Supportive Care in Cancer

, Volume 27, Issue 5, pp 1729–1736 | Cite as

‘A good stepping stone to normality’: a qualitative study of cancer survivors’ experiences of an exercise-based rehabilitation program

  • Amy M. DennettEmail author
  • Casey L. Peiris
  • Nicholas F. Taylor
  • Melissa S. Reed
  • Nora Shields
Original Article



Exercise-based rehabilitation is not routinely offered to patients. We explored the experience of cancer survivors completing an exercise-based cancer rehabilitation program with and without motivational interviewing.


A qualitative study using semi-structured interviews and thematic analysis was completed with a purposive sample of 26 cancer survivors (n = 17 female, n = 18 post-treatment) participating in cancer rehabilitation at a tertiary hospital. Interviews were recorded and transcribed verbatim. Coding was completed by two reviewers independently and confirmed by a third reviewer.


The main theme that emerged was exercise-based rehabilitation facilitated a return to normality after diagnosis which included positive changes in physical activity behaviour. Sub-themes were that rehabilitation is person-centred, challenges expectations, empowering and facilitated by expert staff. Common themes emerged whether participants received additional motivational interviewing or not. However, participants who received motivational interviewing were more likely to report feeling accountable for their physical activity levels. Transition to ongoing independent physical activity remained a challenge for some people who did not feel empowered or socially supported.


Exercise-based cancer rehabilitation is important in facilitating ‘return to normal’ including increased participation in physical activity. To challenge expectations and to empower cancer survivors, rehabilitation programs should be person-centred and led by expert staff.


Cancer Rehabilitation Physical activity Exercise 



This work was supported by a collaborative grant between La Trobe University and Eastern Health. Author AD is supported by an Australian Government Research Training Program Scholarship.

Compliance with ethical standards

The research team have full control of all primary data. The journal will be unable to access the data as it involves individual transcripts of participants, as per our ethical approval.

