Exercise Preferences, Barriers, and Facilitators of Individuals With Cancer Undergoing Chemotherapy Before Stem Cell Transplantation: A Mixed-Methods Study

Graeme M Purdy; Rianna Nanad; Leslie Ternes; Naomi D Dolgoy; Christopher M Sellar; George Francis; Nicole Crisp; Edith Pituskin; Marie de Guzman Wilding; Sarah Perry; Irwindeep Sandhu; Christopher P Venner; Margaret L McNeely

doi:10.1097/NCC.0000000000001240

Exercise Preferences, Barriers, and Facilitators of Individuals With Cancer Undergoing Chemotherapy Before Stem Cell Transplantation: A Mixed-Methods Study

Cancer Nurs. 2023 Apr 13. doi: 10.1097/NCC.0000000000001240. Online ahead of print.

Authors

Graeme M Purdy¹, Rianna Nanad, Leslie Ternes, Naomi D Dolgoy, Christopher M Sellar, George Francis, Nicole Crisp, Edith Pituskin, Marie de Guzman Wilding, Sarah Perry, Irwindeep Sandhu, Christopher P Venner, Margaret L McNeely

Affiliation

¹ Author Affiliations: Department of Physical Therapy, Faculty of Rehabilitation Medicine (Mr Purdy, Mrs Nanad, Mrs Ternes, and Drs Dolgoy, Sellar, and McNeely), and Faculty of Nursing (Dr Pituskin), University of Alberta, Edmonton, Alberta; Cumming School of Medicine, University of Calgary, Calgary, Alberta (Drs Francis and Perry); Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta (Mrs Crisp); Department of Oncology, Cross Cancer Institute, Edmonton, Alberta (Drs Pituskin, Sandhu, and Venner); Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada (Mrs de Guzman Wilding and Drs Perry and McNeely).

PMID: 37058603
DOI: 10.1097/NCC.0000000000001240

Abstract

Background: Exercise can help mitigate side effects of hematopoietic stem cell transplantation (HSCT), particularly when initiated before HSCT. However, the exercise-related barriers, facilitators, and preferences of this population remain unclear.

Objective: This study aimed to explore the patient experience to inform future implementation of a prehabilitation intervention.

Interventions/methods: A 2-phase sequential explanatory mixed-methods study was conducted using (1) cross-sectional survey and (2) focus groups. Survey questions aligned with the Theoretical Domains Framework. Focus group data were analyzed using a directed content analysis approach, followed by inductive thematic analysis to generate themes that represented the exercise-related barriers, facilitators, and preferences of participants.

Results: Twenty-six participants completed phase 1 (n = 22 with multiple myeloma). Fifty percent of participants (n = 13) were fairly/very confident in their ability to exercise pre-HSCT. Eleven participants completed phase 2. Exercise barriers included knowledge/skill limitations, inadequate healthcare provider support, and the emotional toll of treatment. Facilitators included social support and goals. Exercise preferences were related to 2 themes: (1) program structure (subthemes: prescription and scheduling, mode of delivery) and (2) support (subthemes: support from personnel, tailoring, and education).

Conclusion: Key exercise-related barriers included knowledge limitations, disease/treatment effects, and inadequate support. Prehabilitation should be tailored, flexible, and include education and a virtual or hybrid delivery model in this population.

Implications for practice: Nurses are well positioned to identify functional limitations and counsel and refer patients to exercise programming and/or physiotherapy services. Including an exercise professional in the pretransplant care team would provide key supportive care assistance for the nursing team.