oncologists, surgeons, multi-disciplinary health care team) presents a novel, additional challenge for cancer survivors. The fears and concerns patients experience during their cancer treatment continues, but individuals are now required to make attempts to improve their survival journey on their own, without expert guidance or specialist knowledge ( 3 ). 1.1 Benefits of Physical Activity for Cancer Survivors Regular inclusion of physical activity (PA) throughout the cancer continuum can help an individual gain fitness for treatment, manage their treatment-related side effects, and improve overall QoL ( 15 ). In addition, PA has been linked to several physical, psychological and social improvements for cancer patients and survivors ( 3 , 15 – 17 ). For example, cancer-related fatigue can last months, sometimes years, following treatment ( 18 ), and PA has been established as an effective intervention in its reduction ( 3 ), with evidence suggesting that performing light to moderate PA at least three times a week can reduce, and in some cases, prevent it ( 19 ). Unsurprisingly, low to moderate PA has also been linked to enhanced cardiorespiratory fitness in cancer survivors ( 17 , 20 ), which in turn, helps protect against other chronic health conditions often observed in this population, such as diabetes and cardiovascular disease ( 21 ). Improvements in muscular strength, flexibility, range of motion, balance, sleep, blood pressure, resting heart rate, protection from bone loss, body mass index (BMI), pain and weight management have all been ascribed to regular PA ( 7 , 12 , 14 , 20 ). Cancer survivors have an increased prevalence of mental health and stress-related issues compared to the general population ( 3 ). Hewitt and Rowland (2002) reported that cancer survivors use mental health services more than those who have never had cancer, with nearly 60% experiencing depression symptoms and up to 30% having anxiety-related symptoms ( 3 , 22 ). Current evidence suggests that PA can significantly reduce symptoms of depression and anxiety, in addition to lowering mood disturbances and overall stress levels ( 20 , 23 – 26 ). Not only has PA been demonstrated to alleviate the psychological and emotional burden associated with cancer treatment, but it can also improve an individual’s ability to cope with future distress – a phenomenon known as post-traumatic growth ( 27 ). This is observed in changes in mental strength and a renewed sense of gratitude and fulfilment in life ( 3 ). Further research has revealed a moderate relationship between PA and body image concepts, including self-esteem, physique anxiety, positive attitude towards their condition and appearance ( 25 , 28 ). Thus, PA assists in reducing body image concerns that have been amplified during cancer treatment and would otherwise continue to intensify without exercise. This in turn helps improve survivors’ psychological wellbeing and health related QoL ( 3 ). Other physical benefits of PA include enhancements in physical functioning, cognitive functioning and personal organisation, alongside reduced irritability ( 2 , 20 , 29 ). Socially, PA has been shown to reduce the feeling of isolation beyond active treatment that is often experienced by cancer survivors ( 30 , 31 ). Group activities involving previous cancer survivors may promote a sense of connectedness for new survivors and has been recognised as being a valued and essential inclusion in their post-treatment journey ( 3 , 12 ). 1.2 Barriers to Exercise for Cancer Survivors Despite the well-documented evidence for the benefits of PA during both active treatment and cancer survivorship ( 4 ), most survivors do not meet the current minimum exercise guidelines of 150 minutes per week of moderate intensity exercise ( 3 ). An estimated two thirds of cancer patients reduce their PA levels during active treatment due to its side effects ( 7 ). This presents a major challenge to ensure cancer survivors are taking the necessary steps to improve their physical and mental health, and wellbeing and QoL ( 3 , 4 , 32 ). There are three main categories of barriers to participation in PA amongst cancer survivors: physical, psychological and healthcare-related. Cancer-related fatigue is the most prevalent physical barrier to exercise for cancer survivors, with up to 70% of patients reporting difficulties, particularly during active treatment ( 6 , 7 , 33 ). Even three years after active treatment ceases, 30% of cancer survivors still report cancer-related fatigue hindering their participation in PA ( 34 ). In a similar vein, most individuals cite both disease- and treatment-related side effects as highly significant barriers to exercising, including nausea ( 35 ), pain ( 33 ), weight gain ( 36 ), and joint stiffness ( 7 ). Oftentimes, survivors perceive exercise in a negative way, assuming it will be uncomfortable or painful ( 36 ), will worsen their condition ( 7 ), and may increase their risk of injury ( 33 ). Another significant psychological barrier to PA participation is a lack of self-discipline and/or motivation due to exercise not being a priority for cancer survivors ( 6 ). This may also be exacerbated by patients not being aware that it is safe to exercise or that they are recommended to exercise during and after active treatment ( 7 ). Where patients and survivors do participate in PA and/or exercise, there is often limited awareness or knowledge of the correct PA guidelines ( 4 ). Collectively, these psychological barriers can cause survivors to become fearful of exercise, which underpins the central tenet that PA programmes need to consider all aspects of each individual’s cancer experience in order to be effective ( 3 ). Finally, it is evident that survivors may require reassurance and support from their healthcare team surrounding the benefits and safety of participating in PA and/or exercise during and after treatment, as an essential part of their recovery ( 37 ). Smaradottir et al. (2017) demonstrated that more than half of the participants in their study were oblivious to the benefits of exercise, an observation that underpins the disconnect observed between PA guidelines and patient/survivor adherence ( 35 ). A common theme in the literature to date is the perceived lack of PA recommendations for cancer survivors coming from their healthcare providers directly ( 4 , 7 , 35 ). With 51.9% of cancer survivors reporting to be unaware of specialist PA programmes ( 7 ), this could be attributed to limited access to specialists, restricted resources, and a lack of formal education ( 35 , 38 ). 1.3 Aims and Objectives Despite the evidence that PA is safe, feasible and beneficial for cancer survivors, the current minimum PA guidelines are not being achieved within this population ( 3 ). A greater understanding of cancer survivors’ experiences of PA recommendations and their perceptions of PA safety, feasibility and potential benefits, would enable a more effective approach to designing future exercise programmes for this population ( 3 , 6 , 12 ). The aims of this study are to assess cancer survivors’ beliefs surrounding the benefits of and the barriers to exercise, their own exercise experiences during treatment, their perceptions of PA, and their recommendations and considerations for creating an effective, individualised PA programme. By gaining a deeper understanding of cancer survivors’ experiences, healthcare providers will be better able to advise and inform changes in the long-term to increase adherence to exercise guidelines and ultimately improve survivorship QoL. 2. Methods 2.1 Participants This study was performed in line with the principles of the Declaration of Helsinki. Ethical approval was granted by the Loughborough University Ethics Committee of the School of Sport, Exercise and Health Sciences (reference number: 2022-8346-9438). Participants were made aware of any associated risks and their freedom to leave the study at any time, prior to giving written informed consent. Nine cancer charities were contacted to share the survey: two of the charities agreed to this (Look Good Feel Better and Tenovus Cancer Care). The study was advertised on their social media pages and website, and was also included in a promotional email. The survey was open to cancer survivors of any age who were no longer undergoing active treatment. Interested participants completed the informed consent form prior to being sent the link to the questionnaire. Of the 275 individuals who completed the consent form, 198 completed the questionnaire (72% response rate). 2.2 Data Collection A 12-question survey was designed and administered through Qualtrics (Qualtrics, Utah, USA), which included a range of open-ended and closed questions surrounding individual survivors’ PA experiences during their treatment. Questions included perceived potential benefits and barriers, what exercise types should be included/avoided, whether a greater emphasis on PA should be given to cancer patients, who should provide PA support and at what time on the cancer continuum, and what discussions around exercise occurred for each patient (if relevant). For a full list of questions, refer to the supplementary file (Online Resource 1). The questionnaire could be completed anywhere and required 10–15 minutes to complete. Participants were not required to answer every question if they did not wish to. Anonymous data was collected over a two-month period. Within this investigation, the terms PA and exercise were used interchangeably. 2.3 Data Analysis Descriptive statistics (percentages and means) were used for the quantitative responses. For the analysis of qualitative questions, the free-form comments were reviewed to identify common themes with keywords and ideas selected to demonstrate the following key themes: physical benefits; psychological benefits; social benefits; physical barriers; psychological barriers; healthcare-related barriers. 3. Results The responses can be classified into five main categories: 1) benefits of exercise; 2) barriers to exercise; 3) exercise experiences throughout treatment; 4) perceptions of exercise; and 5) exercise recommendations for future reference. For the full questionnaire outputs, see the supplementary file (Online Resource 1). 3.1 Benefits of Exercise Participants were asked to what extent they agree or disagree with commonly perceived benefits of PA during cancer treatment. Responses were categorised into three fields: physical benefits; psychological benefits; and social benefits. Lowered feelings of depression and anxiety was the most often stated benefit of exercise (88.36% of respondents agreed or strongly agreed with this statement). Improved muscular strength (83.33% agreement) and overall better functioning (82.11% agreement) were the next two most often cited benefits among respondents. Overall, there was a greater proportion of agreement to each benefit compared to the level of disagreement (Fig. 1 ). 