Barriers and facilitators for weight management interventions in breast cancer patients: a systematic review of qualitative studies

Figures & data

Table I. Study characteristics.

First author, year	Title	Study type	Sample size/age	Diagnosis, treatment and time since treatment	Intervention + duration	Identified barriers	Identified facilitators
Balneaves L, 2014	Breast cancer survivors’ perspective on a weight loss and physical activity lifestyle intervention	Focus group or interviews by telephone	N=14Mean age 55.6 (SD 9.5) Mean age 55.6 (SD 9.5)	Stage II (67%) Stage III (11%) Unknown (22%) Surgery + radiation (22%) Surgery and chemo (11%) Surgery, chemo and radiation (67%) Time since treatment unknown	24 weeks lifestyle intervention	-Logistics of attending an intervention that required attendance two to three times a week -Fatigue -Negative reaction from their social network	-Inspired by the presence of other cancer survivors -Sharing experiences with like-minded peers
Balneaves L, 2020	Patient and Medical Oncologists’ Perspectives on Prescribed Lifestyle Intervention-Experiences of Women with Breast Cancer and Providers	One-on-one semi-structured interviews	N=12Mean age 51.9 (SD 14.2) Mean age 51.9 (SD 14.2)	Stage I (33%), Stage II (67%) Chemotherapy Time since treatment unknown	35 weeks lifestyle intervention, with exercise component of the NExT parent study	-Restricted gym hours (9 am-3 pm) -Location of the gym due to travel required -Life responsibilities such as childcare and employment	-Managing distress -Gaining social support -Coping with the physical consequences of cancer and beyond
Brunet J, 2015	Fostering positive experience of group-based exercise classes after breast cancer: what do women have to say?	Face to face Interviews	N=7Age range (40–69) Age range (40–69)	Breast cancer stage unknown Chemotherapy, radiation and hormone therapy (4) Hormone therapy (1) Chemo and radiation therapy (2) After completion of treatment	8 weeks exercise programme	-None mentioned	-Access to a qualified, supportive and motivated instructor -Personalized instruction focused on self-improvement
Brunet J, 2013	A qualitative exploration of barriers and motivators to physical activity participation in women treated for breast cancer	Semi-structured interviews	N=9Mean age 55.33 Mean age 55.33	Stage I-III Surgery (100%) Chemotherapy 73% Radiotherapy (82%) Hormone therapy 83%) Completed treatment <5 years (78%)	Physical activity	-Physical symptoms (cancer-related) -Environmental factors (bad weather, lack of equipment) -Psychosocial factors (social support, lack of motivation)	-Physical benefits (weight management, health benefits, increase energy) -Psychosocial benefits (improve body image, enjoyment, social support, positive emotions)
Bulmer S, 2012	Women's perceived benefits of exercise during and after breast cancer treatment	Interviews	N=45Mean age 53.1 (SD 6.24) Mean age 53.1 (SD 6.24)	Not mentioned	Exercise programme with 6 months unlimited access to health club facilities and personal training	-None mentioned	-Social benefits -Reclaiming their body -Feeling better -Health status -Rehabilitation -Managing emotions -Moving forward -Respite from cancer -Social benefits
Fazzino T, 2016	A qualitative evaluation of a group phone-based weight loss intervention for rural breast cancer survivors: Themes and mechanisms of success	Interviews	N=186Mean age 58.8 (SD 8.2) Mean age 58.8 (SD 8.2)	Stage 0: 8% Stage I: 41.4% Stage II: 34.5% Stage III: 16.1% Surgery (100%) Radiation (69,5%) Chemotherapy (67.2%) Hormone therapy (73.6%) Time since treatment 3.3 years (SD 2.4)	Weight loss intervention with structured meal plan and physical activity	-Daily physical activity -Daily self-monitoring -Food diary was time consuming	-Accountability to the group and to self -Convenience of the diet
Hefferon K, 2013	Understanding barriers to exercise implementation 5-year post-breast cancer diagnosis: a large-scale qualitative study	Semi-structured interviews	N=83Age range (29–76) Age range (29–76)	Stage 0-III Chemotherapy Radiation	Exercise	-Lack of motivation -Fears -Dislike of gym -Fatigue -Weight gain -Ageing process and co-morbidities -Employment -Tradition female care-giving activities -Proximity and/or access to facilities -Seasonal weather	-None mentioned
Hirschey R, 2017	Exploration of exercise outcome expectations among breast cancer survivors	Semi-structured interviews	N=20Mean age 62 (SD 8.5) Mean age 62 (SD 8.5)	Stage of disease not mentioned Surgery (100%), chemotherapy and radiation (70%) Time since treatment 4.2 year(2.3)	16 weeks aerobic exercise programme or a moderate intensity programme	-Fatigue	-Motivated to exercise to reduce the fear of recurrence
Husebo A, 2014	Factors perceived to influence exercise adherence in women with breast cancer participating in an exercise programme during adjuvant chemotherapy: a focus group study	Focus groups	N=27Mean age 52 (SD 9) Mean age 52 (SD 9)	Early stage breast cancer Chemotherapy and surgery Time since treatment unknown	Home based-exercise with resistance and aerobic training during chemotherapy, duration not mentioned	-Side effect of breast cancer treatment -Balancing time to exercise and social events	-Positive beliefs about efficacy and outcomes motivate exercise -Constructive support enhances exercise -Restoring and maintaining normality in daily life motivates exercise
