Date of Award

Spring 2026

Document Type

Open Access Dissertation

Department

Public Health

First Advisor

Ciaran Fiarman

Abstract

BACKGROUND: Cancer survivors frequently experience persistent impairments in physical performance that compromise functional independence, quality of life, and long-term health. While supervised exercise programs meaningfully improve physical performance, there is uncertainty regarding the durability of these benefits and the factors that influence long-term participation after programs end. Although exercise oncology programs typically include both aerobic and resistance exercise (RE), participation in RE tends to decline once supervision ends and remains lower than aerobic exercise over time. Therefore, the overarching aims of this dissertation were to: 1) evaluate the sustainability of physical performance improvements following exercise interventions in cancer survivors; 2) examine the impact of a supervised exercise program on behavioral determinants of physical activity; and 3) identify factors that influence continued engagement in RE after program completion. METHODS: A mixed-methods approach was used to address these aims, including three related studies. First, a systematic review and meta-analysis examined the maintenance of physical performance outcomes following exercise oncology interventions. Second, a prospective study evaluated changes in psychological determinants of physical activity during an 8-week exercise oncology program and at a 3-month follow-up. Finally, qualitative interviews explored perceived barriers, facilitators, and recommendations for supporting continued RE after program completion. RESULTS: Pooled data from 24 trials showed clinically meaningful short-term improvements in cardiorespiratory fitness, muscular strength, and walking capacity. At ~3–12 months post-program, walking capacity was generally maintained, whereas cardiorespiratory fitness and strength gains were attenuated and no longer statistically significant. In the prospective study, participants improved physical function and RE self-efficacy immediately post-program; however, at 3-month follow-up, physical function declined and self-efficacy returned to baseline. Other psychological determinants showed little change across time, and only 11/21 (52%) participants reported continuing RE at follow-up. Qualitative interviews identified barriers to RE after program completion including reduced motivation, lack of external support/accountability, physical limitations, uncertainty about technique and progression, limited access to resources, and time constraints. Facilitators included perceived health benefits, access to resources, and social support. Participants recommended take-home instructional resources, structured follow-up support, and greater program continuity to strengthen the transition to independent RE. CONCLUSION: These findings indicate that while exercise oncology programs improve physical performance, these benefits are often transient, and programs may not adequately prepare cancer survivors to maintain exercise independently. This dissertation advances the field by demonstrating the need for exercise models that extend beyond time-limited supervision and identifying potential targets for future behavioral and transition support strategies to sustain RE participation.

Rights

© 2026, Alexander Matthew Brooks

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