3.1.1. Physical Benefits Among the physical benefits cited by the respondents (see supplementary files, [Online Resource 1] Q3) were managing the side effects of medical treatment and maintaining physical function (or regaining that which was lost). Fatigue, restricted movement from surgery, lymphoedema, joint and muscle pain, weight gain and inflamed connective tissues were among the most frequently reported side effects that have been alleviated by PA. Moreover, regaining lost strength and stamina, offsetting muscle deconditioning, and the better ability to cope with treatment were also achieved with PA and exercise. Over three quarters of respondents agreed or strongly agreed with each of the following physical perceived benefits: improved cardiovascular fitness (78.72%), improved muscular strength (83.33%), and decreased fatigue (72.34%; Fig. 1 ). In the free-form comments, a frequent observation was that exercise made patients physically stronger, able to resume full fitness and aid their recovery, and cope with their treatment better. 3.1.2. Psychological Benefits There was a strong association between exercise and the psychological benefit to mental state, mental health and survivors’ wellbeing (supplementary file [Online Resource 1], Q3). The most frequently cited benefit was in reducing levels of depression and anxiety (83.36%) in addition to greater self-esteem and increased happiness, with agreement rates of 83.60% and 80.95%, respectively (Fig. 1 ). Improved mood, self-esteem, stress management, sleep and confidence were also reported as other psychological benefits from PA. A common thread emerged relating to exercise creating a sense of accomplishment and a feeling of being more “normal” or feeling more like themselves as the cancer survivors took proactive steps towards regaining control of their health. 3.1.3. Social Benefits Over two thirds of respondents agreed or strongly agreed that support from family and/or friends helped them to be active during their cancer treatment (73.26%; Fig. 3 ). A major social strength of participating in PA was the encouraged interaction, particularly when experiences between cancer patients and/or survivors were shared. Survivors reported that it was reassuring to have reliable support and guidance from trusted sources, namely oncology staff and cancer charities (Look Good Feel Better and Macmillan were highly commended). One response also mentioned that they discovered a cancer survivor support group through cancer-specific exercise classes, which has prompted discussions on other aspects that can improve their recovery, for example, diet. See supplementary file [Online Resource 1], Q12 for full overview. 3.2 Barriers to Exercise As before, responses were categorised into three fields: physical barriers; psychological barriers; and healthcare-related barriers. The overwhelming majority (85.03%) of survivors cited physical barriers to be the main obstacle to participating in regular PA throughout their cancer journey, with COVID restrictions and time/accessibility being other frequently mentioned issues (Fig. 2 ). 3.2.1 Physical Barriers Fatigue and lack of energy was indisputably the most commonly stated barrier to PA (62.03% or 116 mentions) with physical-related barriers as a whole being reported by 159 survivors (85.03%). All barriers within this theme related to side effects of treatment, medication or the cancer itself, including sickness, pain and fatigue. Isolation due to COVID restrictions was also mentioned. The full list of free-form comments is included in the supplementary file [Online Resource 1], Q4. 3.2.2 Psychological Barriers Psychological issues represented the third highest reported barrier to exercise (37.43%; Fig. 2 ). This included fears and worries about PA doing more harm than good, depression, anxiety, isolation, feeling vulnerable, and a lack of motivation, enthusiasm and confidence (supplementary file [Online Resource 1], Q4). Many respondents described feeling as though they were just surviving and not necessarily living, indicative of a detriment to their emotional wellbeing. 3.2.3 Healthcare-Related Barriers All of the responses within this theme (38.50%; Fig. 2 ) relate to a lack of knowledge, guidance and support from healthcare providers to cancer patients. Many reported receiving no focussed or specific advice around how to participate in PA safely from their medical team and having no awareness of existing support, either through cancer-specific exercise classes or cancer charities and their services. For those respondents who have had discussions around PA with their healthcare providers, only basic advice was given, which was not tailored to the individual’s needs. The full output of free-form responses to Q4 (“Think back to when you were undergoing treatment, what were the biggest challenges to you participating in regular exercise at that time?”, supplementary file [Online Resource 1]) were used to create a word cloud, which depicts the most frequently used words in participants’ responses (Fig. 3 ), demonstrating that fatigue was the biggest challenge faced by most respondents. 3.3 Exercise Experiences During Treatment Almost all survivors (98.94%) agreed or strongly agreed that a greater emphasis should be placed on giving cancer patients knowledge and understanding of the impact of exercise throughout treatment. Only two respondents (1.06%) stated that no change was needed. Of the 48.15% of respondents that did have a discussion with someone in their multidisciplinary team about exercising throughout their treatment plan 75.82% of those were initiated by the patient themselves. Table 1 summarised who in the multidisciplinary healthcare team the respondents spoke to about safe PA. Table 1 Number and percentage of respondents who spoke to different people regarding safe exercise. GP Oncologist Physio PT Charity Specialist Consultant Surgeon Dietician n 31 83 5 2 3 7 3 1 % 22.79 61.03 3.68 1.47 2.21 5.15 2.94 0.74 Abbreviations: GP = general practitioner; n = number; physio = physiotherapist; PT = personal trainer 3.4 Perceptions of Exercise A very small percentage of respondents viewed exercise as being detrimental/harmful or having no effect to the patient undergoing cancer treatment (1.54%; supplementary file [Online Resource 1], Q1). The mean score was 7.79 ± 2.53 (with 10 representing the most positive impact possible). The mode score was 10 (35.90%; 70 responses out of 195). Survivors estimated that the compliance of exercise throughout cancer treatment is most likely around half of the time (42.19%) or sometimes/about a quarter of the time (33.85%). Nearly half of all respondents (44.97%) perceived a clinical nurse specialist to be the best-placed resource to talk to patients about exercising throughout their treatment plan, followed by a consultant (21.69%) or a physiotherapist (21.16%). Other suggestions included cancer charities, other cancer patients, GPs, the internet, and making their own judgement. Additionally, individuals agreed or strongly agreed that positive thinking (79.14%), medical advice/knowledge (55.08%), and setting goals (52.94%) mainly contributed to them being active during their treatment (Fig. 4 ). 3.5 Exercise Recommendations for Future Reference Stretching/yoga-based activities were highly favoured as the best exercise type to be implemented into a programme for cancer patients/survivors (supplementary file [Online Resource 1], Q6; 166 responses), followed by cancer-specific exercise classes (156 responses), cardiovascular exercise (146 responses), and resistance exercise (112 responses). High intensity interval training/circuit-type training was barely recommended (16 responses); however, 155 respondents felt this type of exercise should be avoided. Throughout the cancer continuum, 42.86% suggested the best time to introduce (or increase) PA was at diagnosis, with 18.52% suggesting the start of treatment, and 14.81% believing it best to wait until active treatment has finished. Around a tenth of respondents (11.11%) felt that between treatment cycles would be the best time to introduce (or increase) PA, while only 5.82% felt that during active treatment would be best. Two key suggestions of timings made by the respondents included basing it on individual judgement (4.23%) and having the opportunity to opt in at each stage (1.59%). 4. Discussion The aims of the current study were to assess cancer survivors’ beliefs surrounding the benefits and barriers to exercise, their own exercise experiences during treatment, their perceptions of PA, and their recommendations and considerations for creating an effective, individualised programme. By gaining a clearer understanding of cancer survivors’ experiences with regards to PA and exercise, it is hoped that it could lead to better design of exercise interventions. In previous studies, survivors identified the maintenance and/or recovery of any lost physical attributes as one of the key advantages to engaging in PA, with the reduction in fatigue, offsetting muscle deconditioning, and the better ability to cope with treatment among the most commonly reported physical benefits ( 3 , 6 , 12 , 39 ). Allied to this, side effect management was considered vital in encouraging patients to exercise. These debilitating side effects of treatment have been associated with a reduction in motivation to exercise, which presents an initial barrier to being physically active ( 40 ). This has led to reports of a compromised quality of life throughout survivorship due to cancer-related fatigue, psychological distress, and reduced physical fitness ( 41 , 42 ). In the long-term, this increases the probability for survivors to experience chronic diseases, such as diabetes, osteoporosis, cardiovascular disease and cancer recurrence ( 13 , 43 ). Therefore, not only is PA able to reduce psychological distress while increasing overall fitness and recovery, but it also provides a preventative measure for chronic diseases. In the present study, lowered feelings of depression and anxiety was the top-rated perceived benefit with 83.36% total agreement. This finding is crucial as depression has specifically been linked to poor adherence to PA programmes ( 44 ). As such, survivors who participate in PA are more likely to experience the multitude of physical benefits that PA brings due to the creation of more optimal mental health status. In the current study, physical barriers, such as the side effects of treatment, fatigue, pain and lymphoedema, were the top cited barrier to participating in PA. In one particularly interesting comment, a respondent mentioned the idea of a “cancer hierarchy of needs” stating that if there was such a thing, exercise would be on it, but it would not be the priority when, for example, an immediate priority after receiving chemotherapy can often be simply to keep down a couple of sips of water (supplementary file [Online Resource 1], Q12 free-form comments). Healthcare-related barriers represented the second most prominent barrier to participation, with many respondents mentioning that they were unaware if they were even allowed to exercise due to limited or minimal advice being provided. These types of responses mirror those observed in previous studies ( 7 , 35 , 45 ), which highlights the necessity of implementing a detailed, reliable patient education system to eliminate any fears, concerns or worries surrounding exercise, which in turn could support maximal adherence to regular participation in PA. Healthcare