Shaunna M. Burke

A qualitative exploration of barriers and motivators to physical activity participation in women treated for breast cancer

Abstract Purpose: The adoption and maintenance of a physically active lifestyle among women after breast cancer is an important priority for public health and rehabilitation science. The purpose of this qualitative study was to explore breast cancer survivors’ perceptions of the factors influencing their ability to maintain a self-directed physical activity program. Method: Nine women participated in semi-structured, in-depth interviews. Data were coded into perceived barriers and motivators to maintenance of physical activity using thematic analysis. Results: Women identified a range of physical (e.g. cancer-related physical symptoms), environmental/organizational (e.g. bad weather, lack of equipment/facilities, lack of knowledge, time constraints) and psychosocial (e.g. lack of motivation, low social support, low confidence/skill) barriers. They also identified perceived physical (e.g. weight management, health improvement or maintenance, increase energy) and psychosocial (e.g. improve body image, experience enjoyment, social support, positive emotions) motivators. Conclusions: These findings are consistent with research on barriers and motivators to physical activity initiation, and can be used to develop self-directed physical activity programs that target active breast cancer survivors to sustain regular engagement. Furthermore, the barriers and motivators identified represent key variables for further investigation. Implications for rehabilitation The present study identifies a number of perceived physical, psychosocial and organizational/environmental barriers to naturally occurring physical activity participation among active breast cancer survivors that should be addressed to ensure they maintain a physically active lifestyle This study also provides evidence that comprehensive approaches that address physical and psychosocial motivators to physical activity should be developed to assist women with a history of breast cancer maintain their physical activity levels

Surviving breast cancer: Women's experiences with their changed bodies

In this study, we explored womens experiences with their bodies following treatment for breast cancer. Eleven women who had been treated for the disease (M(time since treatment)=4.45 years) were interviewed. Data were collected and analyzed using interpretative phenomenological analysis (Smith et al., 2009). Four main themes emerged from the data: changing visibly and invisibly; experiencing intense thoughts and emotions; meaning of the body: a vehicle of health, well-being, and social expression; and managing and dealing with physical changes. Overall, the women experienced various physical changes that shaped, mostly in a negative way, their perceptions, thoughts, attitudes, feelings, and beliefs about their bodies. The women described attempts to make positive lifestyle behavior choices (e.g., diet, participate in physical activity), and used other strategies (e.g., wigs, make-up, clothes) to manage their appearances and restore positive body-related experiences. Based on these findings, it is important to be cognizant of womens body image concerns following breast cancer given the poignant and lasting effects they can have on their psychosocial and emotional well-being.

Pain, movement, and mind: does physical activity mediate the relationship between pain and mental health among survivors of breast cancer?

Objectives:This study examined the relationship between pain and mental health outcomes of depression and affect among survivors of breast cancer. The mediating role of physical activity was also tested. Methods:Survivors of breast cancer (N=145) completed self-report measures of pain symptoms at baseline, wore an accelerometer for 7 days, and reported levels of depression symptoms and negative and positive affect 3 months later. Hierarchical linear regression analyses, controlling for personal and cancer-related demographics, were used to test the association between pain symptoms and each mental health outcome, as well as the mediation effect of physical activity. Results:Pain positively predicted depression symptoms [F(6,139)=4.31, P<0.01, R2=0.15] and negative affect [F(5,140)=4.17, P<0.01, R2=0.13], and negatively predicted positive affect [F(6,139)=2.12, P=0.03, R2=0.08]. Physical activity was a significant (P<0.01) partial mediator of the relationship between pain and depression and between pain and positive affect. Discussion:Participation in physical activity is one pathway through which pain influences mental health. Efforts are needed to help survivors of breast cancer manage pain symptoms and increase their level of physical activity to help improve mental health.

The benefits of being self-determined in promoting physical activity and affective well-being among women recently treated for breast cancer

In this study, changes in motivational regulations in women following treatment for breast cancer were described. Changes in motivational regulations as predictors of subsequent change in light and moderate‐to‐vigorous physical activity (PA) and affect were also examined.

