br Some informants already used pedometers or
Some informants already used pedometers or activity trackers to monitor daily activity. Goal-setting and tracking progress were identi-fied as highly motivating strategies that could support long-term mo-tivation.
“I remember it from the time after my EPZ-6438 attack. I kept setting small goals. And by setting small and achievable goals, I was able to succeed. Achievable goals are very important, because then you get successful experiences” (ID 20, 72-year-old male with biliary tract cancer)
3.6. Familiarity raises confidence and motivation
The informants suggested several types of exercise activities. Some informants would prefer exercise that targeted their current needs. For example, cardiovascular training was preferred by some informants who experienced shortness of breath. Other informants who had ex-perienced loss of strength and who struggled with daily activities pre-ferred resistance training. However, the overriding picture that ap-peared from the interviews was that the informants preferred activities that they had previously engaged in and were familiar with. Therefore, exercise preferences varied and included team-based activities with light to moderate intensity aerobic and strength training, walking, cy-cling, badminton and tennis. Talking about former activities and ex-ercise memories brought enthusiasm and excitement to the informants.
“Another thing that I wished I could do is bicycling. I used to bicycle with my friend and my brother. We could bike 60 km in a day, right. We brought some food, drinks and coﬀee. And then we rode to the woods, and walked in the hills” (ID 21, 82-year-old male with biliary tract cancer)
This study explored attitudes towards and experiences with PA and exercise in older patients with advanced cancer during oncological treatment. We found that PA was viewed as a positive self-management strategy during oncological treatment. However, the informants de-scribed that their level of PA had declined after cancer diagnosis, and that staying active was a struggle. Challenges in maintaining PA during cancer treatment have also been documented in prior studies (Dahele et al., 2007; Devoogdt et al., 2010; Granger et al., 2016; Lynch et al., 2007; Midtgaard et al., 2009). In a prospective cohort study, Fassier et al. (2016) investigated levels of PA before and after a cancer diag-nosis among 942 adults. It was found that the PA level decreased after diagnosis, especially among older subjects (≥ 60 years) (Fassier et al., 2016). Despite demonstrated decline in PA during anti-cancer treat-ment, prior research has also shown that most patients with cancer have a positive perception of exercise, and that many have a desire to in-crease their level of PA (Clark et al., 2007; Midtgaard et al., 2009).
Only one informant in the current study expressed fear that exercise could be potentially harmful, and this was specifically focused on the risk of weight loss. These results are in contrast with findings from a qualitative study by Lees et al. (2005), where barriers towards exercise behavior were investigated in 66 older adults (≥ 65 years) through focus-group interviews with exercisers and with non-exercisers, re-spectively. Fear of falling and/or getting injured was the most sig-nificant barrier among non-exercisers, whereas this fear was not ex-pressed among the informants who exercised regularly (Lees et al.,
2005). Hence, current exercise habits could explain the diﬀerences in study results. However, the informants in our study were a relatively even sample of experienced and non-experienced exercisers. But in contrast to the study by Lees et al. (2005), the informants in our study were seriously ill with advanced cancer, and it may be that having advanced cancer and going through oncological treatment simply overshadows other age-related fears of exercise behavior. However, as problems related to balance, bones and joints, and risk of falling are highly associated with older age (Klepin, 2015; Wildes et al., 2015), HCPs must take patients’ concerns about falling seriously, and exercises for balance and strength should be incorporated in exercise programs to reduce the risk of falling.
Several barriers to PA and exercise were expressed in our study. Primarily, fatigue was described as a major barrier. This finding is not surprising, as cancer-related fatigue (CRF) is the most frequently oc-curring symptom during anti-cancer treatment with prevalence rates ranging from around 25%–100% depending on cancer stage, diagnosis, treatment and assessment method (Berger et al., 2015; Weis, 2011). As evidence suggests that exercise can reduce CRF in patients with cancer (Puetz and Herring, 2012), HCPs should inform patients about these potential eﬀects, which may increase patients’ motivation for ex-ercising. In addition, future exercise programs could incorporate edu-cation or counseling on fatigue management to increase adherence to exercise programs.