services may benefit from advertising the excellent services provided by cancer charities in this area, which could form a fundamental component of this education system. From the current findings presented herein and those of prior studies, it is clear that patients want advice and guidance about exercise in order to mitigate the continuing physical and psychological side effects of treatment ( 46 ). A common observation is that patients and survivors rarely have discussions regarding the safety of PA or how to engage in it safely ( 4 ), with over three quarters of the respondents in the current study initiating a discussion themselves due to a substantial absence of advice from their healthcare providers. In a previous study, ~ 82% of cancer survivors said they would prefer receiving PA recommendations from their oncologist and for them to initiate a discussion with them, but less than a third (28%) reported having such an experience ( 47 ). By contrast, in the present study, nearly half of all respondents (44.97%) demonstrated a preference for PA recommendations to come from a clinical nurse specialist, with only 21.69% believing this should come from their consultant. One potential reason for these differences could be the geographical location of each study, with Jones et al.’s study ( 47 ) being conducted in the United States, and the present study being conducted in the UK. The differences in healthcare systems, structures and provisions likely account for these observations. Regardless, these findings only augment the fact that cancer survivors are in agreement that there should be a greater emphasis on providing sufficient knowledge and guidance surrounding safe and efficacious PA to cancer patients and survivors alike. In particular, patients require vital information about the risks and benefits of exercise and PA, and what types of exercise are most appropriate for them ( 39 ). Ideally, this information should be adapted for each individual based on their cancer type, treatment options, and pre-diagnosis fitness level, to better address the specific issues experienced in this population ( 3 , 12 , 35 ). These types of personalised recommendations are in demand, with 68% of patients reporting a need for a programme tailored to their individual needs and 60% agreeing that they would follow this type of programme during treatment ( 39 ). By reducing the amount of generic advice and replacing it with personalised advice, this could enhance long-term adherence to an exercise programme consisting of clear, detailed instructions for the ideal type, duration and intensity of exercise recommendations ( 35 , 48 , 49 ). As a result of the relatively large sample size surveyed in the current study, there is now a clearer picture of how PA programmes can be personalised for cancer patients. One of the suggestions from the questionnaire recommended implementing a cancer specialist trainer within all cancer wards to best advise PA sessions, including any exercises to avoid (see supplementary file [Online Resource 1], Q12 for freeform comments). It was suggested that provided coaches, physiotherapists and gym instructors have the appropriate education to become knowledgeable in how to correctly administer individualised exercise programmes specifically for cancer patients and survivors, they are able to save the healthcare systems time and money by being the primary point of contact in this regard. It was also recommended that personalised programmes should be reviewed every month to ensure appropriate modification relative to any progress or issues that arise for the individual. Combined, these efforts would ensure a supportive environment for cancer patients and survivors to maintain or regain their strength, fitness and physical functioning, where they would have access to the appropriate knowledge and guidance for safe PA, a long-term individualised programme, and a designated specialist to ask questions. It has been well-documented that compliance to PA programmes is poor among cancer patients and survivors ( 3 , 4 , 35 ), therefore the present study focused on assessing cancer survivors’ perceptions of exercise to understand possible reasons underpinning lack of compliance. Despite only 1.54% of respondents believing exercise and PA to be detrimental to cancer prognosis, over a third reported lack of knowledge and awareness of how to engage in PA safely as a barrier to participating in PA throughout their own cancer journey. One of the key limitations of the present study is the lack of demographic data collected. By collecting information regarding sex, age, cancer type, and pre- and post-diagnosis activity levels, comparisons could have been made to generate a deeper understanding of how future PA programmes could be tailored for different cancer types and different populations within the survivorship population, which could be used to adapt programmes to ensure longer-term adherence. However, it was decided that asking for this level of detail may deter some people from answering the call to participate in the survey and therefore anonymous survey data was collected instead. Since healthcare-related barriers represented the second most prominent barrier to participation in PA, an emphasis on educating healthcare providers at all levels on the benefits of PA and exercise throughout the cancer continuum would be a prudent update to current professional training and development provision to ensure more opportunities for conversations around PA at various stages along a cancer patient’s journey. Within this, recommendations for specific, individualised exercises for different patient groups, demographics and cancer types should be at the forefront of future work in this area. This study highlights possibilities which could be executed in order to successfully perform this objective. Future research investigating the effectiveness of individualised programmes, preferably supervised by a cancer exercise specialist or a coach/physiotherapist that has been educated on how to safely administer PA programmes to cancer patients and survivors, is necessary. 5. Conclusion The findings presented in the current study demonstrate comprehensive evidence of the benefits of and barriers to PA in cancer survivors that healthcare practitioners need to be cognisant of when designing individualised exercise programmes for cancer patients and/or survivors. A pivotal disconnect exists between the existing body of knowledge of the benefits and safety of PA and exercise throughout the cancer continuum and patient/survivor education. This disconnect epitomises the substantial challenges faced by patients and survivors and reflects the urgent need for a solution, such as a new, tailored PA programme strategy to maximise adherence to continuing exercise and PA into survivorship by considering all components of a cancer patients’ wellbeing and physical capability. Declarations Data Availability All data is available within the manuscript or supplementary files [Online Resources]. Funding This project was funded by the School of Sport, Exercise and Health Sciences at Loughborough University and no external funding was received. Ethics Approval and Patient Consent This study was performed in line with the principles of the Declaration of Helsinki. Ethical approval was granted by the Loughborough University Ethics Committee of the School of Sport, Exercise and Health Sciences (reference number: 2022-8346-9438). Participants were made aware of any associated risks and their freedom to leave the study at any time, prior to giving informed consent. The authors affirm that human research participants provided informed consent for publication of all images (Figures 1-4 and the supplementary file [Online Resource 1]). Acknowledgements The authors wish to express their deepest thanks to all the participants who took the time to share their invaluable thoughts, opinions and experiences with us. We also wish to extend our gratitude to Lisa Curtis at Look Good Feel Better, and Hannah O’Mahoney at Tenovus Cancer Care for their willingness to share the survey with their network. Authors’ Contributions All authors contributed to the study conception and design. Data was collected, analysed and interpreted by Kristin Dean; the first draft was written by Kristin Dean; the second and subsequent drafts were written by Mhairi Morris and Elizabeth Stamp; Mhairi Morris and Elizabeth Stamp provided Kristin Dean with supervision for the duration of the project. Competing Interests The authors have no relevant financial or non-financial interests to disclose. References Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin [Internet]. 2021 May [cited 2023 Dec 13];71(3):209–49. Available from: http://www.ncbi.nlm.nih.gov/pubmed/33538338 Cancer survival statistics | Cancer Research UK [Internet]. [cited 2023 Dec 13]. Available from: https://www.cancerresearchuk.org/health-professional/cancer-statistics/survival#heading-Zero Sabiston CM, Brunet J. 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Changes in body fat and weight after a breast cancer diagnosis: influence of demographic, prognostic, and lifestyle factors. J Clin Oncol [Internet]. 2005 Feb 1 [cited 2023 Dec 13];23(4):774–82. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15681521 Ingram C, Visovsky C. Exercise intervention to modify physiologic risk factors in cancer survivors. Semin Oncol Nurs [Internet]. 2007 Nov [cited 2023 Dec 13];23(4):275–84. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18022055 Garcia DO, Thomson CA. Physical activity and cancer survivorship. Nutr Clin Pract [Internet]. 2014 Dec [cited 2023 Dec 13];29(6):768–79. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25335787 Courneya KS. Physical activity in cancer survivors: a field in motion. Psychooncology [Internet]. 2009 Apr [cited 2023 Dec 13];18(4):337–42. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19306338 Burnham TR, Wilcox A. Effects of exercise on physiological and psychological variables in cancer survivors. Med Sci Sports Exerc [Internet]. 2002 Dec [cited 2023 Dec 13];34(12):1863–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12471288 Servaes P, Verhagen S, Bleijenberg G. Determinants of chronic fatigue in disease-free breast cancer patients: a cross-sectional study. Ann Oncol [Internet]. 2002 Apr [cited 2023 Dec 13];13(4):589–98. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12056710 Jacobsen PB, Donovan KA, Vadaparampil ST, Small BJ. Systematic review and meta-analysis of psychological and activity-based interventions for cancer-related fatigue. Health Psychol [Internet]. 2007 Nov [cited 2023 Dec 13];26(6):660–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18020836 Speck RM, Courneya KS, Mâsse LC, Duval S, Schmitz KH. An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv [Internet]. 2010 Jun [cited 2023 Dec 13];4(2):87–100. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20052559 McTiernan A. Physical activity after cancer: physiologic outcomes. Cancer Invest [Internet]. 2004 [cited 2023 Dec 13];22(1):68–81. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15069764 Hewitt M, Rowland JH. Mental health service use among adult cancer survivors: analyses of the National Health Interview Survey. J Clin Oncol [Internet]. 