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Barriers to physical activity levels in people with cancer who are undergoing chemotherapy: a narrative systematic review with mapping to the capability, opportunity, motivation behaviour (COM-B) model

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Abstract

Purpose

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Cancer is a leading cause of death and disability. Chemotherapy is one of the most common treatments. Physical activity (PA) can improve chemotherapy side effects, fatigue, adherence, survival rates and quality of life. However, people who are undergoing chemotherapy are insufficiently active. This review aimed to identify the barriers to PA in adults who are undergoing chemotherapy for the treatment of cancer.

Methods

Databases were searched for articles that met the eligibility criteria and screened to determine eligibility and risk of bias using the Clinical Appraisal Study Programme Qualitative Checklist. Studies included adults aged > 18 years who were currently undergoing chemotherapy for any type or stage of cancer. Reflexive thematic analysis was used to develop themes, which were deductively mapped to the capability, opportunity, motivation behaviour (COM-B) model and presented narratively. The behaviour change wheel intervention functions enabled identification of potential strategies to address barriers.

Results

A total of 9774 articles were screened. Twenty studies were eligible, including 1085 participants. Side effects of cancer and chemotherapy, other health conditions (capability), knowledge gaps, accessibility, environmental factors, and lack of social support (opportunity); negative emotional response, not having time/prioritising other commitments, and low motivation (motivation) were identified as barriers to PA. Fatigue was the most commonly identified single barrier. Intervention functions to improve PA levels include environmental restructuring, education, training and enablement.

Conclusion

The most commonly reported barriers to PA in people who are undergoing chemotherapy included side effects of cancer and chemotherapy, not having time/prioritising other commitments, knowledge and accessibility. Changes to service accessibility and delivery, and education for the cancer care team and people who are undergoing chemotherapy should be implemented to support increasing PA levels.

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Data availability

No datasets were generated or analysed during the current study.

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Acknowledgements

The authors would like to acknowledge the support of the University of Canberra and ACT Health and Community Services Directorate.

Funding

This research was supported by an Australian Government Research Training Program (RTP) Scholarship https://doi.org/10.82133/C42F-K220 for Rebecca Cesnik.

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Authors and Affiliations

  1. ACT Health Directorate, ACT Health GPO, Canberra City, Box 825, ACT, 2601, Australia

    Rebecca Cesnik

  2. Sport and Exercise Science, Faculty of Health, University of Canberra, Bruce, ACT, Australia

    Rebecca Cesnik, Kellie Toohey & Stuart Semple

  3. Physical Activity, Sport and Exercise Research Theme, Faculty of Health, Southern Cross University, Lismore, Australia

    Kellie Toohey

  4. Behaviour Works Australia, Monash University, Victoria, Australia

    Breanne Kunstler

  5. Physiotherapy, Faculty of Health, University of Canberra, Bruce, ACT, Australia

    Nicole Freene

  6. Health Research Institute, University of Canberra, Bruce, ACT, Australia

    Nicole Freene & Stuart Semple

  7. Research Institute of Sport and Exercise, University of Canberra, Bruce, ACT, Australia

    Rebecca Cesnik & Stuart Semple

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Contributions

Rebecca Cesnik – Database search; reviewer 1 for abstracts, full-texts and risk of bias; data extraction; primary author. Brea Kunstler – Reviewer 2 for abstracts, reviewer 2 for some full texts, editing and guidance for manuscript development. Kellie Toohey – Reviewer 2 for risk of bias, editing and guidance for manuscript development. Nicole Freene – Reviewer 2 for some full texts, editing and guidance for manuscript development. Stuart Semple – Reviewer 3 for abstracts, full texts and risk of bias, editing and guidance for manuscript development.

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Correspondence to Rebecca Cesnik.

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Cesnik, R., Kunstler, B., Toohey, K. et al. Barriers to physical activity levels in people with cancer who are undergoing chemotherapy: a narrative systematic review with mapping to the capability, opportunity, motivation behaviour (COM-B) model. Support Care Cancer 34, 20 (2026). https://doi.org/10.1007/s00520-025-10174-9

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