Recommendations in the ERAS protocol advise to undertake deliberate activities such as walking or cycling for at least 30 minutes a day before the surgery. Before the surgery it was reported that 58.28% of patients followed these recommendations, while six months after the surgery this statistic was 47.62%. A small percentage of active patients, limitations of PA after diagnosis and during the course of treatment are a common problem confirmed by other researchers [15,16].
It is generally assumed that social support has a positive impact on shaping health behaviors [9,17,18], psychical health [19,20]. Similarly, this study showed that social support facilitates the PA before the surgery. Nevertheless, six months after the surgery, an important role of social support for this type of health behavior was observed: the higher the perceived social support, the lower PA. It may be explained by the phenomenon which we may call “the role of a patient” . Basically, following cancer surgery, people who receive more social support could more often be relieved of most of their daily duties by close relatives, which would result in decreasing their PA. We have shown that the significance of social support for PA changes depending on the period of measurement. Therefore, a systemic approach to health-related behaviors is needed that aims to improve self-managing behavior . It may be claimed that social support should include a specified type of health-related behavior (e.g. social support for undertaking PA, social support for cutting down on alcohol intake) and the period over which the study is carried out (before the surgery, after the surgery).
In the period before the diagnosis and before the surgery, those patients who lived alone showed a lower time of PA than patients lived in partnership. This tendency corresponds to the findings of Hawkins et al., (2010), who proved that the fact of becoming widowed, divorced or separated contributes to decreasing the time of PA. However, a reversed relationship was seen half a year after the surgery – PA of people who lived alone was higher than people in partnership. It may be explained by the fact that people who live alone are forced to undertake more PA in everyday life than people who are assisted by a partner. This dependence confirms the discussed relationship between social support and the increase in PA .
The success of cancer treatment depends on external factors (e.g. the selection of an appropriate method of treatment, selection and care of medical staff) and on the patient (e.g. health behaviors, social support). Although the patient’s role in self-determination and self-management in illness is crucial, there are various factors that determine the extent to which patients are aware of this. Entering the "role of a patient" involves in some way the need to modify one’s own identity, internalizing in oneself those aspects of life that were previously unknown. Illness is a situation that affects not only the patient, but often requires a reformulation of the life of the entire family system. The role of social support in disease discussed in this article is complex, so it is worth looking at theories that can explain the obtained relationships.
According to Seligman’s learned helplessness theory (1974), an organism that has come to terms with its inability to control the situation will react in three ways: motivational deficit, cognitive deficit and emotional deficit. The motivational deficit appears secondary to the belief that there is no control over the situation, and its effect is to refrain from attempting to change. Cognitive deficit is synonymous with the belief that nothing can be done to prevent unpleasant situations. The consequence of such thinking is developing a passive or indifferent attitude in the patient, which may lead to an attempt to take over some of the duties by the closest relatives to help relieve the patient of their daily duties . As mentioned earlier, people who are facing the disease on their own would be more active. Presumably, people without social support in a crisis situation may want to seek such support. Such an inference would explain the time of PA, because leaving home, among others for a walk, a bike ride or a trip to the store, may give the patient a greater chance of meeting someone with whom they might share their concerns. People who are provided with support in their immediate surroundings would not see the need to acquire new contacts, benefitting from a safe and familiar social environment. On the other hand, a patient’s family members and relatives might enter “the role of the protector” to make them feel appreciated, important and responsible for the patient’s life and health . A similar situation applies to medical staff, who might feel the need to fulfill their professional duties.
We have confirmed the positive role of self-efficacy for PA in the period before the surgery. It confirms with the studies by Morey and associates (2015)  and Dennis and associates (2013) . It has been shown that self-efficacy had not related with PA six months after surgery. The experienced cancer symptoms proved to be of key importance for changing this behavior six months after the surgery. The patients’ appraisal of their symptoms as nagging did not favor undertaking PA (symptoms explain the 13% variability in PA). It is noteworthy that such medical variables as the type of surgery, using stoma, and adjuvant treatment were not significant predictors of PA.
The study results could contribute to the development of education programs for medical staff who work with patients as well as for patients and their families. It seems important to educate them about the necessity patients’ own activity in disease. In the lights of these studies it is reasonable to monitor health behaviors not only in the hospital, but also outside the medical facility.