# Perceived Barriers and Facilitators to Physical Activity Engagement Among Cancer Survivors: A Qualitative Study

## TL;DR

This study explores why cancer survivors struggle with physical activity and what can help them stay active, based on interviews with 18 survivors.

## Contribution

The study identifies multilevel barriers and facilitators to physical activity among cancer survivors using the Theoretical Domains Framework.

## Key findings

- Barriers include treatment-related symptoms, low motivation, and lack of healthcare provider support.
- Facilitators include personal motivation, perceived health benefits, and community-based programs.
- Survivors recommend tailored education and structured physical activity programs in survivorship care.

## Abstract

Engaging in physical activity can promote better health, emotional well-being, and quality of life among cancer survivors, yet many survivors struggle to stay active during and after treatment. In this qualitative study, semi-structured interviews were conducted with 18 adult cancer survivors from Nebraska to explore experiences with physical activity, including what makes it difficult, what helps, and what additional support they need. Survivors described barriers such as treatment-related symptoms, low motivation, limited awareness of physical activity guidelines, lack of support from healthcare providers, and challenges related to weather and access to exercise resources. Facilitators included personal motivation, perceived health benefits, encouragement from family and friends, and access to community-based physical activity programs. Survivors emphasized the need for tailored education, supportive counseling from healthcare providers, and structured physical activity programs integrated into survivorship care. These findings highlight opportunities to develop patient-centered strategies to better support physical activity among cancer survivors.

Background: Although physical activity (PA) offers substantial physical and psychosocial benefits, engagement remains suboptimal among cancer survivors. A theory-informed understanding of survivors’ perceived barriers, facilitators, and recommendations is needed to inform patient-centered PA about survivorship interventions. Objective: This study aimed to explore perceived barriers, facilitators, and recommendations for PA engagement among adult cancer survivors using the Theoretical Domains Framework (TDF). Methods: A phenomenological qualitative design was used. Eighteen cancer survivors from Nebraska participated in semi-structured interviews via Zoom or telephone. Semi-structured interviews (guided by open-ended questions with flexibility for probing) were transcribed verbatim, imported into MAXQDA 2024, and analyzed using TDF to identify themes and subthemes. Results: Three overarching themes emerged: barriers, facilitators, and recommendations related to PA engagement. Barriers included individual factors (low motivation and self-efficacy, limited awareness of PA guidelines, time constraints, and physical limitations due to treatment and comorbidities), social factors (limited support from family, friends), clinical factors (limited PA guidance from healthcare providers), and environmental factors (restricted access to resources and unfavorable weather). Facilitators included individual factors (PA knowledge, motivation, goals, and health benefits), social factors (support from family, friends), and clinical factors (encouragement from healthcare providers), and environmental factors (favorable weather and available community PA resources). Recommendations emphasized the need for tailored education, supportive counseling, and structured PA programs within survivorship care. Conclusions: Cancer survivors described multilevel determinants of PA engagement across individual, social, and environmental contexts. Findings highlight the importance of theory-informed, patient-centered strategies that enhance PA guideline awareness, strengthen social and clinical support, and improve access to community resources to promote sustained PA during cancer survivorship.