# Exercise as it relates to Disease/Benefits of Resistance Training for Female Breast Cancer Survivors

This is an analysis of the article "Effects of weight training on quality of life in recent breast cancer survivors" by Ohira, et. al, 2006.

## Background
### Breast Cancer

Worldwide, breast cancer is the most common type cancer for women, with approximately 1.5 million new cases each year. In Australia, Breast Cancer is the fourth highest cause of cancer deaths, with one in eight women diagnosed with breast cancer every year. Breast cancer occurs in the ducts or lobes of the breast. If the cancer cells remain in the localised area it is known as non-invasive breast cancer and when they spread into surrounding areas via bloodstream or lymphatic system it is invasive breast cancer.

### Types of Treatment

Different treatment strategies are used depending on the individuals type and stage of breast cancer.
* Surgery
* Chemotherapy
* Radiation
* Targeted Therapy
* Hormonal Therapy

### Side Effects of Treatment

Adverse effects from treatment strategies may impact on quality of life (QoL) of female breast cancer survivors.
* Deterioration of body mass
* Lowered functional capacity
* Weight gain
* Nausea
* Pain
* Decreased bone density
* Depression
* Poor body image
* Lowered self-esteem
* Sexual dysfunction
* Chronic fatigue
* Sleep disturbances
* Lymphedema

### Quality of Life

World Health Organization (WHO) developed QoL assessment to identify ones perception of their position in life, health and wellbeing based on goals, expectations, standards and concerns. An individual’s QoL is influenced by all physical, psychological and social aspects.

## Research
### The Type of Research, Where it Originated and How it was Achieved

Research was conducted in the Greater Minneapolis and St Paul Metropolitan area in the United States, where female breast cancer survivors were recruited to take part in a randomised controlled weight training intervention. Participants (n = 86) were randomly assigned to the exercise intervention group (n = 43) or the control group (n = 43). Weight training intervention was conducted for six months (13 weeks with supervision by accredited fitness professional and 13 weeks on their own). Resistance machines and free weights were used targeting major muscle groups. Baseline assessments were conducted prior to intervention. QoL was assessed using cancer rehabilitation evaluation system short form (CARES-SF) as it identifies factors (physical, psychosocial, medical interaction, martial, sexual and miscellaneous) that influences QoL in breast cancer patients. Depression was also assessed using the Centre for Epidemiologic Studies Depression Scale (CES-D). A follow up was conducted six months post intervention.

### Basic Results

The resistance group and the control group were similar in terms of demographic, medical, and physical activity variables. The results showed the resistance based training programs improved physical and psychosocial global score significantly compared to the control group, whose physical global score decreased. Increased changes seen in strength and lean muscle mass were significantly correlated with increased scores in both the physical and psychosocial categories. Although no relationship was identified weight training with improved depression score. Therefore, this research suggests resistance based training twice a week can significantly improve the QoL of female breast cancer patients, especially in terms of improving strength and body composition changes.

### Interpretation of Results by Researchers

The researchers compared effects from the resistance training intervention against their baseline scores and initial questionnaires (CARES-SF and CES-D) to identify improvements in the QoL of participants. The results of the resistance training group were also compared against the results of the control group to identify where resistance training improves QoL.

### Research Conclusions and Implications

In conclusion, resistance training at least twice a week is beneficial for female breast cancer survivors, improving their QoL, especially in terms of strength and body composition. It is recommended an accredited health or fitness professional supervises a personalised resistance training program for breast cancer survivors. Further research is needed to identify long term benefits and impacts of resistance based training on female breast cancer survivors.
The research suggests that resistance training at least twice a week improves QoL in female breast cancer survivors. However improvement in QoL can be influenced by other external factors so it should not be implied that resistance training alone will improve a breast cancer survivor QoL.

