Journal of Cancer Survivorship

, Volume 12, Issue 6, pp 744–752 | Cite as

Barriers to physical activity: a study of academic and community cancer survivors with pain

  • Sally A. D. Romero
  • Justin C. Brown
  • Joshua M. Bauml
  • Jennifer L. Hay
  • Q. Susan Li
  • Roger B. Cohen
  • Jun J. Mao



Despite the numerous benefits of physical activity (PA) for patients with cancer, many cancer survivors report challenges to participating in PA. The objectives of this study were (1) to assess barriers to PA and (2) to examine participant characteristics associated with modifiable barriers to PA among cancer survivors with pain.


We conducted a cross-sectional survey study at one academic medical center and 11 community hospitals. Participants completed the 12-item Physical Activity Barriers After Cancer (PABAC) instrument (Cronbach’s alpha = 0.75). Multivariable regression models examined participant characteristics associated with PABAC scores with a higher score indicating more barriers to PA.


Among 662 survivors, 67% had moderate or severe pain (rating 4 or greater on a scale of 0 to 10). Seventy-five percent of survivors did not meet the American Cancer Society PA recommendations on average, and these individuals had higher mean PABAC scores (beta coefficient (β) = 2.02, 95% confidence interval (CI) 0.96–3.09, p < 0.001). In adjusted analyses, cancer survivors who were non-white (β = 1.55, 0.28–2.82, p = 0.02), treated at a community hospital (β = 1.07, 0.09–2.05, p = 0.03), had surgery (β = 1.69, 0.69–2.69, p = 0.001), or within 12 months of diagnosis (β = 1.15, 0.20–2.10, p = 0.02) reported greater barriers to PA.


The majority of cancer survivors with pain are not adequately participating in PA. Key demographic and clinical characteristics are associated with survivors’ barriers.

Implications for Cancer Survivors

Efforts to overcome specific barriers are needed to promote PA after a cancer diagnosis.


Physical activity Barriers Cancer survivors Pain 



The authors would like to thank the cancer survivors, oncologists, nurses, and clinical staff at all study sites for their contributions to this study.

Funding information

Research related to the development of this paper was supported in part by the National Cancer Institute grants to the University of Pennsylvania Abramson Cancer Center (2P30CA016520-40) and the Memorial Sloan Kettering Cancer Center (3P30CA008748-50; 5T32CA9461-32), and the Translational Research and Integrative Medicine Fund at Memorial Sloan Kettering Cancer Center.

Compliance with ethical standards

The institutional review board of the University of Pennsylvania approved the study protocol and survey.

Conflict of interest

The authors declare that they have no conflict of interest. Dr. Mao has full control of all primary data and agrees to allow the journal to review the data if requested. The content is solely the responsibility of the authors and does not necessarily represent official views of the National Institutes of Health.

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

11764_2018_711_MOESM1_ESM.pdf (66 kb)
ESM 1 (PDF 66 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Memorial Sloan Kettering Cancer CenterBendheim Integrative Medicine CenterNew YorkUSA
  3. 3.Dana–Farber Cancer InstituteBostonUSA
  4. 4.Department of Medicine, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  5. 5.Department of Psychiatry and Behavioral SciencesMemorial Sloan Kettering Cancer CenterNew YorkUSA

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