Informational and structural barriers to exercise oncology care in Spain: development of the MOVE - Onco questionnaire and preliminary findings

Abstract

Purpose Exercise is recommended as a core component of supportive cancer care; however, its implementation remains inconsistent. Beyond individual motivation, social and healthcare system factors may shape access to structured exercise programs. This study aimed to develop and content-validate the Motivators, Obstacles, Values, and Exercise in Oncology (MOVE-Onco) questionnaire and to provide preliminary evidence on informational and structural barriers to exercise among oncology patients in Spain. Methods A multi-phase study was conducted including: (1) qualitative item generation through patient interviews and cognitive debriefing; (2) a two-round Delphi process with a multidisciplinary expert panel (N = 16) using a = 75% consensus criterion; and (3) a pilot cross-sectional application in 53 oncology patients to assess internal consistency and describe perceived barriers, facilitators, knowledge, and preferences. Results Content validity was achieved with = 75% expert agreement in the final Delphi round. Internal consistency was excellent for the Barriers scale (a = 0.91) and good for the Facilitators scale (a = 0.85). Although most participants believed exercise improves health outcomes (98.1%) and expressed interest in structured programs (86.9%), 67.9% reported not receiving professional exercise guidance and 94.3% were unaware of specialized oncology exercise resources. Informational barriers were more frequently endorsed than physical or psychological limitations in this pilot sample. Conclusions The MOVE-Onco questionnaire demonstrates preliminary content validity and internal consistency in a Spanish oncology context. Pilot findings suggest that limited professional guidance and low awareness of available resources, rather than lack of patient motivation, may constitute key barriers to exercise engagement. These results highlight potential structural gaps in supportive cancer care delivery. However, these findings should be interpreted cautiously and require confirmation in larger studies.