JMIR Publications

ABSTRACT

Background:

Cardiovascular disease and cancer are leading causes of morbidity and mortality worldwide, with cancer survivors facing elevated cardiovascular risk due to shared risk factors and cardiotoxic treatments. Physical activity is a well-established strategy to improve cardiovascular health and survivorship outcomes; however, most cancer survivors do not meet recommended activity guidelines. Understanding multilevel influences on physical activity engagement and promotion is essential to improving implementation in cardio-oncology care.

Objective:

This study aimed to examine barriers and facilitators to physical activity engagement and promotion in cancer survivorship from both survivor and medical team perspectives using the Capability, Opportunity, Motivation–Behavior (COM-B) framework.

Methods:

A descriptive qualitative study was conducted with 12 cancer survivors and 12 medical team members involved in oncology care. Semi-structured interviews explored experiences, perceptions, and practices related to physical activity across the cancer care continuum. Rapid qualitative analysis was used to identify themes, which were mapped to COM-B domains. Participants also completed surveys assessing physical activity, cardiovascular (CV) health (Life’s Essential 8; LE8), and sociodemographic factors.

Results:

Survivors had a mean age of 65.3 years and were evenly distributed by sex. Physical activity engagement varied, with 41.7% of survivors meeting recommended guidelines. Mean CV health score (LE8) was 71.8, indicating moderate overall health. Across COM-B domains, key capability barriers included physical limitations and symptom burden, while knowledge and prior experience facilitated engagement. Opportunity was shaped by access to exercise resources and social support, with lack of access, time, and environmental constraints acting as barriers. Motivation reflected both perceived health benefits and competing concerns such as safety, fatigue, and emotional responses. Medical team members’ ability to promote physical activity was influenced by survivor readiness, clinical context, and resource availability.

Conclusions:

Physical activity engagement in cardio-oncology is shaped by dynamic interactions among capability, opportunity, and motivation across survivor and medical team member contexts. Although physical activity is widely valued, sustained engagement remains limited due to fluctuating symptoms, environmental constraints, and clinical uncertainties. Interventions should prioritize flexible, survivor-centered approaches and incorporate supportive clinical communication and resource alignment to enhance physical activity across the survivorship trajectory.