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Impact of an exercise programme on sustaining physical activity for recovering cancer patients: A qualitative study.

Martyn Queen, Saul Bloxham, Phil Brown, Melissa Coyle, Ben Jane


Background Pedometers have been shown to improve adherence to exercise programmes. Evidence suggests that PA can improve physical function, wellbeing and reduce the negative impact of some cancer related side-effects. Yet, there are limited PA guidelines for cancer patients in the UK. The aim was to examine the impact of an 8-week exercise programme on sustaining physical activity (PA) at 3-month follow-up.

Method A qualitative study with 12 mixed site cancer patients aged 43-70 (10 women, 2 men), involved in an 8-week exercise programme. The Programme took place at a University in the South West of England, UK. Semi-structured interviews with patients took place 3 times over 6 months. A grounded theory approach was used to analyse the data.

Results We found that the number of patients perceived to be physically active prior to take-up of the physical activity programme were low (20%). At completion, most patients reported being physically active (84%), sustained but to a lesser extent (67%) at 3-month follow-up. Explanations for sustained PA at follow-up included application of knowledge gained from the Programme in relation to walking technique and use of pedometers and perceived health and fitness gains. Explanations for those not physically active included new diagnosis, reduced mobility following surgery and lack of clear exit route or progression to another structured opportunity.

Conclusion Our study has provided valuable insight into how a supervised multi-modal physical activity programme can enable recovering cancer patients to develop a physically active lifestyle.


Cancer patients, care pathways, counselling, exercise programmes, functional capacity, Grounded Theory, living with cancer, pedometers, person-centered healthcare, psychological domains, qualitative research, quality of life, social domains, wellbeing

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Maddams, J., Utley, M. & Møller, H. (2012). Projections of cancer prevalence in the United Kingdom, 2010-2040. British Journal of Cancer 107 (7) 1195-1202.

Campbell, A., Foster, J., Stevinson, C. Cavill, N. (2012). The importance of physical activity for people living with and beyond cancer: A concise evidence review. London: McMillan Publishing.

National Institute of Health and Clinical Excellence. (2014). Exercise referral schemes to promote physical activity. Public Health Guidance 54. London: NICE.

Department of Health. (2011). Start active, stay active: a report on physical activity from the four home countries’ Chief Medical Officers. London: Department of Health.

Edwards, B. & Clarke, V. (2004). The psychological impact of a cancer diagnosis on families: the influence of family functioning and patients illness characteristics on depression and anxiety. Psycho-Oncology 13, 562-576

Fenn, B., Evans, S., McCorkle, R., Digiovanna, M., Pusztai, L., Sanft, T., Hofstatter, E., Killelea, B., Knobf, M., Lannin., D., Abu-Khalaf, M., Horowitz, N.R. & Chaqpar, A.B. (2014). Impact of financial burden of cancer on survivors’ quality of life. Journal of Oncology Practice 10 (5) 332-338.

Smith, H. (2015). Depression in cancer patients: Pathogenesis, implications and treatment (Review). Oncology Letters 9 (4) 1509-1514.

Applebaum, A.J., Stein, E.M., Lord-Bessen, J., Pessin, H., Rosenfeld, B. & Breitbart, W. (2014). Optimism, social support, and mental health outcomes in patients with advanced cancer. Psycho-Oncology, 23, 299-306.

Carmichael, A.R., Daley, A.J., Rea, D.W. & Bowden, S.J. (2010). Physical activity and breast cancer outcome: A brief review of evidence, current practice and future direction. European Journal of Surgical Oncology 36 (12) 1139-1148.

Harriss, D.J., Cable, N.T., George, K., Reilly, T., Renehan, A.G. & Haboubi, N. (2007). Physical activity before and after diagnosis of colorectal cancer: disease risk, clinical outcomes, response pathways and biomarkers. Sports Medicine 37 (11) 947-960.

Brown, J.C., Huedo-Medina, T.B., Pescatello, L.S., Pescatello, S.M., Ferrer, R.A. & Johnson, B.T. (2011). Efficacy of exercise interventions in modulating cancer-related fatigue among adult cancer survivors: A meta-analysis. Cancer Epidemiology Biomarkers and Prevention 20, 123-133.

Holick, C.N., Newcomb, P.A, Trentham-Dietz, A., Titus-Ernstoff, L., Bersch, A.J., Stampfer, M.J. & Willett, W.C. (2008). Physical activity and survival after diagnosis of invasive breast cancer. Cancer Epidemiology, Biomarkers & Prevention 17 (2) 379-386.

Courneya, K.S., Mackey, J.R., Bell, G.J., Jones, L.W., Field, C.J. & Fairey, A.S. (2003). Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: Cardiopulmonary and quality of life outcomes. Journal of Clinical Oncology 21 (9) 1660-1668.

