Physical Activity Engagement and Promotion in Survivors of Locally Advanced Head and Neck Cancer: A Qualitative Study

Background: Survivors of head and neck cancer (sHNC) often show low levels of physical activity (PA), particularly those with advanced disease, despite the well-established benefits of PA. This study explored capabilities, opportunities, and motivation for PA engagement among sHNC and their significant others (SO), and gathered suggestions for PA promotion. Methods: A qualitative descriptive design guided by the COM-B model of behavior was applied. Semistructured interviews were conducted with sHNC and SO. All interviews were audio-recorded, transcribed verbatim, anonymized, and coded using a deductive–inductive approach. Results: Twenty participants (12 sHNC and 8 SO) were interviewed. PA engagement was facilitated by prior PA experience, knowledge, positive beliefs, and intrinsic motivation, but hindered by treatment sequelae and psychosocial factors such as shame and social withdrawal. While structured therapies, expert guidance, and supportive networks presented opportunities, access remained constrained by fragmented care, poor referral coordination, and financial barriers. Participants recommended introducing PA early in treatment, appointing a coordinator, providing structured rehabilitation, and involving families. They emphasized that PA promotion must be tailored, coordinated, and integrated throughout the treatment trajectory. Conclusions: sHNC face multifactorial barriers to PA engagement despite recognizing its importance. Key strategies include enhancing capability through symptom management and education, improving opportunity via coordinated, accessible programs, and strengthening motivation with individualized, supportive approaches. Integrating PA promotion into standard oncologic care and training healthcare professionals in PA counseling may foster sustainable engagement. Future research should evaluate tailored, family-inclusive PA promotion across the cancer care continuum.