Physical activity in people diagnosed with cancer: a rapid review of recommendations and critical appraisal of international guidelines

PURPOSE

There are numerous guidelines that recommend physical activity (PA) in people diagnosed with cancer, but the quality of these guidelines is unknown. The aim of this study was to identify existing PA guidelines for cancer survivors, describe the recommendations, and assess their methodology quality.

METHODS

A rapid review of the literature was conducted in PubMed and EMBASE, supplemented by a search of the grey literature. The methodological quality of the guidelines was assessed using the AGREE II checklist. A descriptive synthesis of the recommendations from guidelines judged to be of good quality has been performed.

RESULTS

A total of nine guidelines published between 2006 and 2019 were included. Of nine guidelines, five achieved a high enough AGREE II score and were judged to be of good quality for use in clinical practice. We found that the recommendations from the five guidelines converged on the prescription of supervised PA (aerobic and resistance exercise) of at least 75 min per week of high intensity or 150 min per week of moderate intensity, spread over two to five sessions per week, equating to a PA dose between 8.70 and 17.5 MET.h/week. The recommendations were applicable to address the most common side effects of cancer and its treatment, namely fatigue, lymphedema, anxiety, depressive symptoms, health-related quality of life (QoL), survival, and physical function. However, no guideline recommends PA to improve other cancer-related outcomes, such as cognitive impairment, falls, sexual function, and peripheral neuropathy frequently experienced by cancer survivors. No guideline also referred to work outcomes (i.e., work ability, return to work, etc.).

CONCLUSION

Most PA guidelines for cancer survivors are of good quality. However, specific PA guidelines are needed for a given cancer site (e.g., location, stage), at a particular phase of the cancer trajectory, and for specific outcomes including return to work (RTW) in order to tailor PA to each cancer survivor.

"We're all in the same boat together": exploring quality participation strategies in dragon boat teams for breast cancer survivors

Background: Dragon boat offers an opportunity to increase physical activity (quantity participation) in breast cancer survivors; however, quality participation experiences have yet to be explored. Quality participation is one's subjective perceptions and experiences. While there is evidence to suggest dragon boat may offer a quality experience, further exploration is needed.Purpose: Guided by a conceptual framework to promote a positive, quality experience in parasport context, the purposes were: (a) to explore strategies that are used to foster elements of quality participation in dragon boat teams for breast cancer survivors and (b) to understand the context in which these strategies are implemented within these teams (i.e., quality participation conditions).Materials and methods: After completing a guiding questionnaire, current and previous leaders on dragon boat teams completed a structured, follow-up telephone interview. Transcripts were thematically analyzed inductively and deductively mapped onto a framework.Results: Leaders fostered quality participation through elements of challenge and mastery and conditions of the social and physical environments. Facilitating strategies included creating friendly competition, using social media to celebrate success, creating mentorship opportunities and being outside, respectively.Conclusions: Future research is encouraged to explore identified strategies for consistency to gain a clearer understanding of quality experiences within dragon boat.IMPLICATIONS FOR REHABILITATIONDragon boat offers opportunities to increase physical activity and participation in breast cancer survivors. These activities have a positive impact on confidence.Based on findings, practical strategies have developed including creating friendly competition between athletes on a voluntary basis to foster perceptions of being appropriately challenge.Leaders can use social media to celebrate athletes' individual successes, which may facilitate increased confidence.Creating formal or informal mentorship opportunities will allow athletes to be seen as role models for both dragon boat and breast cancer survivorship.

Passion among breast cancer survivors: A 12-month prospective study

We examined the prospective relationship between harmonious passion and post-treatment health outcomes among female breast cancer survivors. Participants reported passion toward a favorite activity, physical pain symptoms, and mental health after their final breast cancer treatment (Time 1, N = 188). Twelve months later (Time 2, N = 148), participants reported their physical pain symptoms and mental health. Harmonious passion at Time 1 predicted fewer physical pain symptoms and higher levels of mental health at Time 2. These results show that breast cancer survivors benefit from being harmoniously passionate toward a meaningful activity following treatment.

