br Journal of Geriatric Oncology xxx xxx br Contents lists
Journal of Geriatric Oncology xxx (2019) xxx
Contents lists available at ScienceDirect
Journal of Geriatric Oncology
Barriers and facilitators of adherence to a perioperative physical activity intervention for older adults with cancer and their family caregivers
Virginia Sun a, , Dan J. Raz b, Jae Y. Kim b, Laleh Melstrom b, Sherry Hite c, Gouri Varatkar c, Yuman Fong b
a Department of Population Sciences, United States of America
b Department of Surgery, United States of America
c Department of Rehabilitation, City of Hope, Duarte, CA, United States of America
Received in revised form 31 May 2019 Accepted 5 June 2019 Available online xxxx
Purpose: Perioperative physical activity behavior change in older adults with cancer is complex. Identifying the barriers and facilitators to physical activity before and after surgery can help predict adherence and optimize outcomes. We aimed to determine the barriers and facilitators of adherence to a perioperative physical activity intervention in older adults with lung and gastrointestinal (GI) cancers and their family caregivers (FCGs).
Methods: A qualitative analysis of physical therapy/occupational therapy (PT/OT) baseline geriatric/functional assessment and intervention sessions notes were undertaken (N = 34 dyads). Written text documents (N = 6 independent PT/OT notes per dyad) were transcribed into a spreadsheet for coding and thematic analysis. Content analysis qualitative approach was used to identify themes and guide data interpretation.
Results: Ten themes for barriers and five themes for facilitators emerged, reflecting barriers to and facilitators of perioperative physical activity adherence. Primary barriers to adherence included comorbid health conditions, physical symptoms, functional limitations, anxiety, other roles and responsibilities, unexpected life events, lack of time and motivation, not accustomed to physical activity, and environment/weather. Facilitators that Artesunate enabled intervention adherence included physical activity as part of routine, coping strategies, setting goals for motiva-tion, social/family support, and experiencing benefits from walking. Conclusions: Barriers and facilitators to a perioperative physical activity is multidimensional, and focused on social-ecological determinants of health behaviors, including intrapersonal, interpersonal, and environmental factors. Perioperative physical activity interventions for older adults with cancer and their FCGs should integrate strategies to promote self-efficacy, support realistic activity goals, enhance motivation, and optimize social support.
Cancer is a disease of aging, and older adults are disproportionately affected . Older adults face a number of barriers Nonreplicative transposition affect mobility and functional capacity. These include multi-morbidity, frailty, and persistent physical and psychological symptoms that impairs an individual's ability to engage in physical activity. Cancer treatments, in-cluding surgery, can abruptly decrease a patient's physiologic reserve . Evidence suggests that older adults with cancer are at greater risk for postoperative functional decline and poor outcomes . Geriatric assessment domains, including functional activity, dependency with ac-tivities of daily living (ADL), and severe frailty were associated with major postoperative complications . Loss of independence, defined
Corresponding author at: Division of Nursing Research and Education, Department of Population Sciences, City of Hope, 1500 East Duarte Road, Duarte, CA 91010, United States of America.
as decline in function or mobility, is associated with postoperative readmissions and post-discharge mortality in older adults [5,6].
Physical activity is an evidence-based approach to enhance physical, cognitive, and emotional quality of life (QOL) for cancer patients . Mounting evidence points to the positive benefits of physical activity on functional health and overall survival. Despite these well-known benefits, older adults remain the least active age group, with less than a third meeting recommended physical activity levels [8–11]. Physical activity behavior change is complicated, and adherence to physical ac-tivity is driven by intrapersonal, interpersonal, environmental, and structural factors . In lung cancer patients, symptoms, comorbidi-ties, sedentary lifestyle, mood/fear, and the environment are multidi-mensional barriers to physical activity and exercise .
Social support is recognized as a positive determinant of physical ac-tivity participation in cancer patients. Family caregivers (FCGs) are a major source of social support, and play a significant role in the direct care of cancer patients . FCGs may influence patient physical activity adoption and maintenance by serving as role models and motivators.