Practitioner perceptions of prostate cancer patients’ motives for physical activity and the opportunity for a teachable moment

Globally, prostate cancer (PCa) is one of the most diagnosed male cancers.¹ Early detection and advancements in treatment options have resulted in increased survivorship.² Physical activity (PA) is a modifiable lifestyle behaviour that can benefit men throughout the PCa continuum, from diagnosis and treatment, through to remission and survivorship.^2–5 PA can provide protective benefits for men who are receiving treatment for their PCa.^2–5 Aerobic and resistance exercise can help counteract side effects of androgen deprivation therapy (ADT), such as weight gain and loss of muscle mass, which can be risk factors for type 2 diabetes, metabolic syndrome and osteoporosis.² Targeted pelvic floor exercises (especially through supervised physiotherapy) can benefit men who have had a radical proctectomy and are experiencing urinary incontinence and erectile dysfunction.⁶ Regular PA can also provide protective benefits for survivors of PCa, who as a group can be at risk for PCa recurrence, secondary cancers and cardiovascular disease.^2,3

The American College of Sports Medicine (ACSM) roundtable on exercise guidelines for cancer survivors recommends 150 minutes of moderate intensity PA per week.^3,7 The majority of PCa survivors are not engaging in sufficient PA to achieve health-related gain.⁵ More understanding is required regarding motives for PA in PCa survivors.

The aim of this study was to identify what healthcare practitioners perceive as being their PCa patients’ motives for PA.

The participants were five healthcare practitioners from the fields of urology and oncology who provide specialist treatment to men diagnosed with PCa and who had taken part in a larger qualitative study designed to identify factors that influence healthcare practitioners to promote PA to their patients with PCa.⁸ Participants were individually interviewed at their place of work, and interview data were analysed using an inductive thematic approach. Two main themes were identified.

Theme one: the cancer diagnosis

This theme highlighted how a diagnosis of PCa could be a catalyst for making positive lifestyle changes, especially those relating to diet and PA:

“The moment they hear that there is cancer, they want to do everything they can. They’re happy to change their diet, to become more physically active to help improve their health. You explain to them that it is important for their prostate cancer and their general health. They do respond to that.” – Practitioner 2, urologist

“People change once they get their diagnosis. It’s the cancer that’s the motivating factor. They change their diet and try to improve it. They start to exercise. They try and do all these things.” – Practitioner 5, urologist

Theme two: physical activity to counteract treatment-related side effects

A perceived motive for engaging in PA was to help counteract treatment-related side effects, especially those related to hormone suppression therapy:

“There’s a whole host of motives to try and delay cancer progression and prevent side effects of treatment. They do automatically look at their lifestyle. Trying to be more active.” – Practitioner 8, medical oncologist

“They will use physical activity to help them to stay fit and trim because of the treatment side effects.” – Practitioner 11, radiation oncologist

A diagnosis of PCa can lead to a teachable moment when men are more receptive to making positive healthy lifestyle changes, especially those relating to diet and PA.⁹ Healthcare practitioners are ideally positioned to facilitate a teachable moment through enquiring about a patient’s current PA engagement and providing any form of PA advice or referral to a PA programme or physiotherapist.^8,9 PCa patients are receptive to receiving PA advice (i.e., verbal, written or referral) from their healthcare practitioner, as healthcare practitioners are perceived to be credible and trusted sources of information.^8–10 Findings from a qualitative study involving patients who had localised PCa reported that men wanted to receive lifestyle information and advice from their healthcare practitioner(s) at the time of their PCa diagnosis, despite having to deal with their diagnosis and treatment.⁹ Men can feel empowered if lifestyle information is provided earlier in the cancer journey, as they can engage in behaviour(s) that can benefit their health and wellbeing.⁹

The practitioners in the present study also perceived that their PCa patients engaged in PA to help counteract treatment-related side effects, which is consistent with the literature.^2–6  Future research will qualitatively identify how practitioners have advised and supported their PCa patients to try and overcome barriers to PA.