br Overall you do not really feel
“Overall, you do not really feel like doing anything. Eventually it came back [energy]. I started feeling better and better, and I also got my appetite back. But before that I did not want to eat anything, do anything, or to meet up with anyone. You just do not feel like it”. (ID 5, 73-year-old male with NSCLC)
The informants often experienced fatigue in the days following treatment. In addition, some were aﬀected by side eﬀects from 1403254-99-8 and therefore experienced several ups and downs with fatigue during each treatment cycle. Some were able to organize their life to fit in with the treatment course, and they planned their activities on days when
they expected to be most energetic. For other informants, the feeling of fatigue was totally unpredictable, and they gave up trying to engage in any scheduled activities.
“But then I had a couple of days where I thought ‘Yes, now I can do a whole lot again’. So, I went cycling and WOO-HOO it went well. Until I got to the end of the week and then BOING, right?” (ID 7, 65-year old female with NSCLC)
3.4. Social support is key to short and long-term motivation
The informants identified several motivators and facilitators for PA, including social support from family and friends. The most eﬀective way to activate the informants was if a relative accompanied them in exercising. This friendly nudging and participation from relatives was greatly appreciated by the informants.
“My friend tells me that we are going for a walk. When I am feeling really bad, she picks me up in her car, and then she takes me to a place by the sea to go for a walk” (ID 23, 75-year-old female with biliary tract cancer)
Exercising with peers provided social interaction, enjoyment, shared understanding and equal competition, and was therefore considered as highly motivating. The informants also expressed that exercise, in particularly with others, gave them a break from thoughts and worries and facilitated feelings of normality. Some were already engaged in COPD or cardiac rehabilitation and preferred to continue these activ-ities.
“Perhaps it could just as well be with anyone else. But when you exercise with people who have the same disease as yourself, then you will try to naturally compete with them. You cannot surpass people who are completely healthy. But here, one must try to be the best, right?” (ID 5, 73-year-old male with NSCLC)
3.5. Fixed conditions keep one focused
Structured and supervised exercise was preferred, as fixed agree-ments and shared responsibility made energy easier to attend. In addition, exercising with others motivated the informants to perform better.
“It is because, I know that it is so extremely good for you. And be-cause I can feel, that I have become a horrible couch potato. I know that I need solid support to help me build this up, and that it must be based on my current situation [having cancer]. It must be with a team – or along with someone who I would like to do it with. Otherwise I will not be able to do it at all” (ID 15, 65-year-old female with pancreatic cancer)
Some informants who were used to exercising on their own, pre-ferred to keep doing so, because it was easier to fit it into their everyday routine and treatment schedule. However, most informants recognized or had eventually realized that they needed professional guidance and support.
“I am not so diligent to crawl around on the floor at my own house. You know, the physiotherapist often says: ‘you can lie down on the floor and do these exercises for your back’. It just does not happen. Because then I see the dust bunnies under the chair or something like that, right? And then I think to myself ‘you cannot just lie here and do nothing’” (ID 12, 69-year-old female with pancreatic cancer)
The informants highlighted that exercise programs should be or-ganized in a way that made it as easy as possible to attend. This could be done by placing exercise facilities in the local communities or by providing patients with transportation. It was also suggested that ex-ercise programs could be organized at the hospital, and that patients should be able to exercise in combination with their hospital European Journal of Oncology Nursing 41 (2019) 16–23
appointments. Some informants even argued that exercise programs should be presented to patients as an integrated part of the oncological treatment regimen.
“It cannot be something like ‘you should do this and that’. NO, you must present it as a part of the treatment plan. A necessary part of the treatment” (ID 17, 71-year-old male with pancreatic cancer)