Participation in water-exercising long-term after breast cancer surgery: Experiences of significant factors for continuing exercising as a part of cancer rehabilitation

Abstract

Although physical exercising has great benefits, little is known regarding factors of significance for cancer survivors to continue exercising within their rehabilitation. The objective was to describe factors experienced to be of significance for cancer survivors to continue with water-exercising long-term after breast cancer surgery. Women (n = 29) who had undergone breast cancer surgery (mastectomy 79%, axillary surgery 86%, and radiotherapy 86%) for median (md) 13 (25th-75th percentile 3-21.5) was followed up regarding their rehabilitation, arm function Disabilities of Arm Shoulder and Hand (md 14, IQR 7-32), EQ-5D score (md 0.8, IQR 0.73-1.0) and quality of life EQ health barometer (md 80,. We performed qualitative focus-group interviews regarding the women's views (n = 24). The women had participated in waterexercising 1-46 semesters, md 8 (25th-75th percentile 3-21.5) semesters. Nearly all, 97%, participated in the water-exercising group every week, and 21 (72%) had participated in the water-exercising group at least half of the time since their breast cancer surgery, without complications. The women experienced that factors of significance to continue with water-exercising were the convenience of easily modified weightless exercising in the water, social interaction, and access to a private dressing room. These factors would be important to consider to encourage continuing in exercising. K E Y W O R D Sbreast cancer, cancer rehabilitation, pain, physical activity, physical exercise, quality of life | INTRODUCTIONPhysical activity, for example water-exercising (Linduist, Enblom, Dunberger, & Bergmark, 2015), is a common and desirable part of the lifelong self-care rehabilitation of arm function limitations after breast cancer surgery (Ridner et al., 2012) but little is known regarding factors of significance for the survivors to continue exercising as a part of the cancer rehabilitation.Post-breast cancer surgery, the survivors often develop limitations in arm functioning and pain (De Groef et al., 2017;Ewertz & Jensen, 2011;Harrington et al., 2011) that decrease quality of life (Kaya, and to decrease symptoms such as pain and depression (Bränström, Petersson, Saboonchi, Wennman-Larsen, & Alexanderson, 2015).However, cancer survivors have difficulties to follow physical activity guidelines; their activity level often is way below recommended levels (Bourke et al., 2014;Bränström et al., 2015). Only a third of breast cancer survivors had a relevant level of physical activity before surgery and decreased their physical activity level even more post-surgery (Bränström et al., 2015). Thus it is important to find convenient kinds of physical activities; activities that the survivors could continue with in a long-term rehabilitation perspective (Ridner et al., 2012).One common kind of physical activity in breast cancer survivors is water exercise (Cantarero-Villanueva et al., 2012, 2013Fernández-Lao et al., 2013;Johansson, Hayes, Speck, & Schmitz, 2013;Linduist et al., 2015). In our recent study, we found that ...

Long‐Term Effects of Breast Cancer Surgery, Treatment, and Survivor Care

“…Use of complex decongestive therapy with moderate intensity exercise resulted in significant differences in muscular strength, arm movement, and quality of life, without any increased risk for lymphedema . Complex decongestive therapy is provided by a certified lymphedema specialist and includes manual lymph drainage by gentle massage, compression via garment or compression bandages, exercises to enhance lymphatic pumping, and careful skin care . It can also be adapted to home programs, demonstrating benefits including reduction in pain levels …”

“…Exercise is one of the best studied interventions, and a regular exercise program has been demonstrated to improve mood, fatigue, lymphedema, range of motion, strength, and quality of life while preventing osteoporosis and improving survival rates. 3,[59][60][61][62] The American Cancer Society recommendations include avoiding inactivity, return to activities of daily living as soon as possible, and at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise per week. 17 A Cochrane Review of physical therapy treatments and exercise supported that any amount of exercise or rehabilitation interventions significantly reduced arm and shoulder morbidity, regardless of the method of breast cancer treatment.…”

“…55,64 Complex decongestive ther-apy is provided by a certified lymphedema specialist and includes manual lymph drainage by gentle massage, compression via garment or compression bandages, exercises to enhance lymphatic pumping, and careful skin care. [55][56][57][58][59][60][61][62][63][64] It can also be adapted to home programs, demonstrating benefits including reduction in pain levels. 55,61 A long-term study incorporating water exercise demonstrated lower rates of lymphedema, reduced arm and neck pain, lower pain sensitivity, and improved range of motion in the affected shoulder.…”

“…55,61 A long-term study incorporating water exercise demonstrated lower rates of lymphedema, reduced arm and neck pain, lower pain sensitivity, and improved range of motion in the affected shoulder. 59 Water exercise allowed participants to modify the intensity of the work out, was more comfortable, and kept the affected arm weightless while also offering the benefit of social interaction and support. 59 Yoga and Pilates exercises have demonstrated statistically significant improvements in shoulder and neck mobility while improving quality of life, mood, and body image.…”

“…59 Water exercise allowed participants to modify the intensity of the work out, was more comfortable, and kept the affected arm weightless while also offering the benefit of social interaction and support. 59 Yoga and Pilates exercises have demonstrated statistically significant improvements in shoulder and neck mobility while improving quality of life, mood, and body image. 17,65,66 Yoga had a moderately positive effect on improved sleep and reduction of fatigue.…”