Abstract
Background:Cancer is a common condition, with significant physical, psychological, economic, and social impacts. Physical activity (PA) is recommended as a standard component of cancer care; however, implementation is limited. Physical activity has immense benefits during chemotherapy, including reducing fatigue, increasing quality of life, improving physical and psychological wellbeing and improving side effects. It may also improve hospitalisation rates, length of stay, treatment tolerance, and mortality rates. There is limited research examining physical activity participation during chemotherapy, as well as interventions designed to improve physical activity levels during treatment. The barriers and experiences of PA during chemotherapy are poorly understood. Understanding these factors is essential to improving clinical practice.
Objective:
This thesis aimed to identify whether adults undergoing chemotherapy are participating in sufficient aerobic and resistance PA, and understand the barriers and experiences that impact PA behaviours. This thesis aimed to provide practical and clinically-relevant recommendations to increase PA in people undergoing chemotherapy.
Methodology:
This thesis consists of five studies. Systematic review one evaluated the participation in PA during chemotherapy and evaluated interventions designed to improve PA. A second systematic review was used to understand the barriers to PA during chemotherapy. For each, eight databases were searched, and eligible articles were assessed for risk of bias using appropriate tools. Results were presented narratively. Barriers were analysed using reflexive thematic analysis, and deductively mapped to the Capability, Opportunity, Motivation– Behaviour (COM-B) model.
Three studies had a local lens. Firstly, to understand local PA levels, barriers and education, a cross-sectional survey was completed with 111 adults undergoing outpatient chemotherapy across the Australian Capital Territory (ACT), Australia. Secondly, a mixed methods design informed by the COM-B model was used to understand the experiences of PA during chemotherapy (EPAC). Twenty-three adults undergoing chemotherapy in the ACT, ten carers and 40 clinicians participated in an 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. Finally, a secondary analysis of the EPAC study extracted barriers to PA and PA support; which were mapped to the behaviour change wheel and socio-ecological model to design recommendations to embed PA into chemotherapy care.
Results:
Unsurprisingly, most people undergoing chemotherapy do not meet PA guidelines. The systematic review found that participants in interventions typically maintained their PA, whereas people in control groups demonstrated declines in PA levels. This aligned with ACT PA levels, with only 12-17% of people undergoing chemotherapy considered ‘active’. Importantly, 91% of people wanted to be more active, and over half wanted more PA education. Barriers to PA in the literature generally aligned with those across the cancer continuum, however, the nuances were specific to chemotherapy, with many barriers existing at an organisational level. Eight themes explained the experiences of PA in the ACT: Physical capability; All too much; PA is part of life; Inconsistent education; Tailored access; A desire for integrated PA; Organisational barriers and resources; and Workforce sustainability. Fifty-four barriers were identified, with a significant number of these at an organizational level. Two interventions were recommended to embed PA into chemotherapy care and address these barriers: 1) organisation-led training to build skills, knowledge and confidence of PA in the primary chemotherapy team; and 2) integrate exercise specialists into multidisciplinary chemotherapy team.
Conclusion:
Integrating PA into chemotherapy is a complex process, but strongly desired by consumers and clinicians. Two organisation-led recommendations have been identified and described through a systematic, theoretically-driven process. Embedding exercise specialists into multidisciplinary teams, and increasing the skills and knowledge of the primary cancer team will support PA to be integrated into standard care and fill a critical gap in practice, improving the lives of those undergoing chemotherapy.
| Date of Award | 2026 |
|---|---|
| Original language | English |
| Supervisor | Stuart SEMPLE (Supervisor), Nicole FREENE (Supervisor) & Kellie TOOHEY (Supervisor) |
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