“You've got to exercise more … What does that mean?” understanding experiences of physical activity during chemotherapy (EPAC): A mixed methods study informed by the COM-B model

Purpose While the benefits of physical activity (PA) during cancer are well known, people undergoing chemotherapy are insufficiently active. This study aims to understand the experiences of PA throughout chemotherapy (EPAC). Methods The EPAC study used a mixed methods design informed by the capability, opportunity, motivation-behaviour (COM-B) model. Participants currently undergoing outpatient chemotherapy for the treatment of cancer, their carers or cancer care clinicians participated in a semi-structured interview or focus group and a questionnaire. The Godin-Shepard Leisure-Time Questionnaire identified current and pre-chemotherapy PA levels. Qualitative data were analysed using reflexive thematic analysis, and deductively mapped to the COM-B. Descriptive analysis was used for quantitative data. Results Despite 91 % of people undergoing chemotherapy expressing a desire to be more active, only 17 % were classified as 'active'. Additionally, 78 % of participants reported a decrease in PA during chemotherapy. Ten focus groups and 37 interviews were completed with 40 clinicians, 23 patients, and ten carers. From these, eight themes were developed: PA is part of life; All too much; Physical capacity; Inconsistent education; A desire for PA to be integrated; Tailored access to services; Organisational design and resources; and Workforce sustainability. Subthemes mapped to all components of the COM-B framework. Conclusion Overall, people undergoing chemotherapy wanted to be more active. Experiences across the groups emphasise the need for increased support to improve opportunities, capability and motivation for PA. These findings demonstrate the need for changes to clinical practice to embed PA into routine chemotherapy care through models that reflect the realities of treatment and its side effects, the workforce, and service design.