title: Understanding factors influencing physical activity and exercise in lung cancer: a systematic review.
abstract: Despite evidence and clinical practice guidelines supporting physical activity (PA) for people with lung cancer, this evidence has not translated into clinical practice. This review aims to identify, evaluate and synthesise studies examining the barriers and enablers for patients with lung cancer to participate in PA from the perspective of patients, carers and health care providers (HCPs).
  
  
  
  Systematic review of articles using electronic databases: MEDLINE (1950-2016), CINAHL (1982-2016), EMBASE (1980-2016), Scopus (2004-2016) and Cochrane (2016). Quantitative and qualitative studies, published in English in a peer-reviewed journal, which assessed the barriers or enablers to PA for patients with lung cancer were included. Registered-PROSPERO (CRD4201603341).
  
  
  
  Twenty-six studies (n = 9 cross-sectional, n = 4 case series, n = 11 qualitative) including 1074 patients, 23 carers and 169 HCPs were included. Barriers and enablers to PA were identified (6 major themes, 18 sub-themes): Barriers included patient-level factors (physical capability, symptoms, comorbidities, previous sedentary lifestyle, psychological influences, perceived relevance), HCP factors (time/knowledge to deliver information) and environmental factors (access to services, resources, timing relative to treatment). Enablers included anticipated benefits, opportunity for behaviour change and influences from HCPs and carers.
  
  
  
  This systematic review has identified the volume of literature demonstrating that barriers and enablers to PA in lung cancer are multidimensional and span diverse factors. These include patient-level factors, such as symptoms, comorbidities, sedentary lifestyle, mood and fear, and environmental factors. These factors should be considered to identify and develop suitable interventions and clinical services in attempt to increase PA in patients with lung cancer.
authors.affiliation: Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Building, 161 Barry Street, Parkville, VIC, 3010, Australia. catherine.granger@unimelb.edu.au.|Department of Physiotherapy, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC, 3050, Australia. catherine.granger@unimelb.edu.au.|Institute for Breathing and Sleep, Bowen Centre, 145 Studley Road, Hiedelberg, VIC, 3084, Australia. catherine.granger@unimelb.edu.au.
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Granger
authors.affiliation: Guy's and St. Thomas' NHS Foundation Trust and King's College London National Institute of Health Research Biomedical Research Centre, Strand, London, WC2R 2LS, UK.|Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.|Centre of Human and Aerospace Physiological Sciences, King's College London, Strand, London, WC2R 2LS, UK.
authors.forename: Bronwen
authors.initials: B
authors.lastname: Connolly
authors.affiliation: Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Building, 161 Barry Street, Parkville, VIC, 3010, Australia.|Institute for Breathing and Sleep, Bowen Centre, 145 Studley Road, Hiedelberg, VIC, 3084, Australia.
authors.forename: Linda
authors.initials: L
authors.lastname: Denehy
authors.affiliation: Guy's and St. Thomas' NHS Foundation Trust and King's College London National Institute of Health Research Biomedical Research Centre, Strand, London, WC2R 2LS, UK.|Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.|Division of Asthma, Allergy and Lung Biology, King's College London, Strand, London, WC2R 2LS, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Hart
authors.affiliation: Department of Thoracic Surgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC, 3050, Australia.
authors.forename: Phillip
authors.initials: P
authors.lastname: Antippa
authors.affiliation: Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Building, 161 Barry Street, Parkville, VIC, 3010, Australia.|Department of Physiotherapy, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC, 3050, Australia.
authors.forename: Kuan-Yin
authors.initials: KY
authors.lastname: Lin
authors.affiliation: Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Building, 161 Barry Street, Parkville, VIC, 3010, Australia.
authors.forename: Selina M
authors.initials: SM
authors.lastname: Parry
mesh_terms: D003430:Cross-Sectional Studies; D015444:Exercise / Q000523:psychology*; D006801:Humans; D008175:Lung Neoplasms / Q000503:physiopathology* / Q000523:psychology*; D010465:Perception; D036301:Qualitative Research; D057185:Sedentary Behavior
keywords: Barriers; Exercise; Lung cancer; Physical activity; Systematic review