2002 Dec 1 [cited 2023 Dec 13];20(23):4581–90. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12454116 Galantino M Lou. Influence of yoga, walking, and mindfulness meditation on fatigue and body mass index in women living with breast cancer. Seminars in Integrative Medicine [Internet]. 2003 Sep [cited 2023 Dec 13];1(3):151–7. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1543115003000292 Craft LL, Vaniterson EH, Helenowski IB, Rademaker AW, Courneya KS. Exercise effects on depressive symptoms in cancer survivors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev [Internet]. 2012 Jan [cited 2023 Dec 13];21(1):3–19. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22068286 Pinto BM, Trunzo JJ. Body esteem and mood among sedentary and active breast cancer survivors. Mayo Clin Proc [Internet]. 2004 Feb [cited 2023 Dec 13];79(2):181–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14959912 Stevinson C, Steed H, Faught W, Tonkin K, Vallance JK, Ladha AB, et al. Physical activity in ovarian cancer survivors: associations with fatigue, sleep, and psychosocial functioning. Int J Gynecol Cancer [Internet]. 2009 Jan [cited 2023 Dec 13];19(1):73–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19258945 Tedeschi RG, Calhoun LG. Posttraumatic Growth: Conceptual Foundations and Empirical Evidence [Internet]. Vol. 15. 2004 [cited 2023 Dec 13]. Available from: https://www.jstor.org/stable/pdf/20447194.pdf?casa_token=zvHQZxRj7HkAAAAA:-iyMay07ioehD2B7dvtmkKuF8nxnKsW4lMdvjUNmx13EOBOqcVK4BJj-KHHVQxexTv_amBYX-UvokiscNHM53eDHugbIUlyiY1ZnosQlxl3e0qjvnrPs0g Speck RM, Gross CR, Hormes JM, Ahmed RL, Lytle LA, Hwang WT, et al. Changes in the Body Image and Relationship Scale following a one-year strength training trial for breast cancer survivors with or at risk for lymphedema. Breast Cancer Res Treat [Internet]. 2010 Jun [cited 2023 Dec 13];121(2):421–30. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19771507 Culos-Reed SN, Carlson LE, Daroux LM, Hately-Aldous S. A pilot study of yoga for breast cancer survivors: physical and psychological benefits. Psychooncology [Internet]. 2006 Oct [cited 2023 Dec 13];15(10):891–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16374892 Blaney J, Lowe-Strong A, Rankin J, Campbell A, Allen J, Gracey J. The cancer rehabilitation journey: barriers to and facilitators of exercise among patients with cancer-related fatigue. Phys Ther [Internet]. 2010 Aug [cited 2023 Dec 13];90(8):1135–47. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20558566 Vivar CG, McQueen A. Informational and emotional needs of long-term survivors of breast cancer. J Adv Nurs [Internet]. 2005 Sep [cited 2023 Dec 13];51(5):520–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16098169 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 [Internet]. 2008 May 1 [cited 2023 Dec 13];26(13):2198–204. Available from: https://ascopubs.org/doi/10.1200/JCO.2007.14.6217 Cole SF, Skaczkowski G, Wilson C. The role of illness perceptions and exercise beliefs in exercise engagement during treatment for cancer. Support Care Cancer [Internet]. 2021 Sep [cited 2023 Dec 13];29(9):5065–73. Available from: http://www.ncbi.nlm.nih.gov/pubmed/33594512 Velthuis MJ, May AM, Koppejan-Rensenbrink RA, Gijsen BCM, van Breda E, de Wit GA, et al. Physical Activity during Cancer Treatment (PACT) Study: design of a randomised clinical trial. BMC Cancer [Internet]. 2010 Jun 9 [cited 2023 Dec 13];10:272. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20534147 Smaradottir A, Smith AL, Borgert AJ, Oettel KR. Are We on the Same Page? Patient and Provider Perceptions About Exercise in Cancer Care: A Focus Group Study. J Natl Compr Canc Netw [Internet]. 2017 May [cited 2023 Dec 13];15(5):588–94. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28476738 Husebø AML, Dyrstad SM, Mjaaland I, Søreide JA, Bru E. Effects of scheduled exercise on cancer-related fatigue in women with early breast cancer. ScientificWorldJournal [Internet]. 2014 [cited 2023 Dec 13];2014:271828. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24563628 Humphreys L, Crank H, Frith G, Speake H, Reece LJ. Bright spots, physical activity investments that work: Active Everyday, Sheffield’s physical activity service for all people living with and beyond cancer. Br J Sports Med [Internet]. 2019 Jul [cited 2023 Dec 13];53(13):837–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29212766 Blaney JM, Lowe-Strong A, Rankin-Watt J, Campbell A, Gracey JH. Cancer survivors’ exercise barriers, facilitators and preferences in the context of fatigue, quality of life and physical activity participation: a questionnaire-survey. Psychooncology [Internet]. 2013 Jan [cited 2023 Dec 13];22(1):186–94. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23296635 Peeters C, Stewart A, Segal R, Wouterloot E, Scott CG, Aubry T. Evaluation of a cancer exercise program: patient and physician beliefs. Psychooncology [Internet]. 2009 Aug [cited 2023 Dec 13];18(8):898–902. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19117271 Courneya KS. Exercise interventions during cancer treatment: biopsychosocial outcomes. Exerc Sport Sci Rev [Internet]. 2001 Apr [cited 2023 Dec 13];29(2):60–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11337824 Blanchard CM, Denniston MM, Baker F, Ainsworth SR, Courneya KS, Hann DM, et al. Do adults change their lifestyle behaviors after a cancer diagnosis? Am J Health Behav [Internet]. 2003 [cited 2023 Dec 13];27(3):246–56. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12751621 Reich M, Lesur A, Perdrizet-Chevallier C. Depression, quality of life and breast cancer: a review of the literature. Breast Cancer Res Treat [Internet]. 2008 Jul [cited 2023 Dec 13];110(1):9–17. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17674188 Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM. Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol [Internet]. 2005 Aug 20 [cited 2023 Dec 13];23(24):5814–30. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16043830 Fann JR, Thomas-Rich AM, Katon WJ, Cowley D, Pepping M, McGregor BA, et al. Major depression after breast cancer: a review of epidemiology and treatment. Gen Hosp Psychiatry [Internet]. 2008 [cited 2023 Dec 13];30(2):112–26. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18291293 Hébert ET, Caughy MO, Shuval K. Primary care providers’ perceptions of physical activity counselling in a clinical setting: a systematic review. Br J Sports Med [Internet]. 2012 Jul [cited 2023 Dec 13];46(9):625–31. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22711796 Murnane A, Geary B, Milne D. The exercise programming preferences and activity levels of cancer patients undergoing radiotherapy treatment. Support Care Cancer [Internet]. 2012 May [cited 2023 Dec 13];20(5):957–62. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21523349 Jones LW, Courneya KS. Exercise discussions during cancer treatment consultations. Cancer Pract [Internet]. 2002 [cited 2023 Dec 13];10(2):66–74. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11903271 Buffart LM, Galvão DA, Brug J, Chinapaw MJM, Newton RU. Evidence-based physical activity guidelines for cancer survivors: current guidelines, knowledge gaps and future research directions. Cancer Treat Rev [Internet]. 2014 Mar [cited 2023 Dec 13];40(2):327–40. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23871124 Szymlek-Gay EA, Richards R, Egan R. Physical activity among cancer survivors: a literature review. N Z Med J [Internet]. 2011 Jun 24 [cited 2023 Dec 13];124(1337):77–89. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21946880 Additional Declarations No competing interests reported. Supplementary Files PAThroughouttheCancerContinuumSupplementaryfile.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3870757","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":267747348,"identity":"e5f5f023-f7fa-4314-897b-b50ad90d2a38","order_by":0,"name":"Kristin Dean","email":"","orcid":"","institution":"Loughborough University","correspondingAuthor":false,"prefix":"","firstName":"Kristin","middleName":"","lastName":"Dean","suffix":""},{"id":267747349,"identity":"690f0419-5471-40c8-91bd-e9853400469b","order_by":1,"name":"Elizabeth Stamp","email":"","orcid":"","institution":"Loughborough University","correspondingAuthor":false,"prefix":"","firstName":"Elizabeth","middleName":"","lastName":"Stamp","suffix":""},{"id":267747350,"identity":"4b297ccb-dc3d-4f21-9ebf-3e39ad2da3f8","order_by":2,"name":"Mhairi Morris","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIie2ROwrCQBBARwbWZuK2qfQKI4Jg5VVWBCtFwSalVSrB1iKH8AgrC9rsAawkIlhZ5AAWbmIhCPmUFvuqYeDNF8Dj+UNYtzZILhCAR/PN63JlpFFjUihCNVPGWih8FSFxM2WoiXEeXZcdaTOziq5daJsUydYpdj2Kw8XB7O16ADRjpEuNsogVizA4mCBWkw3MASkrV1jLDINckTb9KPJZp7guheKKf5Qw71IxGBt3KLL5YDN2u6iBCB98TCrW5/O2f6dIcW9nbvdVpLpSTm/p81SuAP7+QEDlVzwej8fThDcpz0966PCmhwAAAABJRU5ErkJggg==","orcid":"","institution":"Loughborough University","correspondingAuthor":true,"prefix":"","firstName":"Mhairi","middleName":"","lastName":"Morris","suffix":""}],"badges":[],"createdAt":"2024-01-16 19:14:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3870757/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3870757/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":49975526,"identity":"d7027344-106a-4e05-8dc1-ba0e811bfd39","added_by":"auto","created_at":"2024-01-22 14:47:24","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":104734,"visible":true,"origin":"","legend":"\u003cp\u003eLevel of agreement, neutrality and disagreement of each perceived benefit of physical activity.\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-3870757/v1/7c353d2bbf442acc8323056a.png"},{"id":49975525,"identity":"e2a3e986-9d71-4039-8404-7f1ab272215c","added_by":"auto","created_at":"2024-01-22 14:47:24","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":88405,"visible":true,"origin":"","legend":"\u003cp\u003ePercentage of respondents that mentioned barriers relating to each of the psychological themes.\u003c/p\u003e","description":"","filename":"Fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-3870757/v1/0b8ced45cad1e318106b3a22.png"},{"id":49975527,"identity":"ba84253d-1f26-4340-b708-cd96a4861522","added_by":"auto","created_at":"2024-01-22 14:47:24","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":899939,"visible":true,"origin":"","legend":"\u003cp\u003eWord cloud depicting the most frequently used words in response to the question regarding the biggest challenges to participating in regular exercise during treatment.\u003c/p\u003e","description":"","filename":"Fig3.png","url":"https://assets-eu.researchsquare.com/files/rs-3870757/v1/0961b72f544d07ecd654932c.png"},{"id":49975528,"identity":"29c157e0-f2b7-42e6-9329-e9b1fcf6bc34","added_by":"auto","created_at":"2024-01-22 14:47:24","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":86282,"visible":true,"origin":"","legend":"\u003cp\u003eLevel of agreement, neutrality and disagreement of perceived support mechanisms throughout treatment.