Impact of Psychological Support on Motivation for Physical Activity in Colorectal Cancer Patients

• Mehdi Soufi

  Laboratory of Biotechnology and Medicine, Faculty of Medicine and Pharmacy of Agadir, Ibn Zohr University, Agadir 80060, Morocco and Department of Digestive and Visceral Surgery, Souss Massa University Hospital Center, Agadir 80060, Morocco

• Lahoucine Amsdar

  Laboratory of Biotechnology and Medicine, Faculty of Medicine and Pharmacy of Agadir, Ibn Zohr University, Agadir 80060, Morocco and High Institute of Nursing Professions and Technical Health, Agadir, 80060, Morocco

Introduction: This study investigates the psychosocial determinants of physical activity (PA) in colorectal cancer (CRC) patients, specifically examining the influence of perceived autonomy support from healthcare providers on exercise behavior.

Methods: A cross-sectional analytical study was conducted among 72 patients with CRC using two validated scales. Perceived autonomy support was assessed via the Health Care Climate Questionnaire (HCCQ). Motivation to exercise during oncology treatment was measured using the Treatment Self-Regulation Questionnaire (TSRQ). Relationships were analyzed using the computed mean item scores of both instruments.

Results: The study results showed a slight male predominance (sex ratio: 1.25) with a mean age of 56±11.94 years. Diagnosis was predominantly late (84.7%), with a high prevalence of stages III and IV (84.7%). Furthermore, the study revealed a non-self-determined profile (index: -2.2), characterized by a healthcare environment perceived as controlling (HCCQ: 2.71). Patients engaged in physical exercise primarily out of guilt or external pressure (controlled regulation score: 5.11) rather than personal conviction (autonomous regulation score: 2.86). Educational level significantly influenced the perception of autonomy support (p = 0.03), to the detriment of the most and least educated patients. Conversely, participants' age and clinical stage (TNM) had no statistically significant impact on the various psychological dimensions assessed (p > 0.05).

Conclusion: In light of patient engagement being driven by external constraint, care in colorectal oncology must shift from directive prescription to autonomy support. To achieve this, integrating therapeutic patient education is essential to facilitate the internalization of the health benefits of exercise. Finally, establishing progressive goals proves indispensable for restoring self-efficacy and consolidating the patient’s perceived competence prior to any focus on functional performance.

[1] Açil HC, Yilmaz AÇ, Aygin D. The effect of recovery status and life conditions on the quality of life in colorectal cancer patients with stoma: a path analysis. Frontiers in Psychology 2025; 16: 1693626.

[2] Wang X, Chen S. Effects of Hospice Care on Anxiety, Depression, and Pain in Patients With Terminal Colon Adenocarcinoma: A Retrospective Cohort Study. Actas Españolas de Psiquiatría 2026; 54(2): 409-18.

[3] Pentheroudakis G, Argilés G, Arnold D, Smyth E, Ducreux M, Committee EG. ESMO Clinical Practice Guideline Express Update on the adoption of physical exercise in patients with localised colon cancer. ESMO Open 2026: 106019.

[4] Campbell KL, Winters-Stone K, Wiskemann J, May AM, Schwartz AL, Courneya KS, et al. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Medicine and Science in Sports and Exercise 2019; 51(11): 2375.

[5] Ohta R, Fujimori T, Tanaka K, Sano C, Hayashi H. The Impact of Exercise on Overall Survival in Patients With Metastatic Colorectal Cancer: A Systematic Review and Meta-Analysis. Cureus 2025; 17(11).

[6] Soares-Miranda L, Abreu S, Ruiz-Casado A, Lucia A. Physical activity and nutritional interventions and health-related quality of life in colorectal cancer survivors: a review. Expert Review of Quality of Life in Cancer Care 2018; 3(4): 95-104.

[7] Van Blarigan EL, Meyerhardt JA. Role of physical activity and diet after colorectal cancer diagnosis. Journal of Clinical Oncology 2015; 33(16): 1825-34.

[8] Sheng Y, Shen F, Xiong M, Huang Q, Li Q, Hu L. Physical activity levels and influencing factors among colorectal cancer patients: A cross-sectional study. BMC Psychology 2025; 13(1): 171.

[9] 9. Custers PA, van der Sande ME, Grotenhuis BA, Peters FP, van Kuijk SM, Beets GL, et al. Long-term quality of life and functional outcome of patients with rectal cancer following a watch-and-wait approach. JAMA Surgery 2023; 158(5): e230146.