Ingram C, 2010	Women's perceptions of home-based exercise performed during adjuvant chemotherapy for breast cancer	Interviews (open-ended questions)	N=8Mean age 47.5 (SD 10) Mean age 47.5 (SD 10)	Stage I-IIIA Surgery and chemotherapy (100%)	Exercise intervention with stretching, aerobic and strengthening 4 times/week, during chemotherapy 24 weeks	-Side effects of chemotherapy -Side effects of medication -Fatigue -Pain -Decreased range of motion (arm/shoulder) -Non-medical life events (vacation, caring for an ill relative, death of a friend)	-Internal motivation -External support -Adapting the routine
Jones L, 2020	Using the integrative model of behavioural prediction to understand female breast cancer survivors’ barriers and facilitators for adherence to a community-based group-exercise programme	Focus groups	N=17	Stage 0-III	6–12 months individualized exercise programme	-None mentioned	-Enjoyment -Exercising with other BC survivors -Comfortable atmosphere -One-on-one supervision -Physical changes -Psychological outcomes
Kim S, 2020	The experience of cancer-related fatigue, exercise and exercise adherence among women breast cancer survivors: insights from focus group interviews	Focus groups	N=16Mean age 48.4 (SD 8.4) Mean age 48.4 (SD 8.4)	Stage I (37.5%) Stage II (62.5%) Surgery and chemotherapy (100%) Radiation (75%) and hormone therapy (37.5%) After completion of surgery and chemotherapy, during radiation and/or hormone therapy	General exercise for an unknown period of time	-Fatigue	-Finding comfort and strength through exercising and interacting with other breast cancer survivors
Kokts-Porietis R, 2018	Breast cancer survivors’ perspectives on a home-based physical activity intervention utilizing wearable technology	Semi-structured interviews	N=6Mean age 58 (SD 7) Mean age 58 (SD 7)	Stage I (33.3%) Stage II (33.3%) Stage III (33.3%) Surgery, chemotherapy and radiation (67%) Hormone therapy (50%) Radiation therapy (66%) After completion of treatment, except for hormone treatment	12 weeks home-based physical activity intervention utilizing wearable technology	-Feeling busy -Lack of motivation -Weather	-Peer support -Progress in results
De Kruif A, 2020	Exploring changes in dietary intake, physical activity and body weight during chemotherapy in women with breast cancer: A Mixed-Methods study	In-depth semi-structured Interviews	N=25Mean age 5.4 range (25–67) Mean age 50.4 range (25–67)	Surgery and chemotherapy (100%)	Physical activity, dietary intake 150 min week physical activity, food diary	-Never liked to be active -Too tired -Side-effect from chemo -Changed appearance (hair loss, deterioration of breasts)	-Valued being active -Keeping fit -Contact with fellow patients
Leddy S, 1997	Incentives and barriers to exercise in women with a history of breast cancer	Semi-structured interviews	N=11Mean age 43 (SD 5.2) Mean age 43 (SD 5.2)	Chemotherapy (N=1) Hormone therapy (N=7) <3 years post treatment (N=9)	Exercise	-Lack of time -Not in routine -No partner -Dislike -Afraid -Hard -Expensive	-Benefit -Responsibility -Enjoyment -Previous experience -Family -Professionals -Fear of complications -Guilt
Lloyd G, 2020	Breast cancer survivors’ preferences for social support features in technology-supported physical activity interventions: finding from a mixed methods evaluation	Semi-structured interviews	N=28Mean age 53.4 (SD 1.1) Mean age 53.4 (SD 10.1)	Stage I (67.9%) Stage II (21.4%) Stage III (10.7%) Surgery (100%) Chemotherapy 50%) Radiation therapy (57%) Hormone therapy (57%) Months since treatment 21.8 (SD 15.1)	Technology supported physical activity intervention for an unknown period of time	-None mentioned	-Technology increased social connectedness -connecting with similar survivors
Loh S, 2010	Physical activity and women with breast cancer: insights from expert patients	Focus groups	N=14Mean age 55 (SD 8.7) Mean age 55 (SD 8.7)	Stage 0 (n=1) Stage I (n=4) Stage II (n=6) Stage III (n=2) Unknown (n=1) After treatment (n=6) During treatment (n=8) Treatment unknown Time since treatment unknown	General physical activity for unknown period of time	-Physical limitations -Weather -Age -Facilities -Role responsibility home/office commitment	-Positive experience from physical activity engagement -Easy access to facility engagement -Good social support
Mackenzie C, 2015	Breast cancer survivors’ experiences of partner support and physical activity participation	Semi-structured interviews	N=36Age range (28–52) Age range (28–52)	Time since diagnosis (11 months-20 years)	Exercise activity	-Fatigue -Domestic work -Childcare	-Supportive partners
Milosevic, 2020	Exploring tensions within young breast cancer survivors’ physical activity, nutrition and weight management beliefs and practices	Semi-structured interviews	N=12Mean age 36 (SD 3.4) Mean age 36 (SD 3.4)	Stage I-III Chemotherapy Within 5 years of diagnosis	General physical activity, nutrition and weight management during an unknown period of time	- Fatigue -Work and family responsibilities	-Exercise helped alleviate the stress -Physical activity helped to regain confidence in physical appearance
Monteiro-Guerra F, 2020	Breast cancer survivors’ perspectives on motivational and personalization strategies in mobile-app-based physical activity coaching interventions: qualitative study	Semi-structured Interviews	N=14Mean age 53.3 9SD 8.7) Mean age 53.3 9SD 8.7)	Stage I-III Surgery Chemotherapy Radiation therapy Time since diagnosis mean 4.25 (SD 2.8)	Exercise programme	-Lack of time -Physical limitations -Emotional challenges -Lack of information	-Social connectedness -Peer support -Confidence and perceived growth
