Prescribing pre- and post-operative physical activity interventions for people undergoing breast cancer surgery: a qualitative systematic review.

IntroductionUndertaking physical activity, pre- and post-operatively, can benefit recovery time and improve post-surgical outcomes. One cohort of patients that have reported these benefits are those undergoing surgery for breast cancer. Yet, what remains unclear is the level to which physical activity interventions are implemented into standard surgical care for patients with breast cancer. AimsThis systematic review aimed to examine existing qualitative evidence focusing on pre- and post-operative physical activity interventions to better understand the benefits and shortcomings of physical activity within the surgical journey. MethodsA systematic literature search was undertaken in November 2022, across five databases: MEDLINE, PsycINFO, Embase, CINAHL and Scopus. Qualitative studies involving people with breast cancer who had undertaken a physical activity intervention, either pre- and/or post-operatively, were included for analysis. The review was registered on PROSPERO: CRD42022372466 and performed according to PRISMA guidelines. The Critical Appraisal Skills Programme qualitative study checklist was used to assess study quality. ResultsFourteen studies were included, comprising the perspectives of 418 people receiving surgery for breast cancer. One study implemented pre-operative physical activity interventions; the remaining studies focused on post-operative interventions. A narrative systematic review was undertaken due to heterogeneity in reported results. Four themes were developed by thematic analysis, centring on: (i) factors promoting engagement with physical activity interventions; (ii) factors preventing engagement with physical activity interventions; (iii) the impact of pre- and post-operative interventions on physical and psychological health; and (iii) participant recommendations for pre- and post-operative interventions. Conclusionpre- and post-operative physical activity interventions were well-accepted. Patients recognised factors which promoted or prevented engagement with interventions, as well as pre- and post-operative physical and psychological benefits that arose as a result. Evidence based co-design studies may further inform successful implementation of physical activity into standard care for surgical breast cancer patients.