# Exercise as it relates to Disease/Effects of a supervised exercise intervention on recovery for breast cancer survivors

This Wikibook page presents a critical appraisal on a research article “Effects of a Supervised Exercise Intervention on Recovery From Treatment Regimens in Breast Cancer Survivors” published by Hsieh, Sprod, Hydock, Carter, Hayward, and Schneider in 2008. This is written as an assignment for the unit Health Disease and Exercise, at the University of Canberra in 2022.

## 1.What is the background to this research?

Breast cancer has become the most prevalent type of cancer in the world; according to WHO (2021), in the year 2020, the number of female diagnosed with breast cancer can reaches 2.3 million, and the number of breast cancer survivors in the past five years can be 7.8 million. In Australia, breast cancer posted the second most prevalent cancer in 2018, and will be very likely to remain its position in 2022. The most commonly treatments for breast cancer patients include surgery, radiation therapy, chemotherapy, along with anti-cancer medicines.
Noticeable that a number of negative symptoms are reported by patients receiving these treatments: fatigue, pain, weaken exercise tolerance, affected cardiovascular and muscular systems, hence their physical activity level would decrease accordingly. On the other hand, a number of studies support that the patients’ physical activity levels are related to their quality of life: breast cancer patients with higher physical activity level are more likely to have better health-related quality of life (HRQOL), and relatively lesser fatigue and pain.
An interesting interaction is observed here: the negative impacts of breast cancer treatments make patients suffer or even lower their function of body, but still they have to engage in certain level of physical activity to mitigate these comfortableness.
Hence, this study looks in efforts of exercise interventions on breast cancer survivors’ cardiopulmonary function and fatigue under different types of treatment.

## 2.Where is the research from?

The study took place in Rocky Mountain Cancer Rehabilitation Institute (RMCRI) in Colorado, America. Participants were chosen from the breast cancer survivors referred to RMCRI for rehabilitative exercise straightway after their cancer treatments. The informed consent was obtained prior to participating.
The authors were the specialists from Rocky Mountain Cancer Rehabilitation Institute (RMCRI) and the School of Sport and Exercise Science at the University of Northern Colorado, American, along with a scholar from the Department of Physical Education at the National HsinChu University of Education, Taiwan.
This research article was published on the journal Oncology Nursing Forum in 2008.

## 3.What kind of research was this?

The researchers assessed these participants’ functions thoroughly both before and after the six-month exercise intervention.
This research design is “pretest and post-test quasi-experimental”.

## 4.What did the research involve?

A total of 96 participants aged 57.9 ± 10.4 years were involved, of which were all female. Based on the type of clinical treatments received, they were divided into 4 groups: surgery alone (n = 22), surgery and chemotherapy (n = 30), surgery and radiation (n = 17), and surgery, chemotherapy, and radiation (n = 27). Noticeable that all of them received surgery.
| Total n=96 | Total n=96 | Type of treatment | Type of treatment | Type of treatment |
| Total n=96 | Total n=96 | surgery | chemotherapy | radiation |
| Group1 | n=22 | V | | |
| Group 2 | n=30 | V | V | |
| Group 3 | n=17 | V | | V |
| Group 4 | n=27 | V | V | V |
A group of certified cancer exercise specialists collected the data with a focus on patients’ cardiovascular endurance, pulmonary function, and fatigue were evaluated. Namely, their following data were collected:
* systolic and diastolic blood pressure
* resting heart rate
* forced vital capacity (FVC)
* forced expiratory volume (FEV1)
* predicted oxygen consumption (predicted VO2max)
* time on treadmill
* fatigue scale (Piper Fatigue Scale)
Exercise prescription and intervention were designed individually by certified cancer exercise specialists. There were individually y supervised exercise sessions for participants 2-3 times per week and for 6 months. Each session’s length was 60 minutes, composed of:
* a 10-minute warm-up
* 40-minute aerobic exercise, resistance training and stretching
* ended with a 10- minute cool down
The intensity was 40-75% of each one’s heart rate. Before every following sessions, participants’ feedbacks and feelings of last exercise session were obtained by the cancer exercise specialists, in order to meet each individual’s circumstance.

