{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T16:52:26Z","timestamp":1784134346360,"version":"3.55.0"},"reference-count":49,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T00:00:00Z","timestamp":1760832000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Physical activity provides substantial survival and quality-of-life benefits for cancer survivors, yet participation remains suboptimal globally, particularly in the Middle East and North Africa (MENA) regions. This study represents the first comprehensive examination of physical activity barriers and facilitators among Tunisian cancer survivors. Methods: This cross-sectional study recruited 120 cancer survivors \u22653 months post-chemotherapy completion from University Hospital Farhat Hached, Sousse, Tunisia (October\u2013December 2024). Participants completed validated questionnaires via structured telephone interviews: the International Physical Activity Questionnaire Short Form (IPAQ-SF), the Physical Activity Barriers After Cancer scale (PABAC), the Fatigue Assessment Scale (FAS), and the Patient Activation Measure (PAM-13). Statistical analyses included descriptive statistics, receiver operating characteristic (ROC) analysis, correlation analyses, and multivariable regression modeling with Bonferroni correction for multiple comparisons. Results: Participants (mean age 51.89 \u00b1 10.2 years, 73.9% female) demonstrated significant physical activity declines post-chemotherapy: moderate activity decreased from 31.1% to 1.7% (p &lt; 0.001), median intensity declined from 297 to 44 MET-min\/week (p &lt; 0.001). Mean PABAC score was 29.72 \u00b1 5.13, with cognitive barriers predominating (2.85 \u00b1 0.58). Fatigue was universal (100%), with 21% reporting severe fatigue (FAS \u2265 35). Only 26.1% received exercise guidance from healthcare professionals. PABAC demonstrated excellent predictive performance for physical inactivity (AUC = 0.805, 95%CI: 0.724\u20130.887). Independent predictors of higher barriers included fatigue severity (\u03b2 = 0.466, p &lt; 0.001), low patient activation (\u03b2 = \u22120.091, p = 0.010), and advanced cancer stage (\u03b2 = 1.932, p = 0.008). Conclusions: Tunisian cancer survivors experience substantial, multidimensional barriers to physical activity, with inadequate healthcare guidance representing a critical system-level gap. Findings support the development of culturally adapted, multidisciplinary interventions that target modifiable cognitive and symptom-related barriers, while enhancing patient activation and healthcare provider engagement.<\/jats:p>","DOI":"10.3390\/cancers17203375","type":"journal-article","created":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T10:44:10Z","timestamp":1760957050000},"page":"3375","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Stifled Motivation, Systemic Neglect: A Cross-Sectional Analysis of Inactivity in Post-Chemotherapy Cancer Survivors in the Middle East and North Africa Region"],"prefix":"10.3390","volume":"17","author":[{"given":"Mariem","family":"Gaddour","sequence":"first","affiliation":[{"name":"Physical Medicine and Rehabilitation Department, Sahloul University Hospital, Faculty of Medicine of Sousse, University of Sousse, Sousse 4002, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maha","family":"Ammar","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation Department, Sahloul University Hospital, Faculty of Medicine of Sousse, University of Sousse, Sousse 4002, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leila Ben","family":"Fatma","sequence":"additional","affiliation":[{"name":"Oncology Department, Farhat Hached University Hospital, Faculty of Medicine of Sousse, University of Sousse, Sousse 4002, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2214-4667","authenticated-orcid":false,"given":"Halil \u0130brahim","family":"Ceylan","sequence":"additional","affiliation":[{"name":"Physical Education and Sports Teaching Department, Faculty of Sports Sciences, Atat\u00fcrk University, Erzurum 25240, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3860-3519","authenticated-orcid":false,"given":"Ines","family":"Loubiri","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation Department, Sahloul University Hospital, Faculty of Medicine of Sousse, University of Sousse, Sousse 4002, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nedra","family":"El Feni","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation Department, Ibn Jazzar University Hospital, Kairouan 3100, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Jemni","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation Department, Sahloul University Hospital, Faculty of Medicine of Sousse, University of Sousse, Sousse 4002, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0825-2707","authenticated-orcid":false,"given":"Luca","family":"Puce","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8409-868X","authenticated-orcid":false,"given":"Nicola Luigi","family":"Bragazzi","sequence":"additional","affiliation":[{"name":"Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ismail","family":"Dergaa","sequence":"additional","affiliation":[{"name":"High Institute of Sport and Physical Education of Ksar Said, University of Manouba, Manouba 2010, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,19]]},"reference":[{"key":"ref_1","first-page":"17","article-title":"Cancer statistics, 2023","volume":"73","author":"Siegel","year":"2023","journal-title":"CA A Cancer J. 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