Exercise promotion in cancer care in Saudi Arabia: A cross-sectional survey of oncology physicians' knowledge, practices, barriers, and facilitators.

PURPOSE: Exercise is increasingly recognized as a critical component of cancer care, reducing treatment-related side effects, and enhancing quality of life. Despite these benefits, exercise promotion remains underutilized in oncology settings. This study aims to assess oncology physicians' knowledge, current practices, perceived barriers, and facilitators related to exercise promotion among people with cancer in Saudi Arabia. METHODS: A descriptive cross-sectional study was conducted between January 2024 and June 2025 among 44 licensed oncology physicians across Saudi Arabia. Data were collected using the validated Clinicians' Perspectives on Exercise in Patients with Cancer (CliPEC) questionnaire. Descriptive statistics were used to analyze the data using SPSS Version 28.0. RESULTS: Only 18% of participants correctly identified international physical activity guidelines, and 63% were unaware of cancer-specific exercise recommendations. While 63% considered exercise safe and appropriate for cancer patients, few routinely discussed or referred patients to exercise programs. Key barriers included limited time, lack of training, and uncertainty about referral pathways. Facilitators identified included practitioner education, patient handouts, and access to oncology-specialized physiotherapists. A majority of participants expressed willingness to incorporate exercise into care if systemic support were available. CONCLUSION: Despite positive attitudes toward exercise, important knowledge gaps and systemic barriers may hinder its integration into oncology care in Saudi Arabia. Targeted education, interdisciplinary collaboration, and institutional support are essential to bridge this gap and align clinical practice with international exercise guidelines. IMPLICATIONS FOR CANCER SURVIVORS: This study suggests that many oncology physicians in Saudi Arabia support the role of exercise in cancer care butmay lack sufficient knowledge, confidence, and referral pathways to promote it consistently. Improving clinician education, strengthening referral systems, and integrating physiotherapists or exercise specialists into oncology teams may help cancer survivors receive more timely and appropriate exercise guidance as part of routine care.