Nock N, 2015	A community-based exercise and support group programme improves quality of life in African-American breast cancer survivors: A quantitative and qualitative analysis	Semi-structured phone interviews	N=19Mean age 56.5 (SD 11.0) Mean age 56.5 (SD 11.0)	Stage I (27.8%) Stage II (61.1%) Stage III (11.1%) Surgery, chemotherapy or irradiation <12 months after completion of treatment	20 weeks exercise and support intervention	-None mentioned	-Improvements in body composition, strength and function -Having fun
Nielsen A, 2019	Preferences for mHealth physical activity interventions during chemotherapy for breast cancer: a qualitative evaluation	Semi-structured phone interviews	N=30Mean age 45.5 (SD 9.6) Mean age 45.5 (SD 9.6)	Stage I (24.1%) Stage II (44.8%) Stage III (31.0%) Time since chemotherapy 5.7 months (SD 3.8) Time since radiation 59.3% Currently radiation 10% Currently hormone therapy 53.3%	Physical activity, goal: 150 min/week moderate-vigorous physical activity	-Side effects of treatment including nausea, fatigue, pain	-Education about PA during chemotherapy -Home-based programme -Personalized intervention -Social support from other breast cancer survivors, friends, family
Owusu C, 2018	Perspective of older African-American and non-Hispanic white breast cancer survivors from diverse socioeconomic backgrounds towards physical activity: A qualitative study	Interviews and focus groups	N=60Mean age 71 (65–87) Mean age 71 (65–87)	Stage I (53%) Stage II (33%) Stage III (24%) Surgery (100%) Radiation therapy (68%) Chemotherapy 30%) Hormone therapy (80%) <2 years of treatment completion	Physical activity	-Health issues -Side effects -Fatigue -Inclement weather -Lack of a PA buddy	-Increasing energy -Helping the body -Reducing stress -Helping emotionally and mentally -Religious faith -Encouraging family -Community environment
Piacentine L, 2018	Promoting team-based exercise among African American breast cancer survivors	Focus groups	N=12	Stage 0 (8%) Stage I (42%) Stage II (33%) Stage III (17%) Surgery (n=12) Chemotherapy (n=7) Radiotherapy (n=9)	14 week exercise and nutrition intervention	-Not wanting to exercise alone -Exercise is not a life or treatment priority -Side effects of cancer treatment (physical and emotional) -Fatigue	-Support by others -Less chance of recurrence -Mental benefits -General health, sleep, weight control -In the same boat -Improved activity
Pila E, 2018	‘The weight is even worse than the cancer’: Exploring preoccupation in women treated for breast cancer	Semi-structured interviews	N=84Mean age 66.3 (SD 1.2) Mean age 66.3 (SD 10.2)	Stage I (72.7%) Stage II (27.3%) Completed primary treatment 3.98 months (SD 3.07)	Weight management behavior	-Lack of willpower -Precipitating negative emotions -Self-criticism -Perceptions of failure	-Reducing breast cancer recurrence -Reducing comorbidities - Better appearance -Fitting societal ideas of how the body and weight should be
Power J, 2020	Experiences of African American breast cancer survivors using digital scales and activity trackers in a weight gain prevention intervention: Qualitative study	Semi-structured interviews	N=21Mean age 62.6 (SD 8.3) Mean age 62.6 (SD 8.3)	Completed primary treatment Years since diagnosis mean 3.38 (SD 2.46)	Weight gain prevention intervention; 6 months diet + physical activity	-Creation of routine (self-weighing) -Fluctuations in weight and increased awareness (self-weighing) -Forgetting or losing Daily Activity Tracking Device	-Improving QoL -Decrease risk of recurrence
Pullen T, 2018	Utilizing RE-AIM to examine the translational potential of Project MOVE, a novel intervention for increasing physical activity levels in breast cancer survivors	Focus groups, interviews	N=71Mean age 59.0 (SD 8.8)Years since diagnosis 9 years (SD 8.2) Mean age 59.0 (SD 8.8) Years since diagnosis 9 years (SD 8.2)	Stage 0 (6.9%) Stage I (14.9%) Stage II (24.1%) Stage III (14.9%) Stage IV (8.0%) Surgery (100%) Radiation therapy (54%) Chemotherapy (51.7%) Hormone therapy (28.7%)	Physical activity programme; Accelerometer, physical activity guidelines	-Pain -Fatigue -Treatment related side effects	-Small group size -Supportive environment -Health benefits -Group commitment − 500 dollar incentive
Van Puymbroeck M, 2013	Perceived health benefits from yoga among breast cancer survivors	Interview	N=18		Yoga intervention	-None mentioned	-Physical health & healing -Mental health & healing -Social health & healing
Rogers L, 2004	Exploring social cognitive theory constructs for promoting exercise among breast cancer patients	Focus groups	N=12Mean age 54 (SD 7.5) Mean age 54 (SD 7.5)	Non-metastatic BC Adjuvant treatment (17%) Months after treatment 16 months (SD 21)	Exercise	-Fatigue -Exercise not a priority -Obstacles of daily responsibilities -Nausea and malaise	-Improved survival -Reduced fatigue
Sander A, 2012	Factors that affect decisions about physical activity and exercise in survivors of breast cancer: A qualitative study	Focus groups	N=34Mean age 56.9 (SD 9.7) Mean age 56.9 (SD 9.7)	Stage 0 (N=1) Stage I (N=18) Stage II (N=8) Stage III (N=5) Surgery (N=43) Chemotherapy (N=19) Radiation therapy (N=30) Months after treatment 56.3 (SD 66.7)	Physical activity, exercise	-Fatigue -Neuropathy -Joint pain -Poor body image -Time -Musculoskeletal pain -Lymphedema	-Social support -Convenience
