# Exercise as it relates to Disease/Tailor made exercise for Breast Cancer survivors

This wiki fact sheet has been created by student u3096575, it provides information on the journal article Experiences of Breast Cancer Survivors Participating in a Tailored Exercise Intervention −A Qualitative Study" written by Luoma ML et al (2014).

## Background

Breast cancer is the most common cancer in women within Australia. In line with improved survival rates, the need for rehabilitation for breast cancer survivors has significantly increased. This study investigates how tailored exercise classes and groups assists breast cancer survivors in their recovery and recalls the experiences of the participants. There is growing evidence that exercise is a positive measure of intervention to improve quality of life during and post treatment.
Breast cancer diagnosis represents 28% of all cancers in women. Treatments for such cancer can be a prolonged experience often extending a year after initial diagnosis. Primary treatment can include surgery, reconstructive surgery, chemotherapy, biotherapy and radiation. Throughout and following treatment, physical and psychosocial side effects may arise, as well as the common side effects of treatment.

##### Table 1: Side-Effects Experienced

| Physical | Pyschosocial |
| Decreased Aerobic Capacity | Anxiety |
| Decreased Muscular Strength | Depression |
| Weight gain | Stress |
| Fatigue | Impaired Quality of Life |
| Menopausal Symptoms | Decreased Self Esteem |
| Insomnia | |
| Alopecia | |
Exercise has assisted in reducing many of the negative side effects, group exercise with other breast cancer patients and survivors in particular Such findings further prove that exercise is a primary rehabilitation technique for this population. Sharing such experience with other breast cancer patients is important for emotional and social support.

## Where is the research from?

This study was performed in Helsinki Finland. The researchers had ties to health, oncology and psychology and therefore there was no bias. The research was funded by The Finnish Cancer Institute and other similar organisations and was sponsored by the Finnish Breast Cancer Group.

## What kind of research was this?

The methodology utilised, phenomenological research method, a method used to describe a phenomenon of life events and experiences was selected to interpret the qualitative data collected. Due to the length of the interviews, information was broken down into meaningful units to make the information more manageable for the investigator. Participants for this study were recruited from another RCT, whereby patients were selected to participate in exercise groups. Focus groups were then formed based on groups from the BREX (breast cancer and exercise) trial.
In phenomenological research interpretation of information is required and in doing this information given through the interviews may become skewed or misinterpreted by the investigator and co-investigator.

## What did the research involve?

Within the focus groups of about 4 women, interviews were conducted by a psychologist, all interviews were transcribed. Focus group lengths ranged from 55 to 76 minutes, the process was semi structured, topics can be seen in table 2. After all topics were covered participants were able to raise any other topics considered important to them in relation to the study. Experiences of the exercise program were shared in an open and supportive environment, psychologists were present and recorded findings throughout.

##### Table 2

* Interview Topics
* Course of illness, treatments and illness experience
* Experiences of taking part in the exercise trial
* Personal meaning of the exercise tailored to breast cancer patients
* Personal meaning of the group
* Reasons to continue taking part in the trial
* Barriers to start exercise after treatment
* Participant’s view of personally meaningful outcomes of exercise

## What were the basic results?

Participants stated they gained multiple benefits from participation in both the BREX study and the current study. Results were broken up into 4 key segments.
* Impact on physical appearance and fitness: Due to the majority of participants being treated with chemotherapy and radiotherapy post-surgery, hair loss was suffered and many had scars, some participants also commented that “they looked ill”. The survivor/ patient only exercise group allowed for many of the participants to overcome this barrier. Relief was felt that no one stared or felt sorry for them because of their illness. Exercising with women who had similar experiences allowed the participants to feel more comfortable in the exercise environment, as many also suffered from fatigue and reduced physical fitness due to treatment.
* Value of the intervention: Many patients stated they felt vulnerable post treatment and were uncertain of what exercise was appropriate. They felt more comfortable knowing their instructor fully understood their specific rehabilitation and situation. It was stated the intervention allowed for the women to move from being a cancer patient to being a healthy woman again, and feel some normality once again.
* Influence of Quality of Life: A large portion of the patients stated the physical activity gave them a sense of control over their body as they felt a lack of control during treatments. It was emphasized by patients how much better they felt post exercise, the feeling of their physical activity levels improving and fatigue symptoms subsiding gave them motivation to continue and improved well-being. Fulfillment was also felt by patients due to a sense of mastery over the disease, this improved psychological functioning and improved moods.
* Peer support: This was one of the main benefits of the exercise program and was multidimensional. Peer support was important in gaining normality back into their lives. Rather than constantly being asked “how are you?”, during the exercise group these constant reminders were not brought up. Many of the women had similar side-effects and could openly discuss these side-effects and gain advice from one another. Many of the participants saw the group as a platform to discuss the illness itself. The program was also a good platform for the women to make friends who have experienced what they have.

