title: Insights into the reluctance of patients with late-stage cancer to adopt exercise as a means to reduce their symptoms and improve their function.
abstract: BACKGROUND
  Exercise reduces cancer-related disablement and adverse symptoms, yet patients' attitudes toward exercise remain largely unexamined.
  
  
  OBJECTIVE
  This qualitative study sought to characterize the beliefs of patients with late-stage disease regarding exercise, its relationship to their symptoms, and their clinicians' roles in providing related counseling.
  
  
  METHODS
  Semistructured interviews with 20 adults (half male and half aged 65 years or older) with Stage IIIB or IV nonsmall cell lung cancer were qualitatively analyzed. Participants were questioned about their levels of activity, the influence of their symptoms on their activities, perceived barriers and facilitators for exercise, and exercise-related instructions received from their professional caregivers.
  
  
  RESULTS
  Participants overwhelmingly cited usual daily activities as their source of "exercise." Symptoms, particularly treatment-related, discouraged participation, with fear of harm being a significant concern only among younger women. Exercise was recognized as important for physical and mental well-being but seldom as a means to mitigate symptoms. Weather, recalled levels of premorbid fitness, and exercise participation modulated current exercise behaviors. Although respondents preferred to receive guidance from their oncologist, none reported receiving more than general encouragement to "stay active." A lack of direction was typically accepted as a sanction of their current activity levels. Participants appeared less receptive to guidance from ancillary health professionals.
  
  
  CONCLUSIONS
  Effective use of exercise and activity modification to ameliorate cancer-related symptoms appears to require a linkage to a patient's usual and past activities, proactive negotiation of potential barriers, education regarding symptoms and exercise, and the positive support of their oncologist.
authors: Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota 55905, USA. Cheville.andrea@mayo.edu
authors: Andrea L
authors: AL
authors: Cheville
authors: Ann Marie
authors: AM
authors: Dose
authors: Jeffrey R
authors: JR
authors: Basford
authors: Lori M
authors: LM
authors: Rhudy
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D004644:Emotions; D015444:Exercise / Q000523:psychology*; D005239:Fear; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology / Q000534:rehabilitation*; D036301:Qualitative Research