Shaw S, 2020	Cancer survivors’ experiences of an exercise programme during treatment and while employed: A qualitative pilot study	Semi-structured interviews	N=5Age range (51–58) Age range (51–58)	Stage IA-IIIA Chemotherapy and radiation therapy (100%)	Community-based exercise programme with one-on-one exercise therapy with resistance bands and free weight exercise; 2 sessions/week 40–45 min.	-none mentioned	-Mental well-being -Support from other BC-patients
Short C, 2013	How social cognitive theory can help oncology-based health professionals promote physical activity among breast cancer survivors	Semi-structured telephone interviews	N=8Mean age 55 range (44–63) Mean age 55 range (44–63)	Chemotherapy (100%) Radiation therapy (N=5) Hormone therapy (N=5) 4 years after treatment (range 3–6)	Exercise	-Lack of motivation -Health-issues -Changes in perspective after cancer -Not finding PA enjoyable	-Enjoyment -Increased energy -Feeling good mentally -Maintaining healthy weight -Sleep improvements -Sense of achievement -Preventing chronic disease -Fighting the ageing process
Smith S, 2015	Lifestyle modification experiences of African American breast cancer survivors: A needs assessment	Focus groups	N=42Mean age 45.73 (SD 7.91) Mean age 45.73 (SD 7.91)		Lifestyle modification needs	-‘pamphlet-only control group’	-peer-facilitated sessions -hands on or interactive nutrition education -support from co-survivors
Smith S, 2017	Community engagement to address socio-ecological barriers to physical activity among African American breast cancer survivors	Focus group	N=60Mean age 45.73 (7.91) Mean age 45.73 (7.91)		Physical activity programme; 24 weeks moderately intensive strength training and yoga	-Post-treatment symptoms (lymphoedema, neuropathy) -Fatigue -Body image -Co-morbidity -Perceptions -Lack of social support -Partner concerns -Lack of family support -Costs -PA preferences -Cultural issues -Lack of resources -Safety concerns -Weather	-None mentioned
Vassbakk-Brovold K, 2018	Experiences of patients with breast cancer of participating in a lifestyle intervention study while receiving adjuvant chemotherapy	Semi-structured interviews	N=10Mean age 53 range (27–68) Mean age 53 range (27–68)	Stage II & III Chemotherapy (100%)	Lifestyle intervention 12 months; diet, physical activity, stress management	-Adverse effects of chemotherapy -Feeling ‘overwhelmed’ -Lack of motivation -Prioritizing family and friends -Lack of energy -Reduced self-image -Tiredness	-Cooking recipes -Health benefits -More insight in own PA-level through counseling -Useful info about how to adjust PA to their health condition
Whitehead S, 2009	Older breast cancer survivors’ views and preferences for physical activity	Semi-structured interviews, focus group	N=29Mean age 66.54 (SD 6.5) Mean age 66.54 (SD 6.5)	1–5 years after diagnosis and treatment (except for hormone therapy)	Physical activity	-Lack of time -Health-related barriers, afraid of getting lymphoedema and soreness -Stiffness -Lack of motivation -Fatigue -Fear of ‘overdoing it’ post-illness -Self-consciousness	-Fight the ageing process -Control medical conditions -Weight loss -Self-image -Enjoyment -Be normal -Increased energy-levels -Well-being
Wu HS, 2019	Breast cancer survivors’ experiences with an activity tracker integrated into a supervised exercise programme: Qualitative study	Semi-structured in-depth interviews	N=10	12 months after diagnosis and treatment (except for hormone therapy)	Exercise programme with activity tracker, 12 weeks with supervised strength and endurance training 2x/week.	-Lack of personal advice -Not a realistic representation of total daily activity -No feedback from physiotherapist	-Activity tracker motivates -More awareness of lifestyle
Wurz A, 2015	Breast cancer survivors’ barriers and motives for participating in a group-based physical activity programme offered in the community	Interviews	N=7Mean age 55.3 Mean age 55.3	Surgery (100%) Chemotherapy/radiation therapy/hormone therapy (N=4) Radiation therapy/hormone therapy (N=2) Hormone therapy (N=1) Few months after treatment	Physical activity programme; 8 weeks group-based programme 2x/week	-Distance and traffic -Competing roles and responsibilities -Cancer-specific limitations	-Gaining social support -Networking -Being around similar others -Feeling a sense of personal fulfillment -Health benefits -Recovering from cancer
Yuve S, 2019	Lifestyle change experiences among breast cancer survivors participating in a pilot intervention: A narrative thematic analysis	Semi-structured interviews	N=4Age range (37–56) Age range (37–56)	Stage II & III Surgery, chemotherapy, radiation therapy (100%) Hormone therapy (N=2)	Healthy lifestyle; 12 weeks programme	-Perceived pressure to eat well and lose weight	-Scientific evidence to reduced cancer recurrence -Quality of life -Health benefits
Yufe S, 2021	Storying my lifestyle change: How breast cancer survivors experience and reflect on their participation in a pilot healthy lifestyle intervention	Semi-structured interviews	N=4	Stage I-III <5 years after chemotherapy and/or radiation therapy	Healthy lifestyle; 12 weeks programme	-Tiredness -Lack of motivation -Self-esteem	-Feel healthier

