Perceived facilitators and barriers to physical exercise adherence in esophageal cancer patients after surgery.

Abstract

94 Background: To achieve optimal effects of exercise interventions in esophageal cancer patients, high adherence is needed. Knowledge on facilitators and barriers can help improving exercise adherence. Hence, the aim of this study is to evaluate perceived facilitators and barriers to physical exercise adherence in esophageal cancer patients in the first year after surgery. Methods: Semi-structured interviews were conducted with patients (n = 16) who were randomised to the exercise group of the Physical ExeRcise Following Esophageal Cancer Treatment (PERFECT) Study. Patients participated in a 12-week supervised combined aerobic and resistance exercise program twice weekly, and were advised to be physically active at least 30 minutes each day. Physiotherapists registered attendance at the supervised sessions and compliance (i.e., performing the exercises according to protocol). Transcribed interviews were analysed using a thematic content approach. Results: Median attendance was 97.9%, interquartile range (IQR): 91.7 – 100%. Median compliance to both components of the exercise program was high: 89.6% (IQR 75.5 – 95.8%) for aerobic exercise and 88.0% (IQR 73.8 – 93.6%) for resistance exercise. The most important perceived facilitators were patients’ own attitudes towards exercise (i.e. motivation, commitment and personal goals) and supervision by a physiotherapist. There were only few perceived barriers, of which the most frequently mentioned were logistic factors (i.e. holidays, conflicting activities and weather circumstances) and impaired physical condition due to regular endoscopic esophageal dilation therapy or general physical complaints, such as fatigue. Conclusions: Esophageal cancer patients after surgery are well capable to perform physical exercise with moderate-to-high intensity. The most important perceived facilitators for the high adherence rates are patients’ own attitudes towards exercise and supervision by a physiotherapist. Completion of the exercise program was only minimally affected by perceived barriers as logistic factors and physical complaints. This information can help in designing future exercise programs for clinical practice.