Discussion
cancer, guilt, fatigue
CANCER
In this qualitative study of older patients with frailty participating in a home-based exercise prehabilitation program prior to cancer surgery, we identified patient-reported barriers and facilitators of adherence to exercise that aligned with 10 of the 14 domains of the TDF. As adequate adherence is likely a key mediator of prehabilitation efficacy, future program design should consider approaches that leverage facilitators and overcome barriers that we have identified. Key facilitators appear to include that the program was manageable and suitable to older adults with frailty, there were adequate resources to support engagement, and participants felt a sense of control over their health and their health outcomes. Furthermore, older adults with frailty expressed no need for previous experience, and perceived better adherence when social support from family or an exercise partner were available. Successful programs will need to identify means to overcome barriers such as pre-existing fatigue and physical ailments, impacts of adverse weather conditions, and emotional support when feelings of guilt or frustration occur where sessions are missed. A need for individualization and variety within the program was offered as a suggestion by participants and was therefore described as both a facilitator and a barrier. Future studies should explore using a tailored approach to prehabilitation targeting individual needs of participants. Individualization could include providing different levels of exercises and equipment, modifying the program based on limitations and skills and exploring exercise options using an interests-based approach.Adherence to prescribed exercise is consistently identified as a challenge in studies aimed at leveraging physical activity to improve health [Although initially developed to guide implementation science related to health professionals’ behaviour, the TDF has since been used to assess barriers and facilitators to behavior change in a variety of settings, including for patients [Previous qualitative assessment of patients’ perspectives regarding prehabilitation have not focused on patients with frailty, but highlight several findings consistent with barriers and facilitators identified in the current study [The literature regarding adherence with exercise therapy in older people with frailty is sparse. Available reviews have either simply reported adherence rates [