Figure 1. PRISMA 2020 flow diagram for new systematic reviews which included searches of databases and registers only.

Table II. Quotes and fragments illustrating the themes.

Theme	nodes	Exemplary quotes and fragments
Attitude	• Physical and mental benefits • Anticipated regret • Lack of motivation	The six most commonly reported expected outcomes or OEs included increased energy, feeling good overall, cardiac health, general health, feeling good mentally and achieving healthy weight (Nielsen et al., 2020). ..a way to deal with the weight gain and body image issues that stemmed from treatment by addressing lifestyle factors that impact overall health, improving her QoL (Jones et al., 2020). Overall, women described a strong and pervasive internalized pressure to maintain their weight, in both the context of reducing risk for cancer reoccurrence and dually linked to issues of appearance and fitting societal ideals of how the body and weight should be (Kokts-Porietis et al., 2019). ‘It helps me feel like I can clear my head’ (de Vries et al., 1995). Some participants spoke about intrinsic rewards, such as feeling good after meeting the challenges they set for themselves, but more commonly participants spoke about negative reinforcers facilitating exercise, such as feeling guilty for not exercising (Vassbakk-Brovold et al., 2018). Some participants suggested that their emotions were also affected after treatment and that it could negatively influence their motivation to participate in PA. Such emotional instability was reflected in feeling more stressed and depressed (Balneaves et al., 2014). Other barriers relating to enrolment in the program were participants’ previous experiences with “gyms” and their attitudes toward the program. Preconceived ideas about the program varied among participants with some unsure, others concerned about enrollment due to it being a new experience or having had a prior negative experience with going to a “gym” (Balneaves et al., 2020).
Self-efficacy	• Integrating the programme in daily life • Stigma and fears	Work and “other commitments” were identified as being the most relevant and uncontrollable factors that adversely influenced level of adherence (Balneaves et al., 2020).Some hesitated joining activities in a group because of their hair loss and the deterioration of their breasts after surgery. They related their appearance to their female identity (Sander et al., 2012). Some hesitated joining activities in a group because of their hair loss and the deterioration of their breasts after surgery. They related their appearance to their female identity (Sander et al., 2012).
Social influence		..a negative reaction from their social network. The women rationalized this response as representing fear on the part of family members and friends who confused weight loss with the progression of cancer (Owusu et al., 2018).
External barriers		I don’t want to get in the car and drive half an hour to do an activity. Something closer to home … somewhere around, but not too far … 10–15 maybe 20 min max, half an hour or an hour is too much’’ (de Vries et al., 1995).“The weather can be real depressing, and even if the weather kind of breaks, if I’ve been stuck inside, I just don’t want to do anything” (Whitehead & Lavelle, 2009) “The weather can be real depressing, and even if the weather kind of breaks, if I’ve been stuck inside, I just don’t want to do anything” (Whitehead & Lavelle, 2009)
Economical and cultural barriers		Prioritizing exercise over traditional female-caring roles can be a difficult decision for these Asian women with strong ties of extended family cultures, and many are living within an extended family system (Milosevic et al., 2020).
Physical barriers		The women expressed how a changed body image due to treatment affected their exercise adherence. A mastectomy required the use of a prosthesis, which had to be well adapted or else the women feared it would fall out during exercise. For most of the women, the chemotherapy also resulted in hair loss. They told that wearing a wig during exercise was not practical, and it also felt uncomfortable as soon as the physical activity (PA) made them start sweating (Kim et al., 2020).‘You can’t use your arm, almost forever. I enjoyed golf but now I had to quit, you know, because you’re not supposed to use your arm.’ (Piacentine et al., 2018) ‘You can’t use your arm, almost forever. I enjoyed golf but now I had to quit, you know, because you’re not supposed to use your arm.’ (Piacentine et al., 2018)
Programme contents	• Timing • Setting • Execution	Oncologists and most patients believed the intervention should be offered as a standard part of breast cancer care, and as early as possible within the cancer trajectory, before the onset of treatment side effects could limit individuals’ enthusiasm and/or perceived capacity to participate (Pullen et al., 2019). Survivors emphasized a desire for flexible coaching, suggesting a mix of scheduled calls, access to a coach during open office hours, and the ability to text questions anytime with answers returned within 24–48 hr (de Kruif et al., 2021). ..their perceptions that yoga helped them physically heal while at the same time providing them with a venue for rediscovering and finding strength and confidence in their changed bodies (Wu et al., 2019). Most survivors felt an exercise coach would be the most feasible in-person option and wanted this person to be highly trained in exercise and breast cancer treatment so they could provide accountability, encouragement and advice on setting goals, creating a workout plan, and overcoming barriers (Loh et al., 2011).

