The experience of outdoor physical activity for skin cancer survivors: understanding the importance of the built and natural environments

Purpose Cancer patients are encouraged to do more physical activity (PA). Exercising in outdoor settings, however, may expose people to UV radiation, which is the main risk factor of melanoma. This study aimed to understand how melanoma diagnoses affect people's perception of the outdoor environment for PA. Method In-depth interviews were conducted among 19 individuals (20-85 years) with a history of melanoma at a skin cancer clinic in the Denver metropolitan area. Transcribed interviews were coded for emergent themes. The coding framework included topics related to PA behavior, sun protection, and perceptions of outdoor environment. Results Respondents reported no change in their level of outdoor activity after the melanoma diagnosis; they tried to reduce the risk of sun exposure by using sunscreen and sun-protective clothing. They also reported seeking shade, trees, and groundcover along urban corridors, in order to avoid sun exposure, reflective surfaces, and heat while being active outdoors. Conclusion Given the public health significance of UV exposure and extreme heat, further investments should be made to craft streetscape design guidelines and implement sun-proof spaces across public facilities, including parks, schools, and sport fields in order to ameliorate environmental risks for skin cancer survivors, to prevent future cancers among those that are vulnerable to the hazards of excessive UV exposure and extreme heat, and to promote outdoor PA. Implications for Cancer Survivors Skin cancer survivors and other vulnerable population subgroups will benefit from discussions around neighborhood-based design interventions that promote PA while accounting for sun safety.