\u003c/p\u003e","description":"","filename":"Fig4.png","url":"https://assets-eu.researchsquare.com/files/rs-3870757/v1/8ff60f7d1ace09c3c8fc9e3a.png"},{"id":49978404,"identity":"9c630620-4ffc-4e20-8efa-b8315ae9da35","added_by":"auto","created_at":"2024-01-22 15:03:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1314959,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3870757/v1/3a4769eb-6e13-4a51-aeda-4dd189667212.pdf"},{"id":49975529,"identity":"ca1f57a5-4c75-4ab7-9a72-faf86a4cbadc","added_by":"auto","created_at":"2024-01-22 14:47:24","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":1271660,"visible":true,"origin":"","legend":"","description":"","filename":"PAThroughouttheCancerContinuumSupplementaryfile.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3870757/v1/805890e147d68abc26d46b10.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Patient Perceptions of the Benefits of Physical Activity Throughout the Cancer Continuum in Cancer Survivor Populations","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eIn 2020, an estimated 19.3\u0026nbsp;million new cancer diagnoses and 10\u0026nbsp;million cancer-related deaths occurred worldwide (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Cancer survival rates in the UK have doubled in the last 40 years (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), primarily due to improvements in early detection, available treatments and cutting-edge research advances (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The survivorship period, defined as an individual with a history of cancer (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), has its own set of unique, varied challenges, dependent upon an individual\u0026rsquo;s experience, emphasising the need to reflect on the cancer continuum as a whole, from initial diagnosis up to the final active treatment (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOne of the key issues facing cancer survivors is ongoing treatment-related problems, including cancer-related fatigue (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), pain (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), psychological distress (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), decreased physical fitness and functioning (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), and a weakened immune system (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Together, these problems impact a survivor\u0026rsquo;s quality of life (QoL) post-treatment (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Moreover, cancer survivors are commonly at an increased vulnerability of cancer reoccurrence and other chronic health issues (e.g., diabetes, osteoporosis, cardiovascular disease) (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). These physical and psychological side effects, coupled with the sudden absence of their healthcare specialists (oncologists, surgeons, multi-disciplinary health care team) presents a novel, additional challenge for cancer survivors. The fears and concerns patients experience during their cancer treatment continues, but individuals are now required to make attempts to improve their survival journey on their own, without expert guidance or specialist knowledge (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Benefits of Physical Activity for Cancer Survivors\u003c/h2\u003e \u003cp\u003eRegular inclusion of physical activity (PA) throughout the cancer continuum can help an individual gain fitness for treatment, manage their treatment-related side effects, and improve overall QoL (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In addition, PA has been linked to several physical, psychological and social improvements for cancer patients and survivors (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). For example, cancer-related fatigue can last months, sometimes years, following treatment (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), and PA has been established as an effective intervention in its reduction (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), with evidence suggesting that performing light to moderate PA at least three times a week can reduce, and in some cases, prevent it (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eUnsurprisingly, low to moderate PA has also been linked to enhanced cardiorespiratory fitness in cancer survivors (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), which in turn, helps protect against other chronic health conditions often observed in this population, such as diabetes and cardiovascular disease (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Improvements in muscular strength, flexibility, range of motion, balance, sleep, blood pressure, resting heart rate, protection from bone loss, body mass index (BMI), pain and weight management have all been ascribed to regular PA (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCancer survivors have an increased prevalence of mental health and stress-related issues compared to the general population (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Hewitt and Rowland (2002) reported that cancer survivors use mental health services more than those who have never had cancer, with nearly 60% experiencing depression symptoms and up to 30% having anxiety-related symptoms (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Current evidence suggests that PA can significantly reduce symptoms of depression and anxiety, in addition to lowering mood disturbances and overall stress levels (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan additionalcitationids=\"CR24 CR25\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNot only has PA been demonstrated to alleviate the psychological and emotional burden associated with cancer treatment, but it can also improve an individual\u0026rsquo;s ability to cope with future distress \u0026ndash; a phenomenon known as post-traumatic growth (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). This is observed in changes in mental strength and a renewed sense of gratitude and fulfilment in life (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Further research has revealed a moderate relationship between PA and body image concepts, including self-esteem, physique anxiety, positive attitude towards their condition and appearance (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Thus, PA assists in reducing body image concerns that have been amplified during cancer treatment and would otherwise continue to intensify without exercise. This in turn helps improve survivors\u0026rsquo; psychological wellbeing and health related QoL (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Other physical benefits of PA include enhancements in physical functioning, cognitive functioning and personal organisation, alongside reduced irritability (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSocially, PA has been shown to reduce the feeling of isolation beyond active treatment that is often experienced by cancer survivors (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Group activities involving previous cancer survivors may promote a sense of connectedness for new survivors and has been recognised as being a valued and essential inclusion in their post-treatment journey (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.2 Barriers to Exercise for Cancer Survivors\u003c/h2\u003e \u003cp\u003eDespite the well-documented evidence for the benefits of PA during both active treatment and cancer survivorship (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), most survivors do not meet the current minimum exercise guidelines of 150 minutes per week of moderate intensity exercise (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). An estimated two thirds of cancer patients reduce their PA levels during active treatment due to its side effects (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). This presents a major challenge to ensure cancer survivors are taking the necessary steps to improve their physical and mental health, and wellbeing and QoL (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). There are three main categories of barriers to participation in PA amongst cancer survivors: physical, psychological and healthcare-related.\u003c/p\u003e \u003cp\u003eCancer-related fatigue is the most prevalent physical barrier to exercise for cancer survivors, with up to 70% of patients reporting difficulties, particularly during active treatment (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Even three years after active treatment ceases, 30% of cancer survivors still report cancer-related fatigue hindering their participation in PA (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). In a similar vein, most individuals cite both disease- and treatment-related side effects as highly significant barriers to exercising, including nausea (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), pain (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), weight gain (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), and joint stiffness (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOftentimes, survivors perceive exercise in a negative way, assuming it will be uncomfortable or painful (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), will worsen their condition (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), and may increase their risk of injury (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Another significant psychological barrier to PA participation is a lack of self-discipline and/or motivation due to exercise not being a priority for cancer survivors (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). This may also be exacerbated by patients not being aware that it is safe to exercise or that they are recommended to exercise during and after active treatment (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Where patients and survivors do participate in PA and/or exercise, there is often limited awareness or knowledge of the correct PA guidelines (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Collectively, these psychological barriers can cause survivors to become fearful of exercise, which underpins the central tenet that PA programmes need to consider all aspects of each individual\u0026rsquo;s cancer experience in order to be effective (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFinally, it is evident that survivors may require reassurance and support from their healthcare team surrounding the benefits and safety of participating in PA and/or exercise during and after treatment, as an essential part of their recovery (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Smaradottir et al. (2017) demonstrated that more than half of the participants in their study were oblivious to the benefits of exercise, an observation that underpins the disconnect observed between PA guidelines and patient/survivor adherence (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). A common theme in the literature to date is the perceived lack of PA recommendations for cancer survivors coming from their healthcare providers directly (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). With 51.9% of cancer survivors reporting to be unaware of specialist PA programmes (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), this could be attributed to limited access to specialists, restricted resources, and a lack of formal education (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e1.3 Aims and Objectives\u003c/h2\u003e \u003cp\u003eDespite the evidence that PA is safe, feasible and beneficial for cancer survivors, the current minimum PA guidelines are not being achieved within this population (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). A greater understanding of cancer survivors\u0026rsquo; experiences of PA recommendations and their perceptions of PA safety, feasibility and potential benefits, would enable a more effective approach to designing future exercise programmes for this population (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe aims of this study are to assess cancer survivors\u0026rsquo; beliefs surrounding the benefits of and the barriers to exercise, their own exercise experiences during treatment, their perceptions of PA, and their recommendations and considerations for creating an effective, individualised PA programme. By gaining a deeper understanding of cancer survivors\u0026rsquo; experiences, healthcare providers will be better able to advise and inform changes in the long-term to increase adherence to exercise guidelines and ultimately improve survivorship QoL.