Table

#	Searches
1	exp breast neoplasms/OR ((breast* or mamma*) adj3 (neoplas* or tumor* or tumour* or cancer* or malign* or oncolog* or carcinom* or sarcoma* or lymphoma*)).ti,ab,kf.
2	exp health promotion/or (((weight or BMI or “body mass index” or “fat mass” or “fat percentage” or “fat distribution” or “muscle mass” or “body fat”) adj3 (maintain or maintaining or managing or manage* or maintenance)) or ((“weight loss” or weightloss or “weight reduct*” or “weight decreas*” or “weight gain” or diet or dietary or “healthy eating” or nutrition* or “eating behaviour” or lifestyle or “food intake” or exercise or “physical activit*” or health-coach*) adj5 (intervention* or programme* or recommendation* or support or promote or promoting or training*))).ti,ab,kf.
3	(barrier* or facilitat* or facilitating or motivat* or challenge* or obstacle* or adher* or enabler* or preference* or constraint* or “planned behav*”).ti,ab,kf. or (exp qualitative research/OR exp focus groups/or exp interview/or exp interviews as topic/or exp narration/or exp personal narratives as topic/or exp tape recording/or exp “surveys and questionnaires”/or ((qualitative adj3 (research* or analys* or stud* or method* or synthes* or approach*)) or “thematic analys*” or “content analys*” or “focus group*” or discussion* or interview* or narration* or narrative or “audio recording*” or audiotape* or “tape recording*” or survey* or questionnaire* or “patient report*” or “patient outcome*”).ti,ab,kf.)
4	1 and 2 and 3

