Barriers, facilitators, and preferences to exercise interventions in patients with metastatic breast cancer: A qualitative study in four European countries

ABSTRACT

Background: Exercise is a promising strategy to improve fatigue and quality of life in patients with metastatic breast cancer (MBC). However, little is known about patients’ barriers, facilitators, and preferences for supervised exercise programs. An in-depth understanding of the patients’ perspective could help to define the role of exercise professionals in this regard and support the development and implementation of successful exercise interventions. Methods: Eleven online focus groups were held, including a total of 44 participants from four European countries (DE, ESP, PL, SE). In semi-structured group sessions, patients were encouraged to discuss their reasons to participate in supervised exercise programs, experienced barriers and exercise preferences. Interviews were transcribed verbatim, translated into English, and coded based on a preliminary coding framework, supplemented by themes that emerged during the sessions. Results: Participants expressed positive attitudes towards exercise. Facilitating factors for participation in supervised programs included the benefits of social contact, professional guidance, and the experience of physical and psychological benefits. The main barriers cited were practical issues, physical limitations due to cancer and its treatment, and safety concerns due to Covid-19. Participants did not have a clear, shared preference regarding exercise type or setting, but would appreciate mixed exercises (i.e., aerobic, strength, and mind-body exercises) in flexible training modules. Individualized training programs and feedback from exercise professionals were strongly desired. Conclusions: While there was common ground regarding several barriers and facilitators, patients expressed mixed preferences for exercise programs. This related to benefits of social interaction in group exercise on the one hand, and the need for individualized tailoring to deal with physical restrictions on the other hand. Exercise professionals can play an important role in supporting exercise for MBC patients by identifying individual needs and providing training programs that are adjusted to patients' abilities and preferences. Legal entity responsible for the study Netherlands Cancer Institute / Antoni van Leeuwenhoek Hospital. Funding: European Commission Research & Innovation Horizon 2020. Disclosure A.M. May Financial Interests, Institutional, Advisory Role, Paid to institution COMPASS. K. Steindorf Financial Interests, Personal, Expert Testimony, < €5,000 Institut National contre le cancer (INCA), Paris, France;Financial Interests, Personal, Expert Testimony, Member of Data Monitoring Board;< €1,000 Swiss Group for Clinical Research (SAAK), Switzerland;Financial Interests, Personal, Invited Speaker, < €1,000 Adviva, Heidelberg, Germany, Pierre Fabre, Freiburg, Germany, Takeda, Breast Cancer Care Center, Unna, Germany, Audi Health Care Insurance, Ingolstadt, Germany, University of Mainz, Germany;Financial Interests, Personal, Invited Speaker, Lecturer fee in Master Course, < €2,000 University of Heidelberg, Germany;Financial Interests, Personal, Expert Testimony, compensation of travel costs, no further fees German Research Foundation (DFG), Bonn, Germany;Financial Interests, Personal, Expert Testimony, < €1,000 University of Vienna, Vienna, Austria. All other authors have declared no conflicts of interest.