Table 3 Main Themes and Subthemes

1. Life is Disrupted by Cancer and Cachexia

 1.1 Altered Sense of Self

I used to do everything. It's affected my thinking, my memory. I'm always tired. I was, I was always busy, busy, busy and now, I don't know how I can feel as if the day's gone and I've done nothing. It's slowed me down. I can't go, I don't go to the shops, not just because of the COVID. But before COVID, I couldn't go to the shops on my own. My husband drives me everywhere. So, I've stopped driving. Yes. So it's just changed from being a very independent person to someone that relies on others. – ID #9

I don't feel as healthy, if I'm not exercising. So, I have a bit of a thing that I want to be doing something every day. And on the days when I'm feeling sick from the treatment, I find it psychologically frustrating as well as physically frustrating to not be able to…even go for a walk or have the strength to do anything like that. So, exercise has been part of my daily routine for a very long time. So I think it's…the change of lifestyle as much as how your body feels for not doing exercise. – ID #11

 1.2 Increased Awareness of Illness

Well, it's hard to gauge, you know, where the disease starts and stops. You know, where it's just constant and symptoms. – ID #3

It's like, it's like a bit of a black spot, you know… you can't do something that you want to do. And you know what the feelings are when you're able to do a particular exercise for a particular period of time, you know how you're gonna feel. But I just know that my system at the moment just wouldn't handle what I would do. Mentally, I think it wears on you and…then you keep saying to yourself, “Well, I wonder whether I'm ever gonna go back to what I had?” – ID #4

2. Exercise Offers Hope

 2.1 Reclaiming Control

I want to do stuff. I want to get myself as fit as I can and…not die just yet. – ID #10

I'd like to maintain at least my level of activity that I have now. I don't want it to deteriorate anymore. I would like… for as long as I can. I realize that I only, I can do this for a certain length of time. But I want to try and keep going as long as I can. – ID #7

 2.2 Cancer and Treatment-specific Benefits

I think it's important just to kind of keep your physical health at a point, at a good point where you can actually deal with side effects. So, I mean… immunotherapy is my first…treatment that I've experienced. So, I haven't done chemo. I haven't done any other ones. So, my, in my mind, it's like… I want to prepare myself for possible change in treatment, different side effects. I mean, your body, medication and your body sometimes is just unpredictable. So, my, my idea is just more to prepare myself, but also feel like I'm contributing to my own health. – ID #2

No, I think it's totally important to have exercise because it's getting all the chemo around you, your cells and your body through, through your blood. And but also, it's not wasting your muscles away. And, and, and especially my bone density, density and my, and all my bones need strengthening…so it's really important. – ID #19

 2.3 An Emotional Outlet

So getting out there and doing a bit of exercise takes your mind off, off your diagnosis as well. And if it makes you feel better, well, naturally, your body's gonna start feeling better as well, you know? – ID #14

Well, well, [exercise], it lifts my mood. It, it levels me out. It levels things out. It makes me clearer. I can think clearer. – ID #1

3. Exercise Barriers are Multifaceted

 3.1 Symptoms are Burdensome

For a while there, it was sort of difficult, just because of not having muscle mass and just also at the moment, because of the breathing. It's a bit of an issue because breathing isn't as good as it used to be. So, I'm aware of my breathing and then I get sort of, if I exert myself really quickly, I can't breathe. – ID #8

You know you tell yourself, I want to go for that walk. But you certainly cannot actually get yourself out of bed. It's the strangest feeling…kind of, it's just weird. Sort of, it's sort of almost…something to do with your will to get up and do it. You can't will yourself. I don't know if it's because of the tiredness because it messes with all the things in your body, and your brain. I don't know, I don't know what it is, but it's weird. – ID #20

 3.2 Safety Concerns Reduce Confidence

I'm just worried that I'll be damaging the spine. That's the only thing, I think. Whether I'll get another crushed vertebrae… because I don't know why. – ID #16

The exercise, I sometimes get a bit paranoid about whether it's the stiffness that I'm getting, because I'm not using [those] muscles…Yeah, so that's where I've got to sort of weigh out whether it is pain from building my muscles up again or whether it's pain from the fractures or, you know, my bones. I suppose I am a bit, bit worried, conscious of all that, because they're the, the tumors are in all my bones. – ID #19

 3.3 Having Cancer in a Pandemic

Because of the COVID, I haven't been anywhere. I haven't been out. – ID #7

Um, I don't think this, this lockdown thing helps at the moment, you know, because you can't see anybody, you can't really go. You know, I would, you know, my daughter would come and take me and she'd make me go for walks and things like that. – ID #6

 3.4 Lack of Personalized Exercise Advice and Services

I think they may have responded to a question I asked about, "Is [exercise] okay?" But it has never been offered as a strategy to use to alleviate some of the symptoms I've experienced. – ID #11

I think one of the frustrations I've been having is that these programs or physiotherapy, or going to the gym… there's no structure or continuity to them. I can't really track so much my progress or create milestones. There's no one really accompanying my physical rehabilitation. It's all just there's some exercise here, some exercise there, and you know, wish for the best sort of thing. – ID #13

 3.5 External Factors

And having a one-on-one, like having a personal trainer, I would say financially because I don't work, and I don't have a pension. So, you know, it's just money out of your own savings, really. – ID #9

4. Exercise Access and Support are Important

 4.1 Professional Supervision and Structure are Valued

Oh, I know that [exercise] would be something that would be beneficial. And I've often thought, geez, maybe I would exercise if I could just do it one-on-one with someone. And if like, they could help me build myself up slowly, rather than…every time you see people exercising, [they’re] just like going at 100 miles an hour and it's like, well, that's not…what I could manage. Anyway, I would need someone who could slowly help me get to a better point. – ID #8

“Well, [an exercise] program motivates me, a specific program.” – ID #1

 4.2 Social Support is Motivating

I'm probably more motivated with the people around me doing it as well. Whereas, if I'm on my own, you don't need to do it. – ID #6

 4.3 Access to Facilitate Exercise

But if you're going through chemo, traveling is a big thing. You want things nearby…It's got to be accessible because if you 're sick and you sleep half of the day, your only window is say, the afternoon. What are you going to do? You want to maximize the time you have to feel that…you have achieved something for the day as well. – ID #20