# Exercise as it relates to Disease/The impact of a community-based exercise intervention on African-American breast cancer survivors

This is a critique of an exercise intervention and how it increases physical activity (in a specific population). This critique has been written as a university assessment for the University of Canberra; Health, Disease, and Exercise (8340).
The paper: Anthropometric Changes Using a Walking Intervention in African American Breast Cancer Survivors: A Pilot Study
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## What is the background to this research?

Not only is breast cancer the most common cancer affecting women in general, it is also more prevalent in African American women than in Caucasian women. African American women have a higher mortality rate as result of the cancer, and are more likely to gain weight after diagnosis. This study focuses on the impact of a community-based intervention and the relationship that physical activity has on both improving the quality of life, and decreasing body mass index (BMI) for African American breast cancer survivors.

## Where is the research from?

Participants were recruited from Massey Cancer clinics (cancer clinics working on collaborative approaches for all cancer types), outreach sites, local churches, cancer support groups and community leaders from Richmond, Virginia in the United States. The target study group, African American breast cancer survivors under the age of 70, was of great importance as there was limited research on recurrence and obesity after diagnosis for such a high-risk group.

## What kind of research was this?

This study was a pilot study and is referenced in other papers after initial publication to assist these other papers in proving their hypotheses. The research is an example of a cross-sectional study or analysis. This type of research is used to describe absolute and relative risks from prevalence data. Data for this study was collected by questionnaires and arthrometric measurements.

## What did the research involve?

The study consisted of an eight-week community-based walking program for African American breast cancer survivors to explore outcome measures over three different time frames:
* baseline
* immediate post-intervention
* three-month follow-up
75 minute weekly meetings were held locally to describe, set and outline:
* benefits and barriers of exercise
* the relationship between exercise, health and cancer risk
* personal assessment and problem-solving for motivation
* weekly progressive set goals determined

### Measurements

* Participant demographic information
* Attitudinal measures- measured with the Exercise Decisional Balance instrument which is a 16 question numerical scale on attitude
* Cancer Anxiety- measured using the Cancer anxiety scale a 14 item self-questionnaire
* Concern on cancer recurrence
* Body Mass Index (BMI)- a person's weight (kilograms) divided by the square of their height (meters)
* Waist, hip and upper arm circumference
* Body fat percentage (%)- using Furtex which normally overestimates body fat in lean subjects by approximately 8% (this was not taken into account in this study)

### Limitations

* Lack of control group- the only control in this study was the measurements made prior to the study intervention
* Small study group- from the 230 eligible participants, only 10% were available. Participants had to have been diagnosed with breast cancer, completed treatment at least three months prior, were mobile and were less than 70 years old
* Self-report questionnaires-not always reliable (patients are not always honest) results always under or overestimated
* Diet-physical activity alone affects fat loss minimally if at all

## What were the basic results?

24 women were enrolled into the intervention although two had to drop out. One for scheduling conflicts and the other for re-diagniosis. The average age of the participants was 55 years.

### Results

Mean results of 22 African American breast cancer survivors
| Header text | Baseline | Immediate post-intervention | 3 mont follow-up |
| Steps per day | 4791 | 8297 | 8319 |
| Cancer Anxiety Total | 6.8 | 6.44 | 6.38 |
| Exercise Attitude Total | 66.2 | 69.2 | 64.75 |
| Body Mass Index (kg/m2) | 32.7 | 32.32 | 32.46 |
| Weight (kg) | 86.73 | 85.82 | 86.1 |
| Body fat (%) | 40.1 | 36.7 | 38.8 |
| Waist circumference (cm) | 99.3 | 94.7 | 94.35 |
| Hip circumference (cm) | 117.9 | 115.8 | 113.9 |
| Forearm circumference (cm) | 34.8 | 33.3 | 32.39 |
| Systolic blood pressure | 140.9 | 139.8 | 138.7 |
| Diastlic Blood pressure | 80.1 | 73.9 | 69.7 |
| Waist-to-Hip ratio | 0.84 | 0.82 | 0.83 |
From the table, one can ascertain that nearly all anthropometric measures either stayed the same or improved by decreasing. At the three-month follow-up, the women displayed a more negative opinion of exercise when compared to the immediate post measurements. This may have been overestimated as daily steps were self-reported. To prevent this decrease in motivation, a follow-up program should have been implemented in addition to not allowing self-reported data.

### How did the researchers interpret the results?

The researchers believed that their findings were a good start to understanding more about African American women and why they are such a high-risk population. They believed the study was important because of the limited studies related to African American women in the field of breast cancer research. in addition to this, a further study is required to test a diet intervention on African American breast cancer survivors. The researchers also underlined the need to have a larger control group.

## What conclusions can we take from this research?

Improvement of anthropometric measures in the target group indicated an overall positive response to the pedometers. The results demonstrate how exercise can improve the quality of life and reduce a possible cancer recurrence. Scheduling availability, the location of meetings, study criteria and time allocated to measurements should be taken into account to explain the limited number of participants in the study.
Motivation to exercise should be encouraged to prevent re-diagnosis of cancers (not only to those in the study). Additional information should include the benefits that exercise has on breast cancer survivors.

