“It Was Part of the Plan, so I Showed up”: An Exploration of Patient Experiences With an Embedded Exercise Referral Process During Cancer Treatment

IntroductionExercise is a key part of cancer care, yet its integration into routine practice remains limited. This study explored the experiences of people living with and beyond cancer, with an updated, opt-out referral model embedded within a supportive oncology setting, focusing on initial engagement with exercise physiology appointments. Through this model, patients were automatically scheduled for a consultation with an in-house exercise professional during their cancer treatment.MethodsA qualitative descriptive design comprised of two focus groups with 13 participants was employed to explore views across pre-defined elements of the model: referral to exercise, appointments, counselling, and tailoring.ResultsParticipants valued the automatic appointment structure as it normalised exercise as being part of their treatment and reduced the burden from decision-making and arrangement of appointments. Trust in their treating doctors and nurses, together with consistent messaging, reinforced exercise as a medically endorsed intervention. Counselling on exercise addressed misinformation, highlighted the physiological rationale, and helped foster a sense of control and agency. The inclusive gym environment and tailored plans further supported engagement with exercise, from which the importance of collaborative but individualised care was noted. While the opt-out process facilitated initial uptake, sustained access to exercise services beyond the clinical setting remains a challenge.ConclusionsFindings support the feasibility and acceptability of integrated referral pathways and underscore the need for system-level changes and community partnerships to ensure long-term, equitable access to exercise in cancer care.