## What conclusions can we take from this research?

Breast cancer patients and survivors can benefit from tailored exercise programs in a both a physical and psychosocial sense. There is a positive correlation between physical activity and quality of life. However, a serious and life changing disease such as breast cancer could lead to women leaving activities that were once important to their quality of life due to side-effects of cancer treatment.
More recent studies into this area further prove exercise can assist in the rehabilitation of breast cancer survivors and patients. And further assist in proving the correlation between physical activity and the improvement of physical side-effects of cancer treatments. Physical activity for the purpose of cancer rehabilitation has the ability to improve the total well-being of patients.

## Practical advice

Breast cancer patients and survivors should take part in a tailored exercise program to improve quality of life post treatment and help ease side-effects as Luoma et al have researched. Survivors and patients should also have opportunity to openly discuss their conditions and exercise programs through focus or support groups as demonstrated within this research. Exercise specialists should have opportunity to become more educated on exercise programs appropriate for breast cancer patients and survivors in order to better suit their specific needs. The authors have clearly discussed the important findings of the tailored exercise program and given better understanding to the key improvements felt by patients to increase in exercise as a rehabilitation method.

## References

* 1 2 3 4 5 6 7 Luoma ML, Hakamies-Blomqvist L, Blomqvist C, Nikander R, Gustavsson-Lilius M, Saarto T. Experiences of breast cancer survivors participating in a tailored exercise intervention–a qualitative study. Anticancer research. 2014 Mar 1;34(3):1193-9.
* 1 2 Cancer Council. Breast Cancer [Internet]. August 2014. Available from: http://www.cancercouncil.com.au/88121/b1000/breast-cancer-13/breast-cancer-statistics/?pp=32452&cc=10024&&ct=4
* 1 2 3 Ganz PA, Kwan L, Stanton AL, Bower JE, Belin TR. Physical and psychosocial recovery in the year after primary treatment of breast cancer. Journal of Clinical Oncology. 2011 Mar 20;29(9):1101-9.
* 1 2 Loprinzi PD, Cardinal BJ. Effects of physical activity on common side effects of breast cancer treatment. Breast Cancer. 2012 Jan 1;19(1):4-10.
* 1 2 3 SAARTO T, Penttinen HM, SIEVÄNEN H, Kellokumpu-Lehtinen PL, Hakamies-Blomqvist L, Nikander R, Huovinen R, Luoto R, Kautiainen H, JÄRVENPÄÄ S, Idman I. Effectiveness of a 12-month exercise program on physical performance and quality of life of breast cancer survivors. Anticancer research. 2012 Sep 1;32(9):3875-84.
* ↑ Larsson IL, Jönsson C, Olsson AC, Gard G, Johansson K. Women’s experience of physical activity following breast cancer treatment. Scandinavian journal of caring sciences. 2008 Sep 1;22(3):422-9.
* ↑ Irwin ML, Crumley D, McTiernan A, Bernstein L, Baumgartner R, Gilliland FD, Kriska A, Ballard‐Barbash R. Physical activity levels before and after a diagnosis of breast carcinoma. Cancer. 2003 Apr 1;97(7):1746-57.
* ↑ Van Vulpen JK, Peeters PH, Velthuis MJ, van der Wall E, May AM. Effects of physical exercise during adjuvant breast cancer treatment on physical and psychosocial dimensions of cancer-related fatigue: A meta-analysis. Maturitas. 2016 Mar 31;85:104-11.
* ↑ Timmerman JG, Dekker-van Weering MG, Tönis TM, Hermens HJ, Vollenbroek-Hutten MM. Relationship between patterns of daily physical activity and fatigue in cancer survivors. European journal of oncology nursing. 2015 Apr 30;19(2):162-8.