\u003c/p\u003e \u003c/div\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Participants\u003c/h2\u003e \u003cp\u003e This study was performed in line with the principles of the Declaration of Helsinki. Ethical approval was granted by the Loughborough University Ethics Committee of the School of Sport, Exercise and Health Sciences (reference number: 2022-8346-9438). Participants were made aware of any associated risks and their freedom to leave the study at any time, prior to giving written informed consent. Nine cancer charities were contacted to share the survey: two of the charities agreed to this (Look Good Feel Better and Tenovus Cancer Care). The study was advertised on their social media pages and website, and was also included in a promotional email. The survey was open to cancer survivors of any age who were no longer undergoing active treatment. Interested participants completed the informed consent form prior to being sent the link to the questionnaire. Of the 275 individuals who completed the consent form, 198 completed the questionnaire (72% response rate).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Data Collection\u003c/h2\u003e \u003cp\u003eA 12-question survey was designed and administered through Qualtrics (Qualtrics, Utah, USA), which included a range of open-ended and closed questions surrounding individual survivors\u0026rsquo; PA experiences during their treatment. Questions included perceived potential benefits and barriers, what exercise types should be included/avoided, whether a greater emphasis on PA should be given to cancer patients, who should provide PA support and at what time on the cancer continuum, and what discussions around exercise occurred for each patient (if relevant). For a full list of questions, refer to the supplementary file (Online Resource 1). The questionnaire could be completed anywhere and required 10\u0026ndash;15 minutes to complete. Participants were not required to answer every question if they did not wish to. Anonymous data was collected over a two-month period. Within this investigation, the terms PA and exercise were used interchangeably.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Data Analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics (percentages and means) were used for the quantitative responses. For the analysis of qualitative questions, the free-form comments were reviewed to identify common themes with keywords and ideas selected to demonstrate the following key themes: physical benefits; psychological benefits; social benefits; physical barriers; psychological barriers; healthcare-related barriers.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eThe responses can be classified into five main categories: 1) benefits of exercise; 2) barriers to exercise; 3) exercise experiences throughout treatment; 4) perceptions of exercise; and 5) exercise recommendations for future reference. For the full questionnaire outputs, see the supplementary file (Online Resource 1).\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Benefits of Exercise\u003c/h2\u003e \u003cp\u003eParticipants were asked to what extent they agree or disagree with commonly perceived benefits of PA during cancer treatment. Responses were categorised into three fields: physical benefits; psychological benefits; and social benefits. Lowered feelings of depression and anxiety was the most often stated benefit of exercise (88.36% of respondents agreed or strongly agreed with this statement). Improved muscular strength (83.33% agreement) and overall better functioning (82.11% agreement) were the next two most often cited benefits among respondents. Overall, there was a greater proportion of agreement to each benefit compared to the level of disagreement (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003e3.1.1. Physical Benefits\u003c/h2\u003e \u003cp\u003eAmong the physical benefits cited by the respondents (see supplementary files, [Online Resource 1] Q3) were managing the side effects of medical treatment and maintaining physical function (or regaining that which was lost). Fatigue, restricted movement from surgery, lymphoedema, joint and muscle pain, weight gain and inflamed connective tissues were among the most frequently reported side effects that have been alleviated by PA. Moreover, regaining lost strength and stamina, offsetting muscle deconditioning, and the better ability to cope with treatment were also achieved with PA and exercise. Over three quarters of respondents agreed or strongly agreed with each of the following physical perceived benefits: improved cardiovascular fitness (78.72%), improved muscular strength (83.33%), and decreased fatigue (72.34%; Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In the free-form comments, a frequent observation was that exercise made patients physically stronger, able to resume full fitness and aid their recovery, and cope with their treatment better.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003e3.1.2. Psychological Benefits\u003c/h2\u003e \u003cp\u003eThere was a strong association between exercise and the psychological benefit to mental state, mental health and survivors\u0026rsquo; wellbeing (supplementary file [Online Resource 1], Q3). The most frequently cited benefit was in reducing levels of depression and anxiety (83.36%) in addition to greater self-esteem and increased happiness, with agreement rates of 83.60% and 80.95%, respectively (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Improved mood, self-esteem, stress management, sleep and confidence were also reported as other psychological benefits from PA. A common thread emerged relating to exercise creating a sense of accomplishment and a feeling of being more \u0026ldquo;normal\u0026rdquo; or feeling more like themselves as the cancer survivors took proactive steps towards regaining control of their health.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003e3.1.3. Social Benefits\u003c/h2\u003e \u003cp\u003eOver two thirds of respondents agreed or strongly agreed that support from family and/or friends helped them to be active during their cancer treatment (73.26%; Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). A major social strength of participating in PA was the encouraged interaction, particularly when experiences between cancer patients and/or survivors were shared. Survivors reported that it was reassuring to have reliable support and guidance from trusted sources, namely oncology staff and cancer charities (Look Good Feel Better and Macmillan were highly commended). One response also mentioned that they discovered a cancer survivor support group through cancer-specific exercise classes, which has prompted discussions on other aspects that can improve their recovery, for example, diet. See supplementary file [Online Resource 1], Q12 for full overview.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Barriers to Exercise\u003c/h2\u003e \u003cp\u003eAs before, responses were categorised into three fields: physical barriers; psychological barriers; and healthcare-related barriers. The overwhelming majority (85.03%) of survivors cited physical barriers to be the main obstacle to participating in regular PA throughout their cancer journey, with COVID restrictions and time/accessibility being other frequently mentioned issues (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003e3.2.1 Physical Barriers\u003c/h2\u003e \u003cp\u003eFatigue and lack of energy was indisputably the most commonly stated barrier to PA (62.03% or 116 mentions) with physical-related barriers as a whole being reported by 159 survivors (85.03%). All barriers within this theme related to side effects of treatment, medication or the cancer itself, including sickness, pain and fatigue. Isolation due to COVID restrictions was also mentioned. The full list of free-form comments is included in the supplementary file [Online Resource 1], Q4.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003e3.2.2 Psychological Barriers\u003c/h2\u003e \u003cp\u003ePsychological issues represented the third highest reported barrier to exercise (37.43%; Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This included fears and worries about PA doing more harm than good, depression, anxiety, isolation, feeling vulnerable, and a lack of motivation, enthusiasm and confidence (supplementary file [Online Resource 1], Q4). Many respondents described feeling as though they were just surviving and not necessarily living, indicative of a detriment to their emotional wellbeing.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003e3.2.3 Healthcare-Related Barriers\u003c/h2\u003e \u003cp\u003eAll of the responses within this theme (38.50%; Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) relate to a lack of knowledge, guidance and support from healthcare providers to cancer patients. Many reported receiving no focussed or specific advice around how to participate in PA safely from their medical team and having no awareness of existing support, either through cancer-specific exercise classes or cancer charities and their services. For those respondents who have had discussions around PA with their healthcare providers, only basic advice was given, which was not tailored to the individual\u0026rsquo;s needs.\u003c/p\u003e \u003cp\u003e The full output of free-form responses to Q4 (\u0026ldquo;Think back to when you were undergoing treatment, what were the biggest challenges to you participating in regular exercise at that time?\u0026rdquo;, supplementary file [Online Resource 1]) were used to create a word cloud, which depicts the most frequently used words in participants\u0026rsquo; responses (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), demonstrating that fatigue was the biggest challenge faced by most respondents.