br A number of participants reported setting goals
A number of participants reported setting goals to motivate and maintain daily participation in the physical activity intervention. Goals varied from returning to outdoors activities to incremental goals to in-crease number of daily steps, travelling, and the ability to keep up with children/grandchildren. The ability to perform activities that are important to participants' quality of life was a strong motivator for physical activity engagement.
An important interpersonal factor that facilitated physical activity behavior was social support. Patient and FCG reciprocal encouragement to walk and participate in the intervention together served as a strong facilitator of physical activity. A number of participants discussed the importance of having a spouse, family member, or friend to “coax” then to engage in the walking program. Family members/friends were also indirect motivators for some, as keeping up with others served as an incentive for patients to maintain an active lifestyle before and after surgery.
As patients and FCGs participated in the physical activity, many spoke about having learned that the intervention was beneficial for symptoms and anxiety. Participants spoke from experience, stating that the walking and lower extremity exercises helped them to relax, reduced stress and anxiety, and even helped with physical symptoms. For some, engaging in physical activity helped with multiple moments where anxiety levels were high.
This study aimed to explore the barriers and facilitators of adherence to a perioperative physical activity intervention for older adults with lung and GI cancers and their FCGs. Our intervention was grounded in classic behavioral change theories, involved comprehensive preopera-tive assessment of functional status and geriatric domains, and the de-velopment of a personalized walking and lower extremity exercise program. The research presented in this LY3009120 paper was funded by City of Hope's Center for Cancer and Aging. Dr. Arti Hurria was the founding di-rector of the center. She provided extensive guidance and support to the study design, specifically with using geriatric assessment to prescribe a personalized walking and lower extremity exercise program for older adults undergoing cancer surgery.
Our results showed that a variety of intrapersonal, interpersonal, and environmental barriers and facilitators influenced intervention ad-herence. Behavioral change theories are predicated on several factors. First, an individual must make multiple, repeated choices on an hourly/daily basis to guide physical activity behaviors. Second, the deci-sions to engage in physical activity is based on behavioral, physical, psy-chological, environmental, and social factors.66 Attention to these social-ecological factors of health behaviors is critical to understanding the physical activity behavior change among older adults with cancer . Older adults with cancer come with varying degrees of frailty, levels of physical activity prior to surgery, symptoms, treatment history, and other sociodemographic and clinical factors, which can all contrib-ute to their behavior change experience . Preferences, aversions, knowledge related to physical activity, as well as sociocultural factors can also influence the patient's ability to engage in physical activity [22,23]. Interventions should be personalized and account for potential barriers and facilitators of physical activity adherence based on these factors.
Our findings confirm that health conditions, including comorbid conditions, physical symptoms, and functional limitations, are impor-tant impediments for physical activity and intervention adherence [9–13,24,25].. In addition, preoperative anxiety, concerns about postop-erative recovery, and other stressful factors could result in lack of confi-dence in participating in physical activity among older adults with cancer. Interventions may have greater benefit if Sex linkage integrate princi-ples of behavior change, including self-efficacy as a modifiable and im-portant predictor of adherence . Attention to not only physical functioning but also the psychological functioning of patients and FCGs in the perioperative setting may help facilitate self-efficacy in physical activity engagement .
A key finding from our study highlights the influence of roles and re-sponsibilities on physical activity engagement. For both patients and FCGs, additional caregiving roles, fluctuating demands, and multiple healthcare related appointments were noted as barriers to intervention adherence in our study. This results in overall lack of time for both pa-tients and FCGs to engage in physical activity preoperatively. In addi-tion, more than half of FCGs (62%) provide care to cancer patients age 65 and older . Older adults with cancer are at higher risk for physi-ological declines during and after treatments; this can result in greater needs for functional assistance [22,27]. FCGs for older adults, therefore, are at greater risk for caregiving burden. However, a substantial number of FCGs set aside their own needs to care for a family member or friend with cancer. More than one-fifth of FCGs (23%) reported lack of