Understanding facilitators and barriers to participation in physical exercise in older adults with colorectal cancer: A qualitative interview study.

INTRODUCTION: Thirty percent of patients with colorectal cancer (CRC) are aged 75 years or older. Despite advances in cancer treatment, complications may arise, impacting patients' quality of life. Physical exercise has shown benefits for cancer-related health outcomes. However, perioperative exercise recommendations for patients with CRC are often inadequate or poorly understood, limiting their participation. This qualitative study aimed to explore the perceived barriers and facilitators to engagement in physical exercise among older adults with CRC scheduled for elective surgery during the perioperative period. MATERIALS AND METHODS: Patients aged ≥75 years with a diagnosis of CRC awaiting elective surgery were purposively sampled from a tertiary referral hospital in Madrid, Spain. Semi-structured individual telephone interviews were conducted, audio-recorded and transcribed verbatim. Data were analyzed using Braun and Clarke's six-phase thematic analysis. RESULTS: Sixteen participants (7 women, mean age 84.8 ± 6.2 years) were included. Three main themes emerged: (1) CRC diagnosis impacts emotion and nutrition among older adults, who described feelings of discouragement and loss of appetite; (2) Multiple barriers across life domains limit exercise engagement in older adults with CRC, including lack of awareness, pain, and low physical function; and (3) Tailored support and autonomy facilitate exercise participation in older patients with CRC, highlighting a preference for home-based exercise guided by written materials rather than digital formats. DISCUSSION: Older adults with CRC preparing for elective surgery face multiple interrelated barriers and facilitators to engaging in physical exercise. These findings highlight the need for tailored, home-based exercise programs supported by clear written guidance and professional supervision.