Conflict of Interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Chasen MR, Jacobsen PB. Rehabilitation in cancer. In: Olver (ed) the MASCC textbook of cancer supportive care and survivorship: multinational Association for Supportive Care in Cancer society; 2011Google Scholar
  2. 2.
    McCorkle R, Ercolano E, Lazenby M, Schulman-Green D, Schilling LS, Lorig K et al (2011) Self-management: enabling and empowering patients living with cancer as a chronic illness. CA: Can J Clin 61:50–62Google Scholar
  3. 3.
    Pinto BM, Trunzo JJ (2005) Health behaviours during and after a cancer diagnosis. Cancer 104:614–623CrossRefGoogle Scholar
  4. 4.
    Cormie P, Zopf EM, Zhang X, Schmitz KH (2017) The impact of exercise on cancer mortality, recurrence, and treatment-related adverse effects. Epidemiol Rev 39:1–22. CrossRefGoogle Scholar
  5. 5.
    Stout NL, Baima J, Swisher AK, Winters-Stone KM, Welsh J (2017) A systematic review of exercise systematic reviews in the cancer literature (2005-2017). PM R 9:S347–s384. CrossRefGoogle Scholar
  6. 6.
    Friedenreich CM, Neilson HK, Farris MS, Courneya KS (2016) Physical activity and cancer outcomes: a precision medicine approach. Clin Cancer Res 22:4766–4775. CrossRefGoogle Scholar
  7. 7.
    Midtgaard J, Hammer NM, Andersen C, Larsen A, Bruun DM, Jarden M (2015) Cancer survivors' experience of exercise-based cancer rehabilitation - a meta-synthesis of qualitative research. Acta Oncol 54:609–617CrossRefGoogle Scholar
  8. 8.
    Silver JK, Raj VS, Fu JB, Wisotzky EM, Smith SR, Kirch RA (2015) Cancer rehabilitation and palliative care: critical components in the delivery of high-quality oncology services. Support Care Cancer 23:3633–3643CrossRefGoogle Scholar
  9. 9.
    McGrath P, Joske D, Bouwman M (2010) Benefits from participation in the chemo club: psychosocial insights on an exercise program for cancer patients. J Psychosoc Oncol 29:103–119CrossRefGoogle Scholar
  10. 10.
    Dennett AM, Peiris CL, Shields N, Morgan D, Taylor NF (2017) Exercise therapy in oncology rehabilitation in Australia: a mixed-methods study. Asia Pac J Clin Oncol 13:e515–e527CrossRefGoogle Scholar
  11. 11.
    Thraen-Borowski KM, Gennuso KP, Cadmus-Bertram L (2017) Accelerometer-derived physical activity and sedentary time by cancer type in the United States. PLoS One 12:e0182554. CrossRefGoogle Scholar
  12. 12.
    Bourke L, Homer KE, Thaha MA, Steed L, Rosario DJ, Robb KA, et al (2013) Interventions for promoting habitual exercise in people living with and beyond cancer. Cochrane Database Syst Rev 9:Cd010192Google Scholar
  13. 13.
    Spencer JC, Wheeler SB (2016) A systematic review of motivational interviewing interventions in cancer patients and survivors. Patient Educ Couns 99:1099–1105CrossRefGoogle Scholar
  14. 14.
    Stacey FG, James EL, Chapman K, Courneya KS, Lubans DR (2015) A systematic review and meta-analysis of social cognitive theory-based physical activity and/or nutrition behavior change interventions for cancer survivors. J Cancer Surviv 9:305–338CrossRefGoogle Scholar
  15. 15.
    Dennett AM, Shields N, Peiris CL, Reed MS, O'Halloran PD, Taylor NF (2017) Does psychoeducation added to oncology rehabilitation improve physical activity and other health outcomes? A systematic review. Rehabil Oncol 35:61–71CrossRefGoogle Scholar
  16. 16.
    Courneya KS, Rogers LQ, Campbell KL, Vallance JK, Friedenreich CM (2015) Top 10 research questions related to physical activity and cancer survivorship. Res Q Exerc Sport 86:107–116CrossRefGoogle Scholar
  17. 17.
    Bowling A (2014) Research methods in health: investigating health and health services. In: Keynes M (ed) Open University press. Philidelphia, BuckinghamGoogle Scholar
  18. 18.
    Pfeiffer E (1975) A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geri Soc 23:433–441CrossRefGoogle Scholar
  19. 19.
    Liamputtong P (2013) Qualitative research methods, 4th edn. Oxford University Press, MelbourneGoogle Scholar
  20. 20.
    Johnson R, Waterfield J (2004) Making words count: the value of qualitative research. Physiother Res Int 9:121–131CrossRefGoogle Scholar
  21. 21.
    Floyd A, Moyer A (2009) Group vs. individual exercise interventions for women with breast cancer: a meta-analysis. Health Psychol Rev 4:22–41. CrossRefGoogle Scholar
  22. 22.
    Wortman CB, Dunkel-Schetter C (1979) Interpersonal relationships and cancer: a theoretical analysis. J Soc Issues 35(1):120–155CrossRefGoogle Scholar
  23. 23.
    Andrykowski MA, Lykins E, Floyd A (2008) Psychological health in cancer survivors. Semin Oncol Nurs 24:193–201. CrossRefGoogle Scholar
  24. 24.
    Estabrooks PA (2000) Sustaining exercise participation through group cohesion. Exerc Sport Sci Rev 28:63–67Google Scholar
  25. 25.
    Burke SM, Carron AV, Eys MA, Ntoumanis N, Estabrooks PA (2006) Group versus individual approach? A meta-analysis of the effectiveness of interventions to promote physical activity. Sport Exerc Psych Rev 2:19–35Google Scholar
  26. 26.
    Bandura A (1997) Self-efficacy: the exercise of control. W.H. Freeman, New YorkGoogle Scholar
  27. 27.
    American College of Sports Medicine (ACSM) (2018) In: Riebe D, Ehrman JK, Liguori G, Magal M (eds) Guidelines for exercise testing and prescription, 10th edn. Wolters Kluwer Health, Philadelphia, PAGoogle Scholar
  28. 28.
    Schmidt MLK, Ostergren P, Cormie P, Ragle AM, Sonksen J, Midtgaard J (2018) "kicked out into the real world": prostate cancer patients' experiences with transitioning from hospital-based supervised exercise to unsupervised exercise in the community. Support Care Cancer.
  29. 29.
    Fox LD, Rejeski WJ, Gauvin L (2000) Effects of leadership style and group dynamics on enjoyment of physical activity. Am J Health Promot 14:277–283CrossRefGoogle Scholar
  30. 30.
    Van Cappellen P, Rice EL, Catalino LI, Fredrickson BL (2018) Positive affective processes underlie positive health behaviour change. Psychol Health 33:77–97. CrossRefGoogle Scholar
  31. 31.
    Peiris CL, Taylor NF, Shields N (2012) Patients value patient-therapist interactions more than the amount or content of therapy during inpatient rehabilitation: a qualitative study. J Physiother 58:261–268. CrossRefGoogle Scholar
  32. 32.
    Wain HR, Kneebone II, Billings J (2008) Patient experience of neurologic rehabilitation: a qualitative investigation. Arch Phys Med Rehabil 89:1366–1371. CrossRefGoogle Scholar
  33. 33.
    Sweegers MG, Altenburg TM, Chinapaw MJ, Kalter J, Verdonck-de Leeuw IM, Courneya KS, Newton RU, Aaronson NK, Jacobsen PB, Brug J, Buffart LM (2018) Which exercise prescriptions improve quality of life and physical function in patients with cancer during and following treatment? A systematic review and meta-analysis of randomised controlled trials. Br J Sports Med 52:505–513. CrossRefGoogle Scholar
  34. 34.
    Henriksson A, Arving C, Johansson B, Igelstrom H, Nordin K (2016) Perceived barriers to and facilitators of being physically active during adjuvant cancer treatment. Patient Educ Couns 99:1220–1226. CrossRefGoogle Scholar
  35. 35.
    Rimmer J, Lai B (2017) Framing new pathways in transformative exercise for individuals with existing and newly acquired disability. Disabil Rehabil 39:173–180. CrossRefGoogle Scholar
  36. 36.
    Michie S, van Stralen MM, West R (2011) The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci 6:42. CrossRefGoogle Scholar
  37. 37.
    Bennett JA, Lyons KS, Winters-Stone K, Nail LM, Scherer J (2007) Motivational interviewing to increase physical activity in long-term cancer survivors: a randomized controlled trial. Nurs Res 56:18–27CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Allied Health Clinical Research Office, Eastern HealthBox HillAustralia
  2. 2.School of Allied HealthLa Trobe UniversityBundooraAustralia
  3. 3.Allied Health, Northern HealthEppingAustralia

Personalised recommendations