Table

#	Searches
1	“breast cancer”/exp OR ((breast* OR mamma*) NEAR/3 (neoplas* OR tumor* OR tumour* OR cancer* OR malign* OR oncolog* OR carcinom* OR sarcoma* OR lymphoma*)):ti,ab,kw
2	“health promotion”/exp OR (((weight OR BMI OR “body mass index” OR “fat mass” OR “fat percentage” OR “fat distribution” OR “muscle mass” OR “body fat”) NEAR/3 (maintain OR maintaining OR managing OR manage* OR maintenance)) OR ((“weight loss” OR weightloss OR “weight reduct*” OR “weight decreas*” OR “weight gain” OR diet OR dietary OR “healthy eating” OR nutrition* OR “eating behaviour” OR lifestyle OR “food intake” OR exercise OR “physical activit*” OR health-coach*) NEAR/5 (intervention* OR programme* OR recommendation* OR support OR promote OR promoting OR training*))):ti,ab,kw
3	“programme acceptability”/exp OR (barrier* OR facilitat* OR facilitating OR motivat* OR challenge* OR obstacle* OR adher* OR enabler* OR preference* OR constraint* OR “planned behav*”):ti,ab,kw OR (“qualitative research”/exp OR “content analysis”/exp OR “thematic analysis”/exp OR “interview”/exp OR “narrative”/exp OR “recording”/exp OR “questionnaire”/exp OR ((qualitative NEAR/3 (research* OR analys* OR stud* OR method* OR synthes* OR approach*)) OR “thematic analys*” OR “content analys*” OR “focus group*” OR discussion* OR interview* OR narration* OR narrative OR “audio recording*” OR audiotape* OR “tape recording*” OR survey* OR questionnaire* OR “patient report*” OR “patient outcome*”):ti,ab,kw)
4	1 and 2 and 3

Table

#	Searches
1	exp Breast Neoplasms/or ((breast* or mamma*) adj3 (neoplas* or tumor* or tumour* or cancer* or malign* or oncolog* or carcinom* or sarcoma* or lymphoma*)).ti,ab,id.
2	exp Health Promotion/or (((weight or BMI or “body mass index” or “fat mass” or “fat percentage” or “fat distribution” or “muscle mass” or “body fat”) adj3 (maintain or maintaining or managing or manage* or maintenance)) or ((“weight loss” or weightloss or “weight reduct*” or “weight decreas*” or “weight gain” or diet or dietary or “healthy eating” or nutrition* or “eating behaviour” or lifestyle or “food intake” or exercise or “physical activit*” or health-coach*) adj5 (intervention* or programme* or recommendation* or support or promote or promoting or training*))).ti,ab,id.
3	exp Programme Evaluation/or (barrier* or facilitat* or facilitating or motivat* or challenge* or obstacle* or adher* or enabler* or preference* or constraint* or “planned behav*”).ti,ab,id. or (exp qualitative methods/or exp surveys/or exp questionnaires/or ((qualitative adj3 (research* or analys* or stud* or method* or synthes* or approach*)) or “thematic analys*” or “content analys*” or “focus group*” or discussion* or interview* or narration* or narrative or “audio recording*” or audiotape* or “tape recording*” or survey* or questionnaire* or “patient report*” or “patient outcome*”).ti,ab,id.)
4	1 and 2 and 3

Milosevic, E., Brunet, J., & Campbell, K. L. (2020). Exploring tensions within young breast cancer survivors’ physical activity, nutrition and weight management beliefs and practices. Disability & Rehabilitation, 42(5), 685–691. https://doi.org/10.1080/09638288.2018.1506512

 PubMed Web of Science ®Google Scholar

Nielsen, A. M., Welch, W. A., Gavin, K. L., Cottrell, A. M., Solk, P., Torre, E. A., Blanch-Hartigan, D., & Phillips, S. M. (2020). Preferences for mHealth physical activity interventions during chemotherapy for breast cancer: A qualitative evaluation. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 28(4), 1919–1928. https://doi.org/10.1007/s00520-019-05002-w

 PubMed Web of Science ®Google Scholar

Jones, L. M., Reinhoudt, L. L., Hilverda, F., Rutjes, C., & Hayes, S. C. (2020). Using the integrative model of behavioral prediction to understand female breast cancer survivors’ barriers and facilitators for adherence to a community-based group-exercise programme. Seminars in Oncology Nursing, 36(5), 151071. https://doi.org/10.1016/j.soncn.2020.151071

 PubMed Web of Science ®Google Scholar

Kokts-Porietis, R. L., Stone, C. R., Friedenreich, C. M., Froese, A., McDonough, M., & McNeil, J. (2019). Breast cancer survivors’ perspectives on a home-based physical activity intervention utilizing wearable technology. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 27(8), 2885–2892. https://doi.org/10.1007/s00520-018-4581-7

 PubMed Web of Science ®Google Scholar

de Vries, H., Backbier, E., & Kok, G. (1995). The impact of social influences in the context of attitude, self-efficacy, intention and previous behaviour as predictors of smoking onset. Journal of Applied Social Psychology, 25(3), 237–257. https://doi.org/10.1111/j.1559-1816.1995.tb01593.x

