The promotion of homebased physical activity for people with lung cancer and cachexia, a qualitative study of healthcare professionals, patients and carers

{"Background": "Lung cancer is a leading cause of morbidity and mortality, with approximately 50% of patients with advanced cancer experiencing cachexia (\u22655% weight loss, or 2% in those with BMI<20 kg/m\u00b2 in the last 6 months). Cachexia is associated with impaired daily activities, independence, and quality of life. Physical activity (PA) can improve quality of life in cancer patients, but evidence in lung cancer, particularly those with established cachexia, is limited and inconsistent. Previous studies have reported high dropout rates in group or hospital-based exercise programmes. A pilot RCT of a homebased walking programme (n=40) using a mobile app showed increased PA and physical role functioning in stage 3\u20134 lung cancer, but patients with weight loss were underrepresented. There is a lack of guidance on acceptable PA types and how to promote behaviour change in this population. The Behaviour Change Wheel and COM-B model (Capability, Opportunity, Motivation, Behaviour) provide a framework for developing behaviour change interventions. This study aimed to explore views of healthcare professionals (HPs), patients with lung cancer and cachexia, and their carers on suitable homebased PA and identify barriers and facilitators.", "Methods": "This qualitative study involved semi-structured telephone interviews with 10 HPs (5 physiotherapists, 1 physiotherapy technician, 2 occupational therapists, 2 nurses; experience range 2\u201323 years; 8 based in South Wales) and face-to-face interviews with 7 patients (4 male, 3 female; age range 51\u201381 years) with lung cancer and cachexia and their 7 carers (all female; age range 38\u201371 years). HPs were purposively recruited from professional events and networks. Patients and carers were recruited from NHS Palliative clinics in the UK. Inclusion criteria for patients: confirmed lung cancer, life expectancy >8 weeks, cachexia (\u22655% weight loss or BMI<20 with any weight loss in preceding 6 months). Exclusion criteria: musculoskeletal or neurological disorders compromising mobility. Interviews were conducted by NG using topic guides informed by behaviour change theory. Interviews were recorded, transcribed verbatim, and analysed thematically. Two transcripts were reviewed by JH for verification. Themes were mapped to COM-B components and linked to intervention functions and behaviour change techniques (BCTs) from Michie et al.'s 40 BCTs. Themes were categorised as barriers or facilitators based on participant language.", "Key Results": "Homebased PA was viewed as acceptable by all groups. Suitable activities were described as functional, individualised, flexible, and starting at low duration and intensity. Patients reported capability ranging from 5 to 15 minutes of activity. HPs suggested progression toward government guidelines (30 minutes, 5 times per week) and discouraging inactivity. Types of activities included chair-based exercise, stairs, mobility, and stretching. COM-B mapping identified: Capability barriers included breathlessness, fatigue, weakness, health variability, balance/falls risk, suboptimal nutrition, lack of knowledge, fear, and low confidence. Opportunity facilitators included physical resources (paper/DVD examples, equipment like walking frames/perching stools) and social support (HP education/advice, carer prompting, including carers in planning). Motivation themes included goal setting, monitoring, perceived benefits, maintaining independence, enjoyment, past PA, competition, and reinforcement. Six intervention functions were identified: Education (increase knowledge, minimise fears), Training (guide what/when/how/why to be active), Enablement (overcome symptoms, nutrition, variability; build confidence), Environmental restructuring (modify home, provide resources), Incentivisation (goal setting to promote/reinforce behaviour), and Persuasion (emphasise benefits, facilitate confidence). Seventeen BCTs were identified from the 40 by Michie et al.", "Clinical Implications": "This is the first study to develop principles for promoting homebased PA in lung cancer and cachexia by combining HP, patient, and carer perspectives with behaviour change theory. The proposed intervention functions and 17 BCTs provide a framework that clinical teams can adapt for local implementation. PA should be individualised, functional, adaptable to variable capability, starting small (5\u201310 minutes, low intensity) and gradually progressed. Symptom management, environmental considerations, equipment provision, and education are needed to promote capability. Personalised PA plans should include environmental setup, resources, activity demonstration, and social support. Motivation strategies should include realistic goal setting, emphasising benefits, maintaining function, enjoyable activities, praise, and anxiety management. The principles may be applicable to other conditions with further development. Limitations include small sample size (though age/gender representative of UK lung cancer statistics), potential professional bias from the lead researcher (physiotherapist), and possible selection bias from purposive sampling. Further research is needed to evaluate effects on physical function and emotional wellbeing."}