UNIVERSITY OF CALGARY

UNIVERSITY OF CALGARY
Head and Neck Cancer Survivors’ Exercise Preferences and Barriers Before and After
Participation in an Exercise Intervention
by
Colleen Lea Jackson
A THESIS
SUBMITTED TO THE FACULTY OF GRADUATE STUDIES
IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE
DEGREE OF MASTER OF SCIENCE
GRADUATE PROGRAM IN KINESIOLOGY
CALGARY, ALBERTA
APRIL, 2016
© Colleen Lea Jackson 2016

Abstract
Purpose: This study examined the exercise preferences and barriers of head and neck cancer
(HNC) survivors in relation to exercise experience. Methodology: Participants from the
ENHANCE trial (n=22) completed questionnaires on exercise preferences and barriers, which
were further explored in semi-structured interviews with a subset of participants (n=17). Results:
Before participation in the ENHANCE program, lack of interest and time were the primary
exercise barriers. After participation, there was a significant decrease in typical barriers including
lack of interest (p=.008)), exercise not a priority (p=.039), and not in routine (p=.004).
Participants also reported significant increases in preferences for engaging in exercise at a cancer
centre (p=.031), and with other survivors (p=.016). Four higher-order themes emerged from
interview data analysis pertaining to preferences (exercise types, company, supervision, and
logistics), and three higher-order themes regarding barriers (physical, psychological and
external). Significance: The results identify key factors for effective HNC exercise program
design.
Keywords: head and neck cancer, exercise, physical activity, behaviour change
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Acknowledgements
I would like to thank my supervisor, Dr. Nicole Culos-Reed, for providing me with life-changing
opportunities and for opening my eyes to what is possible when someone is truly passionate and
invested in what they do. I would also like to thank Lauren Capozzi and Dr. Justine Dowd for
their mentorship, endless encouragement, and guidance. Thank you to my committee members
and examiners, Drs. William Bridel, Harold Y. Lau, Guy Pelletier, and Nancy Moules, for
making this research possible. Finally I would like to thank my family and friends, for
supporting me through the challenges and celebrating with me after the successes.
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Dedication
To the ENHANCERs…
Your endless determination, boundless positivity, and
unimaginable strength of spirit are a true inspiration.
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Table of Contents
Abstract .............................................................................................................................. ii
Acknowledgements .......................................................................................................... iii
Dedication ......................................................................................................................... iv
Table of Contents ...............................................................................................................v
List of Tables ................................................................................................................... vii
List of Figures and Illustrations .................................................................................... vii
List of Symbols, Abbreviations and Nomenclature .................................................... viii
Epigraph ........................................................................................................................... ix
Chapter One: Introduction and Literature Review .......................................................1
Head and Neck Cancer and Exercise ...........................................................................1
Cancer Survivors’ Exercise Preferences and Barriers ...............................................4
Head and Neck Cancer Survivors’ Exercise Preferences and Barriers ...................6
The ENHANCE Exercise Trial .....................................................................................8
Methodology .................................................................................................................10
Statement of Contribution ..........................................................................................11
Chapter Two: Manuscript ..............................................................................................12
Background ..................................................................................................................12
Objectives .....................................................................................................................14
Methods .........................................................................................................................14
Participants. ............................................................................................................14
Questionnaires. .......................................................................................................15
Demographics. ..................................................................................................16
Exercise levels. ..................................................................................................16
Quality of Life. ..................................................................................................16
Depression. ........................................................................................................17
Symptom severity. ..............................................................................................17
Preference and barriers. ...................................................................................17
Interviews. ...............................................................................................................18
Data analysis. ..........................................................................................................18
Quantitative. ......................................................................................................18
Qualitative. ........................................................................................................18
Results ...........................................................................................................................19
Subject characteristics. ..........................................................................................19
Quantitative results. ...............................................................................................21
Preferences. .......................................................................................................21
Barriers. .............................................................................................................23
Qualitative Results ..................................................................................................25
Preferences ........................................................................................................25
Barriers ..............................................................................................................31
Discussion .....................................................................................................................35
Strengths and limitations. ......................................................................................37
Future directions. ...................................................................................................39
Clinical implications. ........................................................................................39
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