From Intention to Action: A Grounded Theory Study on the Staged Mechanisms of Postoperative Exercise Behavior Among Breast Cancer Patients

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Abstract
Exercise is widely recommended for postoperative breast cancer patients due to its benefits for functional recovery and symptom management. However, real-world participation and long-term adherence remain consistently low. Existing research has largely focused on participation rates or perceived barriers, offering limited insight into the behavioral mechanisms that govern how exercise is initiated and sustained over time, particularly within specific cultural contexts. To explore the mechanisms underlying the initiation and maintenance of postoperative exercise behaviors among breast cancer patients, with particular attention to the interaction among behavioral capability, motivation, and cues across different stages of recovery. A qualitative study informed by grounded theory was conducted. Fifteen patients (n = 15) who had undergone unilateral mastectomy were purposively recruited from a tertiary hospital in Foshan, China. Semi-structured, in-depth interviews were carried out and analyzed using open, axial, and selective coding procedures. Postoperative exercise behavior was shaped by the dynamic interaction of three interrelated domains: capability, motivation, and cues. Capability—encompassing physical condition, exercise-related knowledge, and self-regulatory skills—functioned as a threshold condition for behavior initiation. Notably, the capability threshold evolved across the disease trajectory: in the early postoperative phase, it was primarily constrained by acute physical symptoms such as pain and limited mobility, whereas in the long-term recovery phase, it increasingly depended on patients’ self-regulatory capacity and ability to integrate exercise into daily life.Motivation acted as a fluctuating driver influenced by perceived benefits, emotional responses, and external support. Cues, including professional guidance and family reminders, functioned as both behavioral triggers and a key maintenance mechanism. In the absence of sustained cues, behavioral discontinuity frequently occurred, even among patients with adequate motivation and capability.Cultural beliefs regarding rest and activity, rooted in the Chinese context, influenced patients’ perceptions of exercise safety and timing, thereby shaping motivation and responsiveness to cues. Postoperative exercise behavior among breast cancer patients follows a staged mechanism characterized by capability-dependent initiation, motivation-driven fluctuation, and cue-dependent maintenance. These findings highlight the need for nurse-led, continuous, and context-sensitive interventions, rather than one-time education, to support long-term exercise adherence, particularly in cultural contexts where beliefs about rest and activity may shape patients’ exercise behaviors. Nursing interventions should move beyond information delivery and adopt a system-based behavioral support approach that strengthens exercise capability, by incorporating structured exercise prescriptions, continuous nurse-led follow-up, digital reminder systems, and family-supported cueing strategies into routine care.

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