Speck, R.M., Courneya, K.S., Mâsse, L.C., Duval, S. & Schmitz, K.H. (2010). An update of controlled physical activity trials in cancer survivors: A systematic review and meta-analysis. Journal of Cancer Survivorship 4, 87-100.

Courneya, K.S., Segal, R.J., Gelmon, K., Reid, R.D., Mackey, J.R., Friedenreich, C.M. & Mckenzie, D.C. (2008). Predictors of supervised exercise adherence during breast cancer chemotherapy. Medicine and Science in Sports and Exercise 40 (6) 1180-1187.

Blanchard, C.M., Cokkinides, V., Courneya, K.S., Nehl, E.J., Stein, K. & Baker, F. (2003). A comparison of physical activity of posttreatment breast cancer survivors and noncancer controls. Behavioral Medicine 28 (4) 140-149.

Irwin, M. & Aindworth, B. (2004). Physical Activity Interventions Following Cancer Diagnosis: Methodologic Challenges to Delivery and Assessment, Cancer Investigation 22 (1) 30-50.

Daley, A.J., Bowden, S.J., Rea, D.W., Billingham, L. & Carmicheal, A.R. (2008). What advice are oncologists and surgeons in the United Kingdom giving to breast cancer patients about physical activity? International Journal of Behavioral Nutrition and Physical Activity 5, 46.

Keogh, J.W.L., Patel, A., Macleod, R.D. & Masters, J. (2014). Perceived barriers and facilitators to physical activity in men with prostate cancer: Possible influence of androgen deprivation therapy. European Journal of Cancer Care 23, 263-273.

De Backer, I.C., Schep, G., Backx, F.J., Vreugdenhil, G. & Kuipers, H. (2009). Resistance training in cancer survivors: A systematic review. International Journal of Sports Medicine 30, 703-712.

Midtgaard, J., Christensen, J.F., Tolver, A., Jones, L.W., Uth, J., Rasmussen, B. & Rørth, M. (2013). Efficacy of multimodal exercise-based rehabilitation on physical activity, cardiorespiratory fitness, and patient-reported outcomes in cancer survivors: A randomized, controlled trial. Annals of Oncology 24, 2267-2273.

Courneya, K., Segal, R., Gelmon, K., Mackey, J., Friedenreich, C., Yasui , Y., Reid, R., Proulx, C., Trinh, L., Dolan, L., Wooding, E., Vallerand, J.R. & McKenzie, D.C. (2014). Predictors of adherence to different types and doses of supervised exercise during breast cancer chemotherapy. International Journal of Behavioral Nutrition and Physical Activity 11 (85) 1-19.

De Greef, K.P., Deforche, B.I., Ruige, J.B., Bouckaert, J.J., Tudor-Locke, C.E., Kaufman, J.M. & De Bourdeaudhuij, I.M. (2011). The effects of a pedometer-based behavioral modification program with telephone support on physical activity and sedentary behavior in type 2 diabetes patients. Patient Education and Counseling 84 (2) 275-279.

Bjorgaas, M., Vik, J., Saeterhaug, A., Langlo, L., Sakshaug, T., Mohus, R. & Grill, V. (2005). Relationship between pedometer-registered activity, aerobic capacity and self-reported activity and fitness in patients with type 2 diabetes. Diabetes, Obesity & Metabolism 8 (2) 136-145.

Lutes, L.D. & Steinbaugh, E.K. (2010). Theoretical models for pedometer use in physical activity interventions. Physical Therapy Reviews 15 (3) 143-153.

Knols, R.H., de Bruin, E.D., Shirato, K., Uebelhart, D. & Aaronson, N.K. (2010). Physical activity interventions to improve daily walking activity in cancer survivors. BMC Cancer 10, 406.

Strauss, A.L. & Corbin, J. (1998). Basics of Qualitative Research. Techniques and Procedures for Developing Grounded Theory (2nd edn.). California: Sage.

Crone, D. & Guy, H. (2008). “I know it is only exercise, but to me it is something that keeps me going”: A qualitative approach to understanding mental health service users’ experiences of sports therapy: Feature Article. International Journal of Mental Health Nursing 17 (3) 197-207.

Gidlow, C., Johnston, L.H., Crone, D., Morris, C., Smith, A., Foster, C. & James, D.V.B. (2007). Socio-demographic patterning of referral, uptake and attendance in Physical Activity Referral Schemes. Journal of Public Health 29 (2) 107-113.

