Barriers
dizziness, muscle pain
HOLIDAYS, ESOPHAGEAL DILATION
The most important barriers were captured by the themes “physical condition” and “logistics”. Esophageal dilation, commonly performed in post-esophagectomy patients, hampered both attendance and RDI: Due to the hospital visits, appointments with the physiotherapist could be affected and patients needed some time to fully recover from the treatment and sedation (quote 3).“Well, every time I had to go back to the hospital and they had to dilate me [esophagus]. Yes, that day itself you are always... Because 24 hours prior you are not allowed to eat anything. The day itself you are travelling to the hospital all day. Sometimes the day after, you felt a bit drowsy due to the sedation. So, sometimes it was more difficult to keep going with the program.”In few other cases, patients could not comply with the exercises because of other physical complaints, such as dizziness, not feeling well, or pre-existing injuries. Regarding logistics, for the supervised part, mainly national holidays and vacation, and impossibility of changing the training schedule to other days or daytimes, were mentioned as barriers. For the exercise advice, weather circumstances (rain for some, high temperatures for others) influenced adherence, as well as conflicting activities, such as doing the housekeeping and job obligations. To a lesser extent, absence of the physiotherapist could act as a barrier.When patients felt psychologically unhappy or when they just did not feel like exercising, it was more difficult to adhere to the program. Also, limited body confidence, which had developed after surgery, resulted in an insecure feeling when performing the exercise components. Feelings of insecurity were also caused by a lack of knowledge on exercise side effects, e.g., muscle pain. Last, regarding the contents of the program, a perceived lack of variation in exercises was a barrier to some, and intensification of the training load to others.