## Practical advice

The study suggests that exercise is an effective way to enhance all aspects of health in breast cancer survivors. Other studies agree that exercise is an effective way to not only increase the quality of life, but also to help with cardiorespiratory fitness, physical functioning, and fatigue
Although obesity is not a direct cause of breast cancer, the risk can be minimised by obtaining, and maintaining, a healthy weight through regular exercise and a healthy diet. This stresses the importance of exercise in preventing either a diagnosis or recurrence of cancers.
Women who have a high risk of being diagnosed with breast cancer should seek additional options. An example is tamoxifen; a hormone administered over five years. The risk of breast cancer in women is increased with:
* Increasing age
* Family history of breast cancer
* inheritance of mutations in the genes
* Exposure to female hormones
* Previous diagnosis
Cancer patients should seek medical assistance before adhering to either preventative measures.

## Further information/resources

* Cancer Council Australia: http://www.cancer.org.au/about-cancer/types-of-cancer/breast-cancer/#jump_3
* Breast cancer risk reduced by weight loss video: http://abcnews.go.com/Health/exercise-lower-breast-cancer-risk/story?id=16638370
* Exercise Reduces Risk, but Benefits Disappear if Women Stop Exercising: http://www.breastcancer.org/research-news/exercise-reduces-risk-if-continued
* Physical Activity and Cancer: https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/physical-activity-fact-sheet
* Advantages of exercise in breast cancer patients and survivors in addition to its mitigating effect on chest wall pain: Kapoor, S. (2013). Advantages of exercise in breast cancer patients and survivors in addition to its mitigating effect on chest wall pain. Current Oncology, 20(1).
The reference list also provides other breast cancer readings.

## References

* 1 2 3 4 5 6 7 Wilson, D., Porter, J., Parker, G. and Kilpatrick, J. (2005). Anthropometric Changes Using a Walking Intervention in African American Breast Cancer Survivors: A Pilot Study. Preventing Chronic Disease, 2(2).
* ↑ Jemal et al. (2011) 'Global Cancer Statistics'. CA Cancer J 2:69-90
* ↑ Center, V. (2017). Home - VCU Massey Cancer Center. [online] Massey.vcu.edu. Available at: http://www.massey.vcu.edu [Accessed 18 Sep. 2017].
* ↑ En.wikipedia.org. (2017). Cross-sectional study. [online] Available at: https://en.wikipedia.org/wiki/Cross-sectional_study [Accessed 18 Sep. 2017].
* ↑ Midss.org. (2003). Decisional Balance Scale: Exercise | Measurement Instrument Database for the Social Sciences. Available at: http://www.midss.org/content/decisional-balance-scale-exercise [Accessed 18 Sep. 2017]
* ↑ Roth, A., Rosenfeld, B., Kornblith, A., Gibson, C., Scher, H., Curley-Smart, T., Holland, J. and Breitbart, W. (2003). The Memorial Anxiety Scale for Prostate Cancer. Cancer, 97(11), pp.2910-2918.
* ↑ Who.int. (2017). WHO | Obesity. Available at: http://www.who.int/topics/obesity/en/ [Accessed 18 Sep. 2017].
* ↑ McLean K, Skinner J. Med Sci Sports Exerc Validity of FUTREX-5000 for Body Composition Determination. 1992 Feb;24(2):253–258. [PubMed]
* ↑ Hoskin, R. (2012). The dangers of self-report - Science Brainwaves. [online] Science Brainwaves. Available at: http://www.sciencebrainwaves.com/the-dangers-of-self-report/ [Accessed 18 Sep. 2017].
* ↑ Ross, R., Freeman, J. A., & Janssen, I. (2000). Exercise alone is an effective strategy for reducing obesity and related comorbidities. Exercise and Sport Science Reviews, Vol. 28, No. 4, pp. 165-170.
* ↑ McNeely, M. (2006). Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis. Canadian Medical Association Journal, 175(1), pp.34-41.
* ↑ Bower, J., Ganz, P., Desmond, K., Rowland, J., Meyerowitz, B. and Belin, T. (2000). Fatigue in Breast Cancer Survivors: Occurrence, Correlates, and Impact on Quality of Life. Journal of Clinical Oncology, 18(4), pp.743-743
* ↑ Courneya, K., Mackey, J., Bell, G., Jones, L., Field, C. and Fairey, A. (2003). Randomized Controlled Trial of Exercise Training in Postmenopausal Breast Cancer Survivors: Cardiopulmonary and Quality of Life Outcomes. Journal of Clinical Oncology, 21(9), pp.1660-1668.
* 1 2 3 Australia, C. (2017). [online] Cancer.org.au. Available at: http://www.cancer.org.au/about-cancer/types-of-cancer/breast-cancer/#jump_3 [Accessed 18 Sep. 2017].