Factors influencing sedentary behaviour after video-assisted thoracoscopic surgery in patients with early-stage lung cancer: a qualitative study

Abstract Background Prolonged sedentary behaviour is common among patients with early-stage lung cancer during recovery after video-assisted thoracoscopic surgery. Sedentary behaviour is distinct from physical inactivity; even patients who walk or exercise may remain seated or reclined for long periods during other waking hours. Previous research has focused mainly on postoperative physical activity and functional recovery, with limited qualitative understanding of why patients remain sedentary and how they interrupt sedentary behaviour across recovery contexts. This study explored factors influencing sedentary behaviour after VATS and interpretively integrated the findings using the Fogg Behavior Model. Methods A descriptive qualitative study was conducted at a tertiary hospital in Jiangsu Province, China, from October to December 2025. Thirty patients with early-stage lung cancer following VATS were recruited using maximum variation purposive sampling. Fourteen were interviewed during inpatient recovery and 16 during outpatient/home recovery at approximately 1 month after surgery; the groups comprised different participants. Semi-structured interviews were analysed using inductive thematic analysis. After theme development, findings were interpretively integrated using the FBM dimensions of Motivation, Ability, and Prompt. Results Four themes were identified: getting moving was not easy; knowing activity matters, but not how to interrupt sedentary time; rest felt necessary for recovery; and people around them influenced whether they got up and moved. Even when patients recognised the need for activity, prolonged sedentary periods could persist when restorative rest was prioritised, getting up was perceived as unsafe, or specific interruption strategies were lacking. The relative prominence of these influences differed between inpatient recovery and outpatient/home recovery at approximately 1 month after surgery. FBM-based integration suggested that external prompts were more likely to be associated with sedentary interruption when getting up was perceived as safe, feasible, and personally meaningful. Conclusion Reducing or interrupting sedentary behaviour after VATS should not simply be equated with increasing structured exercise. Support should balance restorative rest with safety, provide specific and feasible ways to interrupt sedentary time, and be adapted to different recovery contexts. These findings may inform context-sensitive postoperative sedentary-behaviour support strategies.