Fatigue, barriers to physical activity and predictors for motivation to exercise in advanced Cancer patients

Abstract

Background: In order to counteract fatigue, physical activity (PA) is recommended for all stages of cancer. However, only few advanced cancer patients (ACP) are physically active. Quantitative data with high numbers of ACP reporting barriers to PA are missing. This study aimed to identify barriers to PA in ACP with tiredness/weakness and investigate their motivation towards it. Methods: Outpatients with metastatic cancer receiving cancer care at a German Cancer Center reporting moderate/severe tiredness/weakness during self-assessment (MIDOS II) were enrolled. We assessed Fatigue-(FACF-F) and Depression (PHQ8) Scores, demographics, cancer-specific parameters, motivation for PA, physical, psychological and social barriers. Results: 141 of 440 eligible patients (32.0%) with different diagnoses agreed to participate. Patients frequently reported "I feel weakened due to my tumor therapy" (n = 108; 76.6%), physical symptoms (tiredness, weakness, dyspnea, joint-problems, pain, nausea [n = 107; 75.9%]) and fatigue (n = 99; 70.2%) as barriers to PA. However, no significant group differences regarding these barriers were found between physically active and inactive patients. Social barriers were rarely chosen. Motivated patients were 5.6 times more likely to be physically active (p < 0.001), also motivation turned out to be the strongest predictor for a physically active behavior (β = 1.044; p = 0.005). Motivated attitude towards PA was predicted by fatigue (β = − 2.301; p = 0.008), clinically relevant depression (β = − 1.390, p = 0.039), knowledge about PA and quality of life (QoL) (β = 0.929; p = 0.002), PA before diagnosis (β = 0.688; p = 0.005 and Interest in exercise program (β = 0.635; p = 0.008). Conclusion: "I feel weakened due to my tumor therapy" is the most reported barrier to PA among both, physically and inactive patients. Motivation for PA is the strongest predictor of performing PA. Interest in PA, knowledge about PA/ QoL and PA before diagnosis are main predictors of a motivated attitude. Absence/presence of social barriers did not associate with motivation, fatigue and depression proved to be a negative predictor. Programs including information, motivational counseling and individualized training should be offered for ACP to overcome barriers and reduce fatigue.

Factors influencing physical activity participation among people living with or beyond cancer: a systematic scoping review

“…Studies revealed that cancer and its related treatment’s side effects acted as a significant physiological barrier to PA participation among patients across cancer types and treatment stages (Table 4 ). In five cross-sectional studies, about 70–80% of mixed cancer patient participants at different treatment stages reported that cancer therapy-related adverse effects hindered their PA engagement [ 18 , 20 , 21 , 25 , 48 ]. The most common and significant side effects reported by mixed cancer patients were fatigue, gastrointestinal issues and joint pain.…”

“…The most prevalent co-morbidities reported by cancer patients included arthritis, diabetes and heart disease. Cross-sectional studies by Bluethmann et al [ 121 ] and Frikkel et al [ 18 ] showed that comorbidity was a significant negative predictor of PA levels among mixed cancer patients.…”

“…Likewise, two American cross-sectional surveys of survivors of different cancers revealed a low self-reported adequate PA participation (around 30%) [ 16 , 17 ]. A cross-sectional survey by Frikkel et al [ 18 ] also revealed that only 22% of cancer patients in Germany were physically active. Only 15% of Australian cancer survivors engaged in sufficient PA compared to 45% of the general population [ 19 ].…”

Influence of ballroom dancing on fatigue, body image, self-efficacy, and endurance of cancer patients and their partners

“…Fatigue is the most frequent adverse event reported in cancer patients with over 90% [ 3 ] and has been shown to be a consequence of active treatment, but it may also persist long term into post-treatment periods [ 4 ]. To improve fatigue the National Comprehensive Cancer Network guidelines recommends non-pharmacological interventions such as physical activity (PA) for all stages of cancer.…”

“…Furthermore, the influence of PA was assessed and highlighted as a possible approach to improve patients QoL [ 12 , 13 ]. Despite the benefits, lack of motivation, physical symptoms, fatigue and lack of time are often barriers to PA [ 3 , 14 ]. Therefore, it is highly important to develop interventions that are feasible and empower the patients to adhere to recommendations of PA. An important concept in the empowerment of patients is the model of self-efficacy [ 15 , 16 ].…”