The difference is more than floating: factors affecting breast cancer survivors' decisions to join and maintain participation in dragon boat teams and support groups

Purpose: Peer support can be helpful in rehabilitation from breast cancer, but participation in peer support groups is low. Groups that provide support opportunities in physical activity contexts are an attractive alternative for some survivors. This study examined survivors' reasons for joining and maintaining participation on a dragon boat team, along with perceptions of barriers and attractions to traditional peer support groups. Materials and methods: Seventeen breast cancer survivors were interviewed on five occasions over their first two seasons of a newly formed dragon boating team to explore their perceptions of peer support groups and dragon boating. Data were inductively analyzed using thematic analysis. Results: Categories surrounding physical, psychological, social and community features were identified with several themes emerging within each. Advantages of dragon boating included opportunities to get a combination of physical, psychosocial and community benefits; health improvement and behavior change; and obtaining social support without the focus being on cancer. Peer support groups were identified as having advantages for forming relationships and avoiding barriers associated with physical activity. Conclusions: While neither type of program meets all needs, practical considerations are identified for incorporating advantages of both programs to improve participation. Implications for rehabilitation Further understanding of perceptions, and attractions and challenges to taking part in group programs will inform development of accessible programs that target multiple rehabilitation needs. Physical activity can provide a positive, alternative focus that takes the emphasis off of cancer, which is more accessible to some survivors. Physical activity also provides opportunities to build relationships around a common, positive goal, which can be a foundation for providing support for coping with cancer.

Breast cancer survivors' perceptions of participating in a supervised exercise intervention: An exploratory review of the literature

BACKGROUND

Despite the reported beneficial effects of physical activity (PA) during and after cancer diagnosis, current research data suggest that the percentages of breast cancer survivors who adhere to PA recommendations are low. The objective of the present systematic, critical review was to identify, analyze, and provide a summary of qualitative literature findings, which have explored breast cancer survivors' experiences of participating in an exercise/PA intervention after cancer treatment.

METHODS

A systematic search was conducted using CINAHL, PsychINFO, PubMed, and Scopus electronic databases to search for qualitative literature published during 2000-2016. A total of six studies that met the inclusion criteria were reviewed. Thematic synthesis, following Thomas and Harden's methods, were used to analyze the data.

FINDINGS

Seven descriptive themes were developed: control, focus, transitioning phase, regaining a sense of confidence, enhanced spirits, social support, and safe environment. The findings suggested that participation in supervised exercise interventions enhanced the self-confidence and mood of breast cancer survivors. It allowed them to regain control and provide a focus, thereby allowing them to move forward in their lives.

CONCLUSION

The results of this systematic critical review indicated that the supervised exercise was a positive experience for breast cancer survivors.

Smartphone-Enabled Health Coaching Intervention (iMOVE) to Promote Long-Term Maintenance of Physical Activity in Breast Cancer Survivors: Protocol for a Feasibility Pilot Randomized Controlled Trial

Background

Although physical activity has been shown to contribute to long-term disease control and health in breast cancer survivors, a majority of breast cancer survivors do not meet physical activity guidelines. Past research has focused on promoting physical activity components for short-term breast cancer survivor benefits, but insufficient attention has been devoted to long-term outcomes and sustained exercise adherence. We are assessing a health coach intervention (iMOVE) that uses mobile technology to increase and sustain physical activity maintenance in initially inactive breast cancer survivors.

Objective

This pilot randomized controlled trial (RCT) is an initial step in evaluating the iMOVE intervention and will inform development of a full-scale pragmatic RCT.

Methods

We will enroll 107 physically inactive breast cancer survivors and randomly assign them to intervention or control groups at the University Health Network, a tertiary cancer care center in Toronto, Canada. Participants will be women (age 18 to 74 years) stratified by age (55 years and older/younger than 55 years) and adjuvant hormone therapy (AHT) exposure (AHT vs no AHT) following breast cancer treatment with no metastases or recurrence who report less than 60 minutes of preplanned physical activity per week. Both intervention and control groups receive the 12-week physical activity program with weekly group sessions and an individualized, progressive, home-based exercise program. The intervention group will additionally receive (1) 10 telephone-based health coaching sessions, (2) smartphone with data plan, if needed, (3) supportive health tracking software (Connected Wellness, NexJ Health Inc), and (4) a wearable step-counting device linked to a smartphone program.

Results

We will be assessing recruitment rates; acceptability reflected in selective, semistructured interviews; and enrollment, retention, and adherence quantitative intervention markers as pilot outcome measures. The primary clinical outcome will be directly measured peak oxygen consumption. Secondary clinical outcomes include health-related quality of life and anthropometric measures. All outcome measures are administered at baseline, after exercise program (month 3), and 6 months after program (month 9).

Conclusions

This pilot RCT will inform full-scale RCT planning. We will assess pilot procedures and interventions and collect preliminary effect estimates.

