Barriers to physical activity levels in people with cancer who are undergoing chemotherapy: a narrative systematic review with mapping to the capability, opportunity, motivation behaviour (COM-B) model

Rebecca Cesnik; Breanne Kunstler; Kellie Toohey; Nicole Freene; Stuart Semple

doi:10.1007/s00520-025-10174-9

Barriers to physical activity levels in people with cancer who are undergoing chemotherapy: a narrative systematic review with mapping to the capability, opportunity, motivation behaviour (COM-B) model

Support Care Cancer. 2025 Dec 10;34(1):20. doi: 10.1007/s00520-025-10174-9.

Authors

Rebecca Cesnik^{1

2

3}, Breanne Kunstler⁴, Kellie Toohey^{5

6}, Nicole Freene^{7

8}, Stuart Semple^{5

8

9}

Affiliations

¹ ACT Health Directorate, ACT Health GPO, Canberra City, Box 825, ACT, 2601, Australia. rebecca.cesnik@canberra.edu.au.
² Sport and Exercise Science, Faculty of Health, University of Canberra, Bruce, ACT, Australia. rebecca.cesnik@canberra.edu.au.
³ Research Institute of Sport and Exercise, University of Canberra, Bruce, ACT, Australia. rebecca.cesnik@canberra.edu.au.
⁴ Behaviour Works Australia, Monash University, Victoria, Australia.
⁵ Sport and Exercise Science, Faculty of Health, University of Canberra, Bruce, ACT, Australia.
⁶ Physical Activity, Sport and Exercise Research Theme, Faculty of Health, Southern Cross University, Lismore, Australia.
⁷ Physiotherapy, Faculty of Health, University of Canberra, Bruce, ACT, Australia.
⁸ Health Research Institute, University of Canberra, Bruce, ACT, Australia.
⁹ Research Institute of Sport and Exercise, University of Canberra, Bruce, ACT, Australia.

PMID: 41369919
DOI: 10.1007/s00520-025-10174-9

Abstract

Purpose: Cancer is a leading cause of death and disability. Chemotherapy is one of the most common treatments. Physical activity (PA) can improve chemotherapy side effects, fatigue, adherence, survival rates and quality of life. However, people who are undergoing chemotherapy are insufficiently active. This review aimed to identify the barriers to PA in adults who are undergoing chemotherapy for the treatment of cancer.

Methods: Databases were searched for articles that met the eligibility criteria and screened to determine eligibility and risk of bias using the Clinical Appraisal Study Programme Qualitative Checklist. Studies included adults aged > 18 years who were currently undergoing chemotherapy for any type or stage of cancer. Reflexive thematic analysis was used to develop themes, which were deductively mapped to the capability, opportunity, motivation behaviour (COM-B) model and presented narratively. The behaviour change wheel intervention functions enabled identification of potential strategies to address barriers.

Results: A total of 9774 articles were screened. Twenty studies were eligible, including 1085 participants. Side effects of cancer and chemotherapy, other health conditions (capability), knowledge gaps, accessibility, environmental factors, and lack of social support (opportunity); negative emotional response, not having time/prioritising other commitments, and low motivation (motivation) were identified as barriers to PA. Fatigue was the most commonly identified single barrier. Intervention functions to improve PA levels include environmental restructuring, education, training and enablement.

Conclusion: The most commonly reported barriers to PA in people who are undergoing chemotherapy included side effects of cancer and chemotherapy, not having time/prioritising other commitments, knowledge and accessibility. Changes to service accessibility and delivery, and education for the cancer care team and people who are undergoing chemotherapy should be implemented to support increasing PA levels.

Keywords: Barriers; Cancer; Chemotherapy; Exercise; Physical activity.

Publication types

Systematic Review

MeSH terms

Adult
Antineoplastic Agents* / adverse effects
Antineoplastic Agents* / therapeutic use
Exercise* / psychology
Health Knowledge, Attitudes, Practice
Humans
Motivation
Neoplasms* / drug therapy
Neoplasms* / psychology
Quality of Life
Social Support

Substances

Antineoplastic Agents

Grants and funding

Research Training Program (RTP)/Australian Government