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Exercise Experiences During Treatment\u003c/h2\u003e \u003cp\u003eAlmost all survivors (98.94%) agreed or strongly agreed that a greater emphasis should be placed on giving cancer patients knowledge and understanding of the impact of exercise throughout treatment. Only two respondents (1.06%) stated that no change was needed. Of the 48.15% of respondents that did have a discussion with someone in their multidisciplinary team about exercising throughout their treatment plan 75.82% of those were initiated by the patient themselves. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarised who in the multidisciplinary healthcare team the respondents spoke to about safe PA.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNumber and percentage of respondents who spoke to different people regarding safe exercise.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOncologist\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePhysio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCharity Specialist\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eConsultant\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSurgeon\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDietician\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eAbbreviations: GP\u0026thinsp;=\u0026thinsp;general practitioner; n\u0026thinsp;=\u0026thinsp;number; physio\u0026thinsp;=\u0026thinsp;physiotherapist; PT\u0026thinsp;=\u0026thinsp;personal trainer\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Perceptions of Exercise\u003c/h2\u003e \u003cp\u003eA very small percentage of respondents viewed exercise as being detrimental/harmful or having no effect to the patient undergoing cancer treatment (1.54%; supplementary file [Online Resource 1], Q1). The mean score was 7.79\u0026thinsp;\u0026plusmn;\u0026thinsp;2.53 (with 10 representing the most positive impact possible). The mode score was 10 (35.90%; 70 responses out of 195). Survivors estimated that the compliance of exercise throughout cancer treatment is most likely around half of the time (42.19%) or sometimes/about a quarter of the time (33.85%). Nearly half of all respondents (44.97%) perceived a clinical nurse specialist to be the best-placed resource to talk to patients about exercising throughout their treatment plan, followed by a consultant (21.69%) or a physiotherapist (21.16%). Other suggestions included cancer charities, other cancer patients, GPs, the internet, and making their own judgement. Additionally, individuals agreed or strongly agreed that positive thinking (79.14%), medical advice/knowledge (55.08%), and setting goals (52.94%) mainly contributed to them being active during their treatment (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Exercise Recommendations for Future Reference\u003c/h2\u003e \u003cp\u003eStretching/yoga-based activities were highly favoured as the best exercise type to be implemented into a programme for cancer patients/survivors (supplementary file [Online Resource 1], Q6; 166 responses), followed by cancer-specific exercise classes (156 responses), cardiovascular exercise (146 responses), and resistance exercise (112 responses). High intensity interval training/circuit-type training was barely recommended (16 responses); however, 155 respondents felt this type of exercise should be avoided. Throughout the cancer continuum, 42.86% suggested the best time to introduce (or increase) PA was at diagnosis, with 18.52% suggesting the start of treatment, and 14.81% believing it best to wait until active treatment has finished. Around a tenth of respondents (11.11%) felt that between treatment cycles would be the best time to introduce (or increase) PA, while only 5.82% felt that during active treatment would be best. Two key suggestions of timings made by the respondents included basing it on individual judgement (4.23%) and having the opportunity to opt in at each stage (1.59%).\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe aims of the current study were to assess cancer survivors\u0026rsquo; beliefs surrounding the benefits and barriers to exercise, their own exercise experiences during treatment, their perceptions of PA, and their recommendations and considerations for creating an effective, individualised programme. By gaining a clearer understanding of cancer survivors\u0026rsquo; experiences with regards to PA and exercise, it is hoped that it could lead to better design of exercise interventions.\u003c/p\u003e \u003cp\u003eIn previous studies, survivors identified the maintenance and/or recovery of any lost physical attributes as one of the key advantages to engaging in PA, with the reduction in fatigue, offsetting muscle deconditioning, and the better ability to cope with treatment among the most commonly reported physical benefits (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Allied to this, side effect management was considered vital in encouraging patients to exercise. These debilitating side effects of treatment have been associated with a reduction in motivation to exercise, which presents an initial barrier to being physically active (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). This has led to reports of a compromised quality of life throughout survivorship due to cancer-related fatigue, psychological distress, and reduced physical fitness (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). In the long-term, this increases the probability for survivors to experience chronic diseases, such as diabetes, osteoporosis, cardiovascular disease and cancer recurrence (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). Therefore, not only is PA able to reduce psychological distress while increasing overall fitness and recovery, but it also provides a preventative measure for chronic diseases. In the present study, lowered feelings of depression and anxiety was the top-rated perceived benefit with 83.36% total agreement. This finding is crucial as depression has specifically been linked to poor adherence to PA programmes (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). As such, survivors who participate in PA are more likely to experience the multitude of physical benefits that PA brings due to the creation of more optimal mental health status.\u003c/p\u003e \u003cp\u003eIn the current study, physical barriers, such as the side effects of treatment, fatigue, pain and lymphoedema, were the top cited barrier to participating in PA. In one particularly interesting comment, a respondent mentioned the idea of a \u0026ldquo;cancer hierarchy of needs\u0026rdquo; stating that if there was such a thing, exercise would be on it, but it would not be the priority when, for example, an immediate priority after receiving chemotherapy can often be simply to keep down a couple of sips of water (supplementary file [Online Resource 1], Q12 free-form comments). Healthcare-related barriers represented the second most prominent barrier to participation, with many respondents mentioning that they were unaware if they were even allowed to exercise due to limited or minimal advice being provided. These types of responses mirror those observed in previous studies (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e), which highlights the necessity of implementing a detailed, reliable patient education system to eliminate any fears, concerns or worries surrounding exercise, which in turn could support maximal adherence to regular participation in PA. Healthcare services may benefit from advertising the excellent services provided by cancer charities in this area, which could form a fundamental component of this education system.\u003c/p\u003e \u003cp\u003eFrom the current findings presented herein and those of prior studies, it is clear that patients want advice and guidance about exercise in order to mitigate the continuing physical and psychological side effects of treatment (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). A common observation is that patients and survivors rarely have discussions regarding the safety of PA or how to engage in it safely (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), with over three quarters of the respondents in the current study initiating a discussion themselves due to a substantial absence of advice from their healthcare providers.\u003c/p\u003e \u003cp\u003eIn a previous study, ~\u0026thinsp;82% of cancer survivors said they would prefer receiving PA recommendations from their oncologist and for them to initiate a discussion with them, but less than a third (28%) reported having such an experience (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). By contrast, in the present study, nearly half of all respondents (44.97%) demonstrated a preference for PA recommendations to come from a clinical nurse specialist, with only 21.69% believing this should come from their consultant. One potential reason for these differences could be the geographical location of each study, with Jones et al.\u0026rsquo;s study (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e) being conducted in the United States, and the present study being conducted in the UK. The differences in healthcare systems, structures and provisions likely account for these observations. Regardless, these findings only augment the fact that cancer survivors are in agreement that there should be a greater emphasis on providing sufficient knowledge and guidance surrounding safe and efficacious PA to cancer patients and survivors alike. In particular, patients require vital information about the risks and benefits of exercise and PA, and what types of exercise are most appropriate for them (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Ideally, this information should be adapted for each individual based on their cancer type, treatment options, and pre-diagnosis fitness level, to better address the specific issues experienced in this population (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). These types of personalised recommendations are in demand, with 68% of patients reporting a need for a programme tailored to their individual needs and 60% agreeing that they would follow this type of programme during treatment (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). By reducing the amount of generic advice and replacing it with personalised advice, this could enhance long-term adherence to an exercise programme consisting of clear, detailed instructions for the ideal type, duration and intensity of exercise recommendations (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e As a result of the relatively large sample size surveyed in the current study, there is now a clearer picture of how PA programmes can be personalised for cancer patients. One of the suggestions from the questionnaire recommended implementing a cancer specialist trainer within all cancer wards to best advise PA sessions, including any exercises to avoid (see supplementary file [Online Resource 1], Q12 for freeform comments). It was suggested that provided coaches, physiotherapists and gym instructors have the appropriate education to become knowledgeable in how to correctly administer individualised exercise programmes specifically for cancer patients and survivors, they are able to save the healthcare systems time and money by being the primary point of contact in this regard. It was also recommended that personalised programmes should be reviewed every month to ensure appropriate modification relative to any progress or issues that arise for the individual. Combined, these efforts would ensure a supportive environment for cancer patients and survivors to maintain or regain their strength, fitness and physical functioning, where they would have access to the appropriate knowledge and guidance for safe PA, a long-term individualised programme, and a designated specialist to ask questions.