 Web of Science ®Google Scholar

Vassbakk-Brovold, K. J, Antonsen, A., Berntsen, S., Kersten, C., & Fegran, L. (2018). Experiences of patients with breast cancer of participating in a lifestyle intervention study while receiving adjuvant chemotherapy. Cancer Nursing, 41(3), 218–225. https://doi.org/10.1097/NCC.0000000000000476

 PubMed Web of Science ®Google Scholar

Balneaves, L. G., Van Patten, C., Truant, T. L. O., Kelly, M. T., Neil, S. E., & Campbell, K. L. (2014). Breast cancer survivors’ perspectives on a weight loss and physical activity lifestyle intervention. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 22(8), 2057–2065. https://doi.org/10.1007/s00520-014-2185-4

 PubMed Web of Science ®Google Scholar

Balneaves, L. G., Truant, T. L. O., Van Patten, C., Kirkham, A. A., Waters, E., & Campbell, K. L. (2020). Patient and medical Oncologists’ perspectives on prescribed lifestyle intervention—experiences of women with breast cancer and providers. Journal of Clinical Medicine, 9(9), 9(9. https://doi.org/10.3390/jcm9092815

 PubMed Web of Science ®Google Scholar

Sander, A. P., Wilson, J., Izzo, N., Mountford, S. A., & Hayes, K. W. (2012). Factors that affect decisions about physical activity and exercise in survivors of breast cancer: A qualitative study. Physical Therapy, 92(4), 525–536. https://doi.org/10.2522/ptj.20110115

 PubMed Web of Science ®Google Scholar

Nock, N. L., Owusu C, Flocke S, Krejci SA, Kullman EL, Austin K, Bennett B, Cerne S, Harmon C, Moore H, Vargo M. A (2015). A community-based exercise and support group programme improves quality of life in African-American breast cancer survivors: A quantitative and qualitative analysis. International Journal of Sports and Exercise Medicine, 1(4), 1(3. https://doi.org/10.23937/2469-5718/1510020

 PubMedGoogle Scholar

de Kruif, A. J., Westerman, M. J., Winkels, R. M., Koster, M. S., van der Staaij, I. M., van den Berg, M. M. G. A., de Vries, J. H. M., de Boer, M. R., Kampman, E., & Visser, M. (2021). Exploring changes in dietary intake, physical activity and body weight during chemotherapy in women with breast cancer: A mixed-methods study. Journal of Human Nutrition and Dietetics: The Official Journal of the British Dietetic Association, 34(3), 550–561. https://doi.org/10.1111/jhn.12843

 PubMed Web of Science ®Google Scholar

Whitehead, S., & Lavelle, K. (2009). Older breast cancer survivors’ views and preferences for physical activity. Qualitative Health Research, 19(7), 894–906. https://doi.org/10.1177/1049732309337523

 PubMed Web of Science ®Google Scholar

Kim, S., Han, J., Lee, M. Y., & Jang, M. K. (2020). The experience of cancer-related fatigue, exercise and exercise adherence among women breast cancer survivors: Insights from focus group interviews. Journal of Clinical Nursing, 29(5–6), 758–769. https://doi.org/10.1111/jocn.15114

 PubMed Web of Science ®Google Scholar

Piacentine, L. B., Robinson, K. M., Waltke, L. J., Tjoe, J. A., & Ng, A. V. (2018). Promoting Team-based exercise among African American breast cancer survivors. Western Journal of Nursing Research, 40(12), 1885–1902. https://doi.org/10.1177/0193945918795313

 PubMed Web of Science ®Google Scholar

Pullen, T., Bottorff, J. L., Sabiston, C. M., Campbell, K. L., Eves, N. D., Ellard, S. L., Gotay, C., Fitzpatrick, K., Sharp, P., & Caperchione, C. M. (2019). Utilizing RE-AIM to examine the translational potential of project MOVE, a novel intervention for increasing physical activity levels in breast cancer survivors. Translational Behavioral Medicine, 9(4), 646–655. https://doi.org/10.1093/tbm/iby081

 PubMed Web of Science ®Google Scholar

Wu, H. S., Gal, R., van Sleeuwen, N. C., Brombacher, A. C., IJsselsteijn, W. A., May, A. M., & Monninkhof, E. M. (2019). Breast cancer survivors’ experiences with an activity tracker integrated into a supervised exercise programme: Qualitative study. JMIR mHealth Uhealth, 7(2), e10820. https://doi.org/10.2196/10820

 PubMed Web of Science ®Google Scholar

Loh, S. Y., Chew, S. L., & Lee, S. Y. (2011). Physical activity and women with breast cancer: Insights from expert patients. Asian Pacific Journal of Cancer Prevention: APJCP, 12(1), 87–94.

 PubMedGoogle Scholar