## 5.What were the basic results?

After the 6-month exercise intervention, participants’ significant improvements in cardiopulmonary function were observed in all groups (p < 0.05), without significant differences among the 4 groups. More specificity, their predicted VO2max and time on treadmill had been improved. Moreover, group 4 (the surgery, chemotherapy, and radiation group) showed reductions in resting heart rate along with concurrent increases on FVC %pred. In terms of fatigue scale, the scores reduced significantly in all groups.

## 6.What conclusions can we take from this research?

This study showed that exercise interventions can improve breast cancer survivors’ cardiopulmonary function, and reduce fatigue score. And this finding is in line with previous studies. Most importantly, this study is the first to compare exercise intervention’s effort on patients who had different cancer treatment type.
The most positive part of this study is, the participants' adherence to follow the exercise prescriptions was pretty high- around 90%. The authors supposed that’s because every participant received a personalized exercise prescriptions, individual supervised exercise sessions, and most importantly, their feedbacks and feelings were obtained before next exercise start by cancer exercise specialists.
Of no doubt, the results were outstanding. The critical appraisal part of the article is, how many ordinary cancer patients in the world are luckily enough to reach these kind of luxury services: personalized exercise prescriptions, individual supervised exercise sessions services, and by cancer exercise specialists?

## 7.Practical advice

The main take home messages are:
* Cancer’s treatments can affect a person’s normal body functions negatively while working on tumors.
* A great number of studieshave shown that certain physical activity level can help cancer patients reduce these negative symptoms effectively. The authors of this study suggested moderate intensity, personalized, prescriptive exercise sessions.
* The health workers should raise awareness of the efforts of exercise on cancer patients, and so on other chronic disease suffers. Recommendations, referrals should be given. According to this study, the excellent works of exercise specialists have been seen.

## 8.Further information/resources

For further information concerning the breast cancer and exercise, see the links below.
* Exercise During Cancer Treatment. https://www.cancer.net/survivorship/healthy-living/exercise-during-cancer-treatment
* World Health Organization.(2021). Breast cancer. https://www.who.int/news-room/fact-sheets/detail/breast-cancer
* Cancer Australia. (2022). Breast cancer in Australia statistics. https://www.canceraustralia.gov.au/cancer-types/breast-cancer/statistics
* Rocky Mountain Cancer Rehabilitation Institute (RMCRI), Colorado, America. https://www.rockymountaincancercenters.com/

## 9.References

* 1 2 3 Hsieh, C. C., Sprod, L. K., Hydock, D. S., Carter, S. D., Hayward, R., & Schneider, C. M.. (2008). Effects of a Supervised Exercise Intervention on Recovery From Treatment Regimens in Breast Cancer Survivors. Oncology Nursing Forum, 35(6), 909–915. https://doi.org/10.1188/08.ONF.909-915
* 1 2 World Health Organization.(2021). Breast cancer. Retrieved 3 September 2022, from https://www.who.int/news-room/fact-sheets/detail/breast-cancer
* ↑ Australian Government Cancer Australia. (2022). Breast cancer in Australia statistics. Retrieved 3 September 2022, from https://www.canceraustralia.gov.au/cancer-types/breast-cancer/statistics
* 1 2 3 Cimprich, B.. (1993). Development of an intervention to restore attention in cancer patients. Cancer Nursing, 16(2), 83-92. https://doi.org/10.1097/00002820-199304000-00001
* 1 2 3 Pihkala, J., Happonen, J. M., Virtanen, K., Sovijarvi, A., Siimes, M. A., Pesonen, E., & Saarinen, U. M.. (1995). Cardiopulmonary evaluation of exercise tolerance after chest irradiation and anticancer chemotherapy in children and adolescents. Pediatrics, 95(5), 722-726. https://doi.org/10.1542/peds.95.5.722
* 1 2 3 Courneya, K. S.. (2001). Exercise Interventions During Cancer Treatment: Biopsychosocial Outcomes. Exercise and Sport Sciences Reviews, 29(2), 60-64. https://doi.org/10.1097/00003677-200104000-00004
* 1 2 3 Shin, W. K., Song, S., Jung, S. Y., Lee, E., Kim, Z., Moon, H. G., Noh, D. Y., & Lee, J. E.. (2017). The association between physical activity and health-related quality of life among breast cancer survivors. Health and Quality of Life Outcomes, 15, 132. https://doi.org/10.1186/s12955-017-0706-9