## Other Research
### Benefits of Resistance Training on QoL

Literature shows that resistance training is beneficial for female breast cancer survivors, especially improving an individual’s physical, psychological and social aspects, therefore increasing their overall QoL. Research looked at progressive resistance training in breast cancer survivors and the results suggest that progressive resistance training post-treatment improved the QoL of female breast cancer survivors. Another study found that resistance training combined with impact exercises significantly improved muscle strength as well as QoL of female breast cancer survivors.
| Exercises Decrease | Exercise Improves/Maintains |
| Nausea | Body Weight |
| Fatigue | Energy Levels |
| Depression | Sex Drive |
| Breast Cancer Reoccurring | Mobility |
| | Strength |
| | Bone Density |
| | Sleep Patterns |
| | Self Esteem |
| | Survival Rate |

### Recommendations

Current literature recommends resistance training should initially start at low intensity and light weights and slowly progress, to minimise stress on the body. Initially female breast cancer survivors should be supervised to ensure correct technique and minimising injury risk. Programs should be tailored to the individual.
| Parameter | Recommendation |
| Frequency | 2-3 times per/week on non-consecutive days |
| Intensity | Low intensity, light weights training at: 50-80% of 1RM, or 6-10RM |
| Duration | 1-4 sets per muscle group, 6-9 different exercises, with 60–90 seconds recovery between sets |
| Progression | Increase number of repetitions; then increase number of sets, dropping the number of repetitions back to 6 each time a set is added; increase the load or resistance and reduce the number of repetitions/sets. |

### Considerations

Research suggest to consult a general practitioner (GP) or accredited health/fitness professional prior to training to identify any potential risks (i.e. Adult Pre-exercise Screening System). If lymphedema is present it is recommended to consult your GP and wear individualized lymphedema compression sleeve.

## Further reading

For further information on breast cancer
* Breast Cancer Network Australia https://www.bcna.org.au/
* Cancer Australia http://canceraustralia.gov.au/affected-cancer/cancer-types/breast-cancer
* National Breast Cancer Foundation http://www.nbcf.org.au/
* Cancer Council http://www.cancer.org.au/about-cancer/types-of-cancer/breast-cancer.html

## References

* 1 2 3 Ohira T, Schmitz K, Ahmed R, Yee D. Effects of weight training on quality of life in recent breast cancer survivors. Cancer. 2006;106(9):2076-2083.
* ↑ Lokal_Profil [CC BY-SA 2.5 (http://creativecommons.org/licenses/by-sa/2.5)], via Wikimedia Commons
* ↑ Wcrf.org. Breast cancer statistics | World Cancer Research Fund International [Internet]. 2015 [cited 28 September 2015]. Available from: http://www.wcrf.org/int/cancer-facts-figures/data-specific-cancers/breast-cancer-statistics
* 1 2 3 4 5 6 Canceraustralia.gov.au. Living with breast cancer | Cancer Australia [Internet]. 2015 [cited 28 September 2015]. Available from: http://canceraustralia.gov.au/affected-cancer/cancer-types/breast-cancer/living-breast-cancer
* 1 2 The World Health Organization quality of life assessment (WHOQOL): Position paper from the World Health Organization. Social Science & Medicine. 1995;41(10):1403-1409.
* 1 2 By Everkinetic (http://everkinetic.com/) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
* 1 2 Loprinzi P, Cardinal B, Winters-Stone K, Smit E, Loprinzi C. Physical Activity and the Risk of Breast Cancer Recurrence: A Literature Review. Oncology Nursing Forum. 2012;39(3):269-274.
* 1 2 3 Winters-Stone K, Dobek J, Bennett J, Nail L, Leo M, Schwartz A. The effect of resistance training on muscle strength and physical function in older, postmenopausal breast cancer survivors: a randomized controlled trial. Journal of Cancer Survivorship. 2011;6(2):189-199.
* 1 2 3 . Cheema B, Gaul C, Lane K, Fiatarone Singh M. Progressive resistance training in breast cancer: a systematic review of clinical trials. Breast Cancer Res Treat. 2007;109(1):9-26.
* 1 2 3 4 Wolin K, Schwartz A, Matthews C, Courneya K, Schmitz K. Implementing the Exercise Guidelines for Cancer Survivors. The Journal of Supportive Oncology. 2012;10(5):171-177.
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