Barriers and facilitators of physical activity in patients with oral cancer during surgical hospitalization: insights from a qualitative study

Purpose: Adherence to physical activity (PA) during hospitalization remains low in patients with oral cancer, despite the benefits of early mobilization emphasized in oncological rehabilitation protocols. Insight into how patients perceive PA in the immediate postoperative period is crucial for designing effective, patient-centered interventions. This qualitative study explored patients’ experiences of PA during hospitalization following oral cancer surgery. Methods: A qualitative study was conducted using semistructured interviews guided by the behavior change wheel (BCW) framework. Dutch-speaking patients treated for oral cancer at the oral and maxillofacial department of University Hospitals Leuven (Belgium) and head and neck surgical oncology department of University Medical Center Utrecht (The Netherlands) were purposively sampled. Interviews were conducted at discharge, transcribed verbatim, and thematically analyzed in NVivo (QSR International, version 12, Burlington, MA, USA). Results: Fifteen patients were included until saturation occurred. Seven overarching themes were identified: (A) barriers to PA, (B) activities of daily living (ADL), (C) support, (D) emotional state, (E) perceptions of PA, (F) PA patterns, and (G) recovery expectations. Walking was the most common activity, but participation was restricted by fatigue, medical devices, and a predominantly passive hospital culture. PA was strongly linked to regaining autonomy, coping with confinement, and preparing for discharge. Conclusion: Despite substantial barriers, patients with oral cancer demonstrate intrinsic motivation to remain active. However, this motivation often remains unmet due to insufficient personalized support and limited integration of PA into routine care. Perioperative physiotherapeutic interventions may help to overcome barriers and promote sustainable engagement in recovery-oriented activity.