Hillsdon, M., Thorogood, M., White, I. & Foster, C. (2002). Advising people to take more exercise is ineffective: a randomized controlled trial of physical activity promotion in primary care. International Journal of Epidemiology 31 (4) 808-815.

Harrison, R.A., Roberts, C. & Elton, P.J. (2005). Does primary care referral to an exercise programme increase physical activity 1 year later? A randomized controlled trial. Journal of Public Health 27 (1) 25-32.

James, D.V.B., Johnston, L.H., Crone, D., Sidford, A.H., Gidlow, C., Morris, C. & Foster, C. (2008). Factors associated with physical activity referral uptake and participation. Journal of Sports Sciences 26 (2) 217-224.

Morgan, O. (2005). Approaches to increase physical activity: Reviewing the evidence for exercise-referral schemes. Public Health 119 (5) 361-370.

Crone, D., Johnston, L. & Grant, T. (2004). Maintaining quality in exercise referral schemes: A case study of professional practice. Primary Health Care Research and Development 5, 96-103.

Queen, M., Crone, D. & Parker, A. (2015). Long-term Engagement With a Practice-based Exercise Referral Scheme: Patients’ Perceptions of Effectiveness. European Journal for Person Centered Healthcare, 3 (3) 369-376.

Vinson, D. & Parker, A. (2012). Exercise, service and support: client experiences of physical activity referral schemes (PARS). Qualitative Research in Sport, Exercise and Health 4 (1) 15-31.

Wormald, H., Waters, H., Sleap, M. & Ingle, L., (2006). Participants' perceptions of a lifestyle approach to promoting physical activity: targeting deprived communities in Kingston-upon-Hull. BMC Public Health 6, 202-212.

Dinan, S., Lenihan, P., Tenn, T. & Iliffe, S. (2006). Is the promotion of physical activity in vulnerable older people feasible and effective in general practice? British Journal of General Practice 56 (531) 791-793.

Gidlow, C., Johnston, L.H., Crone, D. & James, D.V.B. (2008). State of the Art Reviews: Methods of Evaluation: Issues and Implications for Physical Activity Referral Schemes. American Journal of Lifestyle Medicine 2 (1) 46-50.

Leijon, M.E., Bendtsen, P., Ståhle, A., Ekberg, K., Festin, K. & Nilsen, P. (2010). Factors associated with patients self-reported adherence to prescribed physical activity in routine primary health care. BMC Family Practice 11 (38) 1-9.

Damush, T.M., Stump, T.E., Saporito, A. & Clark, D.O. (2001). Predictors of Older Primary Care Patients’ Participation in a Sub maximal Exercise Test and a Supervised, Low-Impact Exercise Class. Preventative Medicine, 33 (5) 485-494.

Dugdill, L., Graham, R.C. & McNair, F. (2005). Exercise referral: the public health panacea for physical activity promotion? A critical perspective of exercise referral schemes; their development and evaluation. Ergonomics 48 (11-14) 1390-1410.

Michie, S. & Johnston, M. (2012). Theories and techniques of behaviour change: Developing a cumulative science of behaviour change. Health Psychology Review 6 (1) 1-6.

Bryman, A. (2012). Social Research Methods (4th edn.). Oxford: Oxford University Press.

Kelle, U. (2005). Emergence vs. ‘Forcing’ of Empirical Data? A Crucial Problem of ‘Grounded Theory’ Reconsidered. Forum: Qualitative Social Research 6 (2) 27.

Hutchinson, A.J., Johnston, L. & Breckon, J. (2011). Grounded Theory Based Research with Exercise Psychology: A Critical Review. Qualitative Research in Psychology 8, 247-272.

Lincoln, Y.S. & Guba, E.G. (1985). Naturalistic Enquiry. California: Sage.

Fairey, A.S., Courneya, K.S., Field, C.J. & Mackey, J.R. (2002). Physical exercise and immune system function in cancer survivors: A comprehensive review and future directions. Cancer 94 (2) 539-551.

Leach, H.J., Danyluk, J.M. & Culos-Reed, S.N. (2014). Design and implementation of a community-based exercise program for breast cancer patients. Current Oncology 21, 267-271.

Kwan, M.L., Cohn, J.C., Armer, J.M., Stewart, B.R. & Cormier, J.N. (2011). Exercise in patients with lymphedema: A systematic review of the contemporary literature. Journal of Cancer Survivorship 5, 320-336.

Sander, A.P., Wilson, J., Izzo, N., Mountford, S.A. & Hayes, K.W. (2012). Factors That Affect Decisions About Physical Activity and Exercise in Survivors of Breast Cancer: A Qualitative Study. Physical Therapy 92 (4) 525-536.

Hammersley, M. (1992). What’s Wrong with Ethnography. Oxon: Routledge.



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