Trial Registration

ClinicalTrials.gov NCT02620735; https://clinicaltrials.gov/ct2/show/NCT02620735 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT02620735)

Physical activity before and after breast cancer diagnosis and survival - the Norwegian women and cancer cohort study

Background

The main aim of this study was to investigate pre- and post-diagnostic physical activity (PA) levels, as well as changes in pre- and post-diagnostic PA levels, and their association with all-cause and breast cancer-specific mortality in women with breast cancer. Our study will add to the knowledge on whether a modifiable behavior such as PA can improve survival.

Methods

We included 1,327 women with breast cancer from the population-based Norwegian Women and Cancer study, which enrolled women from 1991 to 2003. Breast cancer cases were identified through linkage to the Cancer Registry of Norway; date and cause of death were obtained from the National Register for Causes of Death through 31 December 2012. Self-reported pre- and post-diagnostic PA levels were assessed, and Cox proportional hazard regression and spline regression were used to evaluate the associations.

Results

Pre-diagnostic PA levels were not associated with all-cause or breast cancer-specific mortality. Post-diagnostic PA levels were associated with a significant trend (P < 0.001) of decreased all-cause and breast cancer-specific mortality, which was stronger among older women (aged 50–74 years) and did not differ across categories of body mass index. All-cause mortality (hazard ratio [HR] = 1.76, 95 % confidence interval [CI] 1.21–2.56) and breast cancer-specific mortality (HR = 2.05, 95 % CI 1.35–3.10) increased among women who reduced their post-diagnostic PA level. These values were similar among women whose maintained an inactive PA level pre- and post-diagnosis.

Conclusion

Overall, we observed a dose–response trend, with an inverse association between increased post-diagnostic PA level and all-cause and breast cancer-specific mortality, as well as a higher mortality risk among women who reduced their post-diagnostic PA levels. Our results are very promising for women with breast cancer, and indicate that health care professionals should consider adding PA as a part of primary cancer treatment.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-015-1971-9) contains supplementary material, which is available to authorized users.

Breast cancer survivors' barriers and motives for participating in a group-based physical activity program offered in the community

Purpose

The purpose of this qualitative study was to explore the barriers and motives experienced by women attending an 8-week group-based physical activity program offered in the community following treatment for breast cancer.

Methods

Seven women were interviewed during the first and last week of the program. Data were analyzed using thematic analysis.

Results

Factors that hindered women’s continued participation could be subdivided into situational barriers, which encompassed community (i.e., distance of center and traffic) and institutional factors (i.e., competing roles and responsibilities), and internal barriers, which consisted of cancer-specific limitations. Motives for initial and continued participation were situational (i.e., gaining social support, networking, and being around similar others) and internal (i.e., feeling a sense of personal fulfillment, acquiring health benefits, and recovering from cancer).

Conclusions

The findings contribute to a deeper understanding of women’s motives to engage in a group-based physical activity program after treatment for breast cancer. Further, they underscore the necessity of considering situational and internal barriers when developing group-based physical activity programs to increase regular participation, optimize adherence, and reduce drop-out.

Rehabilitation following cancer treatment

PURPOSE

Cancer survivorship is increasing. However, life-saving treatments often leave people with physical, cognitive and emotional sequelae that contribute to activity and participation limitations. The purpose of this review is to summarize current evidence regarding rehabilitation interventions to address problems during survivorship.

METHOD

Best evidence synthesis. The review took as its starting point a systematic review of patient needs and supportive care interventions following cancer treatment. The study team identified the needs which could be addressed by rehabilitation and suggested others not originally included. Then they built on the earlier review's conclusions regarding effective intervention through extraction of results from subsequent systematic reviews and randomized controlled trials.

RESULTS

Evidence regarding the effectiveness of potential rehabilitation interventions was reviewed for physical functioning, fatigue, pain, sexual functioning, cognitive functioning, depression, employment, nutrition and participation. With the exception of physical rehabilitation interventions following breast cancer, this literature tends to focus on psychoeducational interventions, which have demonstrated limited effectiveness for rehabilitation outcomes.

CONCLUSIONS

Most of the knowledge available regarding potential rehabilitation interventions comes from psychosocial oncology literature. While there are limitations, this literature provides an excellent starting point to examine the potential effectiveness of rehabilitation interventions within cancer survivorship programs.

IMPLICATIONS FOR REHABILITATION

Good evidence exists for the use of exercise/physical rehabilitation in reducing fatigue after treatment for most cancers, and improving upper extremity functioning following treatment for breast cancer. Preliminary evidence exists in a number of areas that may be improved by rehabilitation interventions, such as pain, sexual functioning, cognitive functioning and return to work, but further research is needed. No intervention studies addressing participation limitations were identified. Rehabilitation professionals are encouraged to take the lead in exploring participation limitations among cancer survivors and developing suitable interventions.