3.6. Determinants of recreational physical activity in cancer patients and survivors While the determinants of RPA are well documented for apparently healthy populations, patients receiving cancer treatment will likely experience negative side effects that limit their ability to exercise during or after treatment. In fact, a plethora of persistent negative side effects, across multiple systems of the body, have been well documented for the most commonly used curative cancer therapies [33]. These include deleterious side effects such as fatigue, pain, cardiovascular and pulmonary changes, neuropathy, cognitive impairment, endocrine changes (i.e., early menopause), changes in body composition (lean mass loss), changes in bone density, damage to musculoskeletal tissue, impaired immune function (including anemia and lymphedema), gastrointestinal damage, and changes in skin [33]. Not only is overall physical function diminished during treatment, but evidence also suggests that treatment-related impairments are long term. For example, in one epidemiological study of survivors who were 5 years post-treatment, more than half reported physical limitations including standing, lifting 10 lb, and walking a quarter of a mile [57]. Furthermore, the presence of comorbidities and specific diseaserelated symptoms may also compound these commonly experienced side effects of cancer treatment [57]. Given the added challenges facing cancer patients and survivors, it is not surprising that adherence to regular RPA is lower among EOC survivors in comparison to the general population. While approximately 50% of adult women in the United States report meeting the PAGA recommendation of 150 min of activity per week [58] existing evidence suggests that only 31% of EOC survivors met the guidelines [59]. In the same study of survivors, researchers also identified several key factors that were most strongly associated with meeting activity guidelines including younger age, higher education and income, employment, lower BMI, absence of arthritis, longer time since diagnosis, earlier disease stage, being disease-free and having the intention to exercise [59]. Despite the unique set of barriers to RPA that may be perceived and experienced by cancer patients and survivors, RPA and structured exercise programs are safe and efficacious, both during and after cancer