Exercise stage of change, barriers, expectations, values and preferences among breast cancer patients during treatment: a pilot study

Abstract

With increasing evidence supporting physical activity benefits during breast cancer treatment, addressing exercise adherence with consideration of the unique exercise barriers, outcome expectations and preferences of cancer patients is needed. Our pilot study aimed to determine the following during breast cancer treatment: (1) exercise barriers, outcome expectations/values and associations with exercise stage of change and (2) exercise preferences. A cross-sectional survey was administered to 23 breast cancer patients during treatment. Participants were primarily aged 50-60 years (52%), Caucasian (91%), with stage I (30%), II (44%) or III (26%) disease. A total of 48% were receiving chemotherapy. In total, 50% were in the pre-contemplation/contemplation stage of change, with 34% in action/maintenance. Common exercise adherence barriers (i.e. lack of priority, self-discipline, procrastination and fatigue) demonstrated statistically significant negative associations with exercise. Frequent outcome expectations included improving heart/lungs, reducing disease risk, building muscle strength and losing weight. Important outcomes included improving state of mind, reducing fatigue and avoiding injury. Outcome expectations (i.e. less depression, boredom and nausea) were positively associated with exercise. The majority preferred walking (100%), moderate-intensity (61%), home-based (78%) exercise. Among breast cancer patients during treatment, exercise adherence barriers are general and disease specific. Outcome expectations are physical benefits, with the most important outcomes being psychological or avoidance of risk (i.e. injury).

Physical Activity and Cancer

“…Intervention studies have shown that it is possible for cancer survivors to be active to some extent both during and soon after the completion of treatment with very few observed negative consequences (Battaglini, 2011;Keogh & MacLeod, 2012;Schmitz et al, 2011). Additionally, many of the barriers to physical activity which are frequently reported by cancer survivors are not treatment related (Rogers et al, 2007;Ottenbacher et al, 2011). This suggests that physical condition alone does not determine whether someone participates in physical activity or not.…”

“…Conversely, studies have found that autonomous motives are linked with more positive attitudes towards exercise both in the general population and amongst cancer survivors, and it has been shown that autonomous motivations result in a higher level of physical activity engagement (Ryan et al, 1997;Wilson et al, , 2006. Since cancer survivors report lack of enjoyment as a barrier to physical activity (Leddy, 1997;Rogers et al, 2006;Rogers et al, 2007), it may be important to take into account cancer survivors' preferences in constructing physical activity programmes in order that they are more intrinsically enjoyable, providing autonomous motives and may therefore be more likely to be adhered to.…”

“…In terms of favourable attitudes, the majority of cancer survivors appear to be well aware of the potential benefits of engaging in physical activity, and expect physical activity to improve heart/lung functioning, reduce disease risk, build muscle strength, aid weight loss, alleviate stress and improve state of mind (Craike et al, 2011;Rogers et al, 2004Rogers et al, , 2007. Blaney et al (2010) reported that cancer survivors with CRF also recognised that being active is a way of achieving a goal and regaining a sense of normality.…”

“…In contrast, motives are autonomous when the behaviour is inherently pleasurable and valued so that the behaviour will be undertaken without the need for external pressure or incentive, and the cause of the behaviour is perceived as internal. The majority of factors which cancer survivors report as motivating are controlling, such as improved physical functioning, aiding recovery from surgery, increasing self-esteem, social contact, improving body image and weight loss, although some survivors also report that they find physical activity relaxing (Blaney et al, 2010;Craike et al, 2011;Rogers et al, 2004Rogers et al, , 2007Schrop et al, 2007).…”

Exercise Barriers in Korean Colorectal Cancer Patients

“…Several studies have been conducted to explore the barriers that keep cancer patients from participating in exercise, including breast (Nelson, 1991;Leddy, 1997;Rogers et al, 2006;Rogers et al, 2007;Courneya et al, 2008;Gho et al, 2010;Loh et al, 2012;Ottenbacher et al, 2013), prostate (Ottenbacher et al, 2013), and head and neck (Rogers et al, 2008) cancer. For colorectal cancer, Courneya et al (2005) identified exercise barriers during an exercise program intervention and Lynch et al (2010) reported barriers to physical activity for colorectal cancer patients according to the time period after diagnosis.…”