Factors promoting and impeding exercise behaviour in patients with colorectal cancer and comorbid diabetes during chemotherapy in Zhejiang, China: a qualitative study.

Patients with colorectal cancer and comorbid diabetes undergoing chemotherapy perceived physical benefits of exercise including improved physical functioning and disease management.

• Physical benefits were identified as a sub-theme under Perceived Benefits of Exercise within the Health Belief Model framework
• Study included 11 patients with a mean age of 58.09±7.70 years
• Mean duration of colorectal cancer was 0.88±0.91 years and mean duration of diabetes was 9.24±7.75 years
• Data were collected via semi-structured interviews conducted in May and June 2023 at the Department of Medical Oncology, Zhongshan Hospital, Fudan University

Patients perceived psychosocial benefits of exercise, including psychological well-being improvements, as a motivating factor for exercise during chemotherapy.

• Psychosocial benefits constituted the second sub-theme under Perceived Benefits of Exercise
• The Health Belief Model (HBM) was used as a post-hoc interpretive framework to organize inductively derived themes
• Data were analysed using Colaizzi's seven-step phenomenological method
• The qualitative descriptive phenomenological approach captured patients' lived experiences of exercise during chemotherapy

Health status and chemotherapy-related side effects were identified as a primary barrier to exercise in this patient population.

• This sub-theme fell under the Perceived Barriers to Exercise theme in the HBM framework
• Participants were undergoing active chemotherapy at the time of interviews, making side effects a contemporaneous concern
• The comorbid nature of colorectal cancer and diabetes created compounding physical challenges to exercise engagement
• Semi-structured interviews with 11 patients were used to elicit detailed personal experiences of barriers

Psychological apprehension was identified as a second key barrier impeding exercise behaviour during chemotherapy.

• Psychological apprehension was the second sub-theme under Perceived Barriers to Exercise
• The HBM sensitising framework guided the interview guide to ensure broad coverage of relevant experiential domains including psychological factors
• This finding was inductively derived from patient interviews and subsequently mapped onto the HBM
• The combination of cancer diagnosis, diabetes management, and chemotherapy treatment was the context in which apprehension arose

Social support functioned as a significant cue to action that facilitated exercise behaviour in patients during chemotherapy.

• Social support was identified as the first sub-theme under the Cues to Action for Exercise theme
• Three overarching themes and six sub-themes in total were identified from the data
• The authors recommend that healthcare professionals provide effective social support to address identified barriers and facilitate exercise adherence
• This theme was organized under the HBM's 'Cues to Action' construct as a post-hoc interpretive step

Professional guidance was identified as a cue to action that promoted exercise behaviour during chemotherapy.

• Professional guidance was the second sub-theme under Cues to Action for Exercise
• Healthcare professionals are recommended to prioritise health education and diversify formats of patient instruction based on this finding
• The study was conducted at a single centre (Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai, China)
• Authors note that the relationship between exercise adherence and long-term prognosis requires further investigation in larger, longitudinal studies