Exercise preferences, barriers, and facilitators of individuals with cancer undergoing chemotherapy prior to stem cell transplantation: A mixed- methods study

Background: Exercise can help to mitigate side effects of hematopoietic stem cell transplantation (HSCT), particularly when initiated prior to HSCT. However, the exercise-related barriers, facilitators, and preferences of this patient population remain unclear. This study aimed to explore the patient experience in order to inform future implementation of a prehabilitation intervention.
Methods: A sequential explanatory mixed methods study was conducted in two phases: (1) cross-sectional survey, and (2) focus groups. Survey questions were framed to align 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 one; 11 went on to complete phase two. 81% (n=21) of participants reported knowing the benefits of exercise pre-HSCT, while 50% (n=13) felt they knew how to exercise safely. Only 50% (n=13) were fairly/very confident in their ability to exercise pre-HSCT. Barriers to exercise included limitations in knowledge and skills, inadequate healthcare provider support/availability, and the emotional toll of treatment. Facilitators included social support from others, and goals. Participants’ exercise preferences were related to two themes: (1) Program Structure (sub-themes: prescription, scheduling, mode of delivery); (2) Support (sub-themes: support from personnel, tailoring, education).
Conclusion: Findings suggest that exercise prehabilitation may be optimized by enhanced education, inclusion of an exercise professional in the pre-transplantation healthcare team, a virtual or hybrid delivery model, and flexible program scheduling.