[10] Romero-Elías M, González-Cutre D, Ruiz-Casado A, Tortosa-Martínez J, Beltrán-Carrillo VJ. Autonomy support in an exercise intervention with colorectal cancer patients during chemotherapy: a qualitative perspective. Psychology & Health 2025; 40(11): 1856-74.

[11] Ng JY, Ntoumanis N, Thøgersen-Ntoumani C, Deci EL, Ryan RM, Duda JL, et al. Self-determination theory applied to health contexts: A meta-analysis. Perspectives on Psychological Science 2012; 7(4): 325-40.

[12] Ishii K, Morita K, Sumita H. Reliability and validity of the Japanese treatment self-regulation questionnaire for Japanese workers. BMC Public Health 2022; 22(1): 1892.

[13] Ahles TA, Saykin AJ. Candidate mechanisms for chemotherapy-induced cognitive changes. Nature Reviews Cancer 2007; 7(3): 192-201.

[14] Crowder SL, Hoogland AI, Small BJ, Carpenter KM, Fischer SM, Li D, et al. Associations among frailty and quality of life in older patients with cancer treated with chemotherapy. Journal of Geriatric Oncology 2022; 13(8): 1149-55.

[15] Ntoumanis N, Ng JY, Prestwich A, Quested E, Hancox JE, Thøgersen-Ntoumani C, et al. A meta-analysis of self-determination theory-informed intervention studies in the health domain: effects on motivation, health behavior, physical, and psychological health. Health Psychology Review 2021; 15(2): 214-44.

[16] Díaz-Sánchez C, Rodríguez-Muñoz PM, Navarro-López V, Carmona-Torres JM, Sánchez-Gil A, Sánchez-González JL, et al., editors. Impact of ostomy on quality of life in patients with colorectal cancer: a systematic review and meta-analysis. Healthcare 2026: MDPI.

[17] Bae E-J, Kim Y-H. Mediation effects of basic psychological needs between autonomy support from healthcare providers and self-management among cancer survivors. Osong Public Health and Research Perspectives 2019; 10(6): 385.

[18] Liska CM, Morash R, Paquet L, Stacey D. Autonomisation des survivants du cancer pour répondre à leurs besoins physiques et psychosociaux: évaluation d’un projet. Canadian Oncology Nursing Journal 2018; 28(2): 82.

[19] Qiu X, Wang Y, Mao J, Wang C, Yang X, Zhao J, et al. The congruence and interrelationships of family resilience in couples coping with colorectal cancer: A cross-sectional study from a dyadic perspective. Eur J Oncol Nurs 2025; 74: 102767.

[20] Lu R, Zhou J, Ge J, Xia X, Lei C, Zhao S, et al. The Construction Level of Health Literate Health Organizations and Its Impact on Patients’ Health Literacy: Based on Self-Determination Theory and Structural Equation Modeling. Inquiry: The Journal of Health Care Organization, Provision, and Financing 2025; 62: 00469580251351178.

[21] Barello S, Palamenghi L, Graffigna G. The mediating role of the patient health engagement model on the relationship between patient perceived autonomy supportive healthcare climate and health literacy skills. International Journal of Environmental Research and Public Health 2020; 17(5): 1741.

[22] Ryan RM, Deci EL. Self-determination theory and the role of basic psychological needs in personality and the organization of behavior 2008.

[23] Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist 2000; 55(1): 68.

[24] Milne HM, Wallman KE, Guilfoyle A, Gordon S, Courneya KS. Self-determination theory and physical activity among breast cancer survivors. Journal of Sport and exercise Psychology 2008; 30(1): 23-38.

[25] Wilson PM, Blanchard CM, Nehl E, Baker F. Predicting physical activity and outcome expectations in cancer survivors: an application of Self‐Determination Theory. Psycho‐Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer 2006; 15(7): 567-78.

[26] Ferri-Caruana A, Leyton-Román M, Fresno-Alba S, Jiménez-Castuera R. Motivation and quality of life in breast cancer survivors: A self-determination theory perspective for physical activity promotion. Journal of Human Sport and Exercise 2026; 21(2): 595-605.

• PDF

• Original Research Articles

Copyright (c) 2026 Mehdi Soufi, Lahoucine Amsdar

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.