\u003c/p\u003e \u003cp\u003eIt has been well-documented that compliance to PA programmes is poor among cancer patients and survivors (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), therefore the present study focused on assessing cancer survivors\u0026rsquo; perceptions of exercise to understand possible reasons underpinning lack of compliance. Despite only 1.54% of respondents believing exercise and PA to be detrimental to cancer prognosis, over a third reported lack of knowledge and awareness of how to engage in PA safely as a barrier to participating in PA throughout their own cancer journey.\u003c/p\u003e \u003cp\u003eOne of the key limitations of the present study is the lack of demographic data collected. By collecting information regarding sex, age, cancer type, and pre- and post-diagnosis activity levels, comparisons could have been made to generate a deeper understanding of how future PA programmes could be tailored for different cancer types and different populations within the survivorship population, which could be used to adapt programmes to ensure longer-term adherence. However, it was decided that asking for this level of detail may deter some people from answering the call to participate in the survey and therefore anonymous survey data was collected instead.\u003c/p\u003e \u003cp\u003eSince healthcare-related barriers represented the second most prominent barrier to participation in PA, an emphasis on educating healthcare providers at all levels on the benefits of PA and exercise throughout the cancer continuum would be a prudent update to current professional training and development provision to ensure more opportunities for conversations around PA at various stages along a cancer patient\u0026rsquo;s journey. Within this, recommendations for specific, individualised exercises for different patient groups, demographics and cancer types should be at the forefront of future work in this area. This study highlights possibilities which could be executed in order to successfully perform this objective. Future research investigating the effectiveness of individualised programmes, preferably supervised by a cancer exercise specialist or a coach/physiotherapist that has been educated on how to safely administer PA programmes to cancer patients and survivors, is necessary.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThe findings presented in the current study demonstrate comprehensive evidence of the benefits of and barriers to PA in cancer survivors that healthcare practitioners need to be cognisant of when designing individualised exercise programmes for cancer patients and/or survivors. A pivotal disconnect exists between the existing body of knowledge of the benefits and safety of PA and exercise throughout the cancer continuum and patient/survivor education. This disconnect epitomises the substantial challenges faced by patients and survivors and reflects the urgent need for a solution, such as a new, tailored PA programme strategy to maximise adherence to continuing exercise and PA into survivorship by considering all components of a cancer patients\u0026rsquo; wellbeing and physical capability.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data is available within the manuscript or supplementary files [Online Resources].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project was funded by the School of Sport, Exercise and Health Sciences at Loughborough University and no external funding was received.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Patient Consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Ethical approval was granted by the Loughborough University Ethics Committee of the School of Sport, Exercise and Health Sciences (reference number: 2022-8346-9438). Participants were made aware of any associated risks and their freedom to leave the study at any time, prior to giving informed consent. The authors affirm that human research participants provided informed consent for publication of all images (Figures 1-4 and the supplementary file [Online Resource 1]).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors wish to express their deepest thanks to all the participants who took the time to share their invaluable thoughts, opinions and experiences with us. We also wish to extend our gratitude to Lisa Curtis at Look Good Feel Better, and Hannah O\u0026rsquo;Mahoney at Tenovus Cancer Care for their willingness to share the survey with their network.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Data was collected, analysed and interpreted by Kristin Dean; the first draft was written by Kristin Dean; the second and subsequent drafts were written by Mhairi Morris and Elizabeth Stamp; Mhairi Morris and Elizabeth Stamp provided Kristin Dean with supervision for the duration of the project.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin [Internet]. 2021 May [cited 2023 Dec 13];71(3):209\u0026ndash;49. Available from: http://www.ncbi.nlm.nih.gov/pubmed/33538338\u003c/li\u003e\n\u003cli\u003eCancer survival statistics | Cancer Research UK [Internet]. [cited 2023 Dec 13]. Available from: https://www.cancerresearchuk.org/health-professional/cancer-statistics/survival#heading-Zero\u003c/li\u003e\n\u003cli\u003eSabiston CM, Brunet J. Reviewing the Benefits of Physical Activity During Cancer Survivorship. Am J Lifestyle Med [Internet]. 2012 Mar 26 [cited 2023 Dec 13];6(2):167\u0026ndash;77. Available from: http://journals.sagepub.com/doi/10.1177/1559827611407023\u003c/li\u003e\n\u003cli\u003eEng L, Pringle D, Su J, Shen X, Mahler M, Niu C, et al. Patterns, perceptions, and perceived barriers to physical activity in adult cancer survivors. Supportive Care in Cancer [Internet]. 2018 Nov 29 [cited 2023 Dec 13];26(11):3755\u0026ndash;63. Available from: http://link.springer.com/10.1007/s00520-018-4239-5\u003c/li\u003e\n\u003cli\u003eDenlinger CS, Carlson RW, Are M, Baker KS, Davis E, Edge SB, et al. Survivorship: introduction and definition. Clinical practice guidelines in oncology. J Natl Compr Canc Netw [Internet]. 2014 Jan [cited 2023 Dec 13];12(1):34\u0026ndash;45. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24453291\u003c/li\u003e\n\u003cli\u003eGho SA, Munro BJ, Jones SC, Steele JR. Perceived exercise barriers explain exercise participation in Australian women treated for breast cancer better than perceived exercise benefits. Phys Ther [Internet]. 2014 Dec [cited 2023 Dec 13];94(12):1765\u0026ndash;74. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25060956\u003c/li\u003e\n\u003cli\u003eFernandez S, Franklin J, Amlani N, DeMilleVille C, Lawson D, Smith J. Physical activity and cancer: A cross-sectional study on the barriers and facilitators to exercise during cancer treatment. Can Oncol Nurs J [Internet]. 2015 [cited 2023 Dec 13];25(1):37\u0026ndash;48. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26642493\u003c/li\u003e\n\u003cli\u003eShapiro CL, Recht A. Side effects of adjuvant treatment of breast cancer. N Engl J Med [Internet]. 2001 Jun 28 [cited 2023 Dec 13];344(26):1997\u0026ndash;2008. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11430330\u003c/li\u003e\n\u003cli\u003eStull VB, Snyder DC, Demark-Wahnefried W. Lifestyle interventions in cancer survivors: designing programs that meet the needs of this vulnerable and growing population. J Nutr [Internet]. 2007 Jan [cited 2023 Dec 13];137(1 Suppl):243S-248S. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17182834\u003c/li\u003e\n\u003cli\u003eHarrison S, Hayes SC, Newman B. Level of physical activity and characteristics associated with change following breast cancer diagnosis and treatment. Psychooncology [Internet]. 2009 Apr [cited 2023 Dec 13];18(4):387\u0026ndash;94. 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Available from: http://www.ncbi.nlm.nih.gov/pubmed/21946880\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"physical activity, exercise, cancer survivors, benefits, patient perceptions","lastPublishedDoi":"10.21203/rs.3.rs-3870757/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3870757/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePhysical activity (PA) and exercise have multiple benefits throughout the cancer continuum, including alleviating treatment side effects, improving quality of life, and preventing secondary recurrence. Despite these benefits being well-documented, most cancer survivors do not meet the minimum exercise guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo assess cancer survivors’ beliefs and experiences surrounding exercise during treatment, a 12-question survey was disseminated to a range of cancer survivors. Free-form comments were reviewed to identify common themes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of the 275 initial respondents, 198 male and female cancer survivors completed the questionnaire, upon which qualitative and quantitative analysis was conducted revealing a reduction in feelings of depression and anxiety in 83.36% of respondents. Physical barriers were the most common reported theme, followed by healthcare-related barriers due to lack of knowledge and guidance, with 99% of respondents agreeing a greater emphasis on this aspect is needed. Stretching/yoga-based activities were the most favoured type of exercise amongst respondents.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings presented herein comprehensively demonstrate the benefits of and barriers to participating in PA throughout the cancer continuum. Healthcare practitioners working with cancer survivors need to be cognisant of these barriers when designing interventions aimed at improving PA adherence.\u003c/p\u003e\n\u003cp\u003eImplications for Cancer Survivors: Individualised exercise programmes that consider all aspects of an individual’s cancer journey (cancer type, treatment modalities, etc.) may be able to correct the disconnect between knowledge of the benefits of PA and adherence to current guidelines amongst cancer survivors.\u003c/p\u003e","manuscriptTitle":"Patient Perceptions of the Benefits of Physical Activity Throughout the Cancer Continuum in Cancer Survivor Populations","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-22 14:47:19","doi":"10.21203/rs.3.rs-3870757/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3105e6b2-e422-4a08-8037-eb02cc083c5b","owner":[],"postedDate":"January 22nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-03-06T08:45:22+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-22 14:47:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3870757","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3870757","identity":"rs-3870757","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}