DETERMINANTS OF PHYSICAL ACTIVITY MAINTENANCE AND ACCEPTABILITY OF A REMOTE COACHING INTERVENTION FOLLOWING SUPERVISED EXERCISE ONCOLOGY REHABILITATION: A QUALITATIVE STUDY

A.T. Weemaes^1,2, J.M. Sieben^2,3, M. Beelen^1,4, L.T. Mulder^1,2, A.F. Lenssen^1,2

¹Maastricht University Medical Centre+, Department of Physiotherapy, Maastricht, Netherlands, ²Maastricht University, Care and Public Health Research Institute (CAPHRI), Maastricht, Netherlands, ³Maastricht University, Department of Anatomy and Embryology, Maastricht, Netherlands, ⁴Maastricht University, Department of Human Biology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht, Netherlands

Background: Regular physical activity (PA) results in positive health outcomes in survivors of cancer. A supervised rehabilitation program is a way to increase PA, but patients experience difficulties with PA maintenance beyond completion of such programs. In order to improve this, it is necessary to get insight in factors that influence PA behaviour during this transition period. Remote interventions are promising in the delivery of lifestyle interventions in survivors of cancer and are expected to improve PA maintenance following supervised rehabilitation. Even when effective, implementation of such interventions is only likely to succeed when they are acceptable for the target population.

Purpose: To investigate perceived determinants of PA maintenance following supervised exercise oncology rehabilitation and the acceptability of a remote coaching intervention.

Methods: A phenomenological qualitative study with semi-structured interviews was conducted. Participants were recruited from the intervention group and control group of a randomized controlled trial (RCT) on the effectiveness of remote coaching following a 10-week supervised exercise oncology rehabilitation program at the Maastricht University Medical Centre+, until data saturation was reached. Participants in the intervention group received a 6-month remote coaching intervention after completing the exercise program, aimed at stimulating PA maintenance. During a physical intake appointment, the coach gave individually tailored exercise advice. After the intake, the program consisted of remote coaching, via phone calls or e-mails. Interviews were based on the Capability, Opportunity, and Motivation model of Behaviour (COM-B model) and the framework of acceptability (TFA) and analysed using template analysis.

Results: Nineteen participants were included (16 women/3 men). All participants answered questions about determinants for PA maintenance. Twelve partcicipants (63%) received the coaching intervention and answered questions about the acceptability of this intervention. Structure and routine emerged as important enablers for PA maintenance and were dependent on the patients’ social environment and prior PA habits. Self-efficacy was another major theme. Positive beliefs about and experiences with exercise were perceived to increase self-efficacy. The remote coaching intervention was generally acceptable to the study population. Participants appreciated the personal attention which was a source of social support and it made them feel confident about performing PA. Some participants would have preferred face-to-face appointments instead of phone calls.

Conclusions: PA should be incorporated in daily life and could potentially be supported by (remote) appointments with others, to optimize long-term PA maintenance in survivors of cancer. This seems easier for patients with a history of exercise. When patients do not have properties of self-efficacy, it still remains difficult to maintain PA levels. A remote coaching intervention following supervised rehabilitation was perceived acceptable and effective to improve PA maintenance. Future studies should focus on identifying survivors of cancer at risk for turning inactive after rehabilitation, choosing appropriate methods to reach these patients, and determining personalized follow-up interventions for patients with different needs.

Implications: Looking at the current results and previous studies, it should be recommended to add personalized guidance for long-term PA maintenance to supervised exercise oncology programs. Interventions for PA maintenance should focus on habit-forming and improving self-efficacy.

Funding acknowledgements: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Keywords:
Physical activity behaviour
Qualitative research
Intervention acceptability

Topics:
Oncology, HIV & palliative care
Disability & rehabilitation
Health promotion & wellbeing/healthy ageing/physical activity

Did this work require ethics approval? Yes

Institution: Maastricht University Medical Centre+

Committee: Medical Ethics Committee azM/UM

Ethics number: registration number 18-050