Passion in breast cancer survivors: Examining links to emotional well-being

This study (1) identified the activities that breast cancer survivors report as passionate; (2) examined whether levels of passion differed based on the types of passionate activities reported and; (3) examined the association between harmonious and obsessive passion and emotional well-being. Early post-treatment breast cancer survivors (N = 177) reported passionate physical activities as most prevalent, and reported higher harmonious passion scores compared to women reporting relaxing and social leisure activities. Harmonious passion was associated with higher positive affect and lower cancer worry. Obsessive passion was linked to higher negative affect, cancer worry, and posttraumatic growth. Passion is important for enhanced well-being.

Climbing towards recovery: investigating physically injured combat veterans' psychosocial response to scaling Mt. Kilimanjaro.

Purpose: To explore physically injured combat veterans’ psychosocial response to scaling Mt. Kilimanjaro. Method: Participants (n = 4) were male and ranged in age from 22 to 44 years. They had all been wounded as a result of active duty in Afghanistan between 15 and 42 months (M = 27.25) before the study. Data were collected throughout a 9-day climb on Mt. Kilimanjaro using multiple sources of ethnographic data collection techniques including semi-structured interviews and detailed observations. Data were analyzed using cross case analysis. Results: The findings are divided into themes that were drawn out of the data to illustrate the participants’ psychosocial response to their experience of climbing on Mt. Kilimanjaro. Key themes of self-determination, active coping and social support were identified from the data. Conclusion: Support for those in recovery from trauma should foster psychosocial resources needed for healthy functioning. Future research should explore the role of meaningful and challenging activities as a way of improving the experience of recovery following serious injury. Implications for Rehabilitation Injured combat veterans Acquiring an injury may result in physical disability, pain, physical limitations, stress and vulnerability, and loss of family and friends thereby hindering veterans’ capacity to recover. In a relatively small sample, this study shows that pursuing meaningful and challenging activities such as scaling Mt. Kilimanjaro may complement rehabilitation strategies. Services and support for those in recovery from trauma should foster psychosocial resources needed for healthy functioning.

Physical activity and quality of life in cancer survivors: A meta-synthesis of qualitative research

Qualitative research on the impact of physical activity on quality of life (QoL) in adults diagnosed with cancer is accumulating. However, the field of physical activity and cancer survivorship lack a synthesis of this research to reliably understand the implications for future research and practice. The aim of this meta-synthesis was to identify, appraise, and synthesize qualitative research on cancer survivors’ perspectives of the impact of physical activity on their QoL. Seven electronic databases were searched for original studies published in English, and reference lists of relevant studies were hand-searched to identify additional studies. Forty studies met eligibility criteria and were included in this meta-synthesis. Study characteristics and major findings were extracted, and findings were summarized, compared, and synthesized. Themes identified in this review revealed that physical activity positively impacted four dimensions of cancer survivors’ QoL: physical (e.g., managing the physical consequences of cancer and its treatment), psychological (e.g., evoking positive self-perceptions), social (e.g., feeling understood by others), and spiritual (e.g., redefining life purpose). This meta-synthesis corroborates conclusions from reviews of quantitative research and illustrates that physical activity can be used to improve QoL in adult cancer survivors, regardless of diagnosis (i.e., stage, cancer type) and treatment status. It also provides detailed insight into specific aspects within each dimension of QoL impacted by physical activity from cancer survivors’ perspectives, which is important for understanding the meaning and utility of physical activity for them. However, more research is needed to further develop the qualitative evidence base in order to better understand how physical activity impacts on QoL experiences in men, young adults, and adults diagnosed with less common types of cancer at different points along cancer trajectory (i.e., diagnosis, treatment, post-treatment, palliation).

The effects of neoadjuvant chemoradiotherapy and an in-hospital exercise training programme on physical fitness and quality of life in locally advanced rectal cancer patients (The EMPOWER Trial): study protocol for a randomised controlled trial

BackgroundThe standard treatment pathway for locally advanced rectal cancer is neoadjuvant chemoradiotherapy (CRT) followed by surgery. Neoadjuvant CRT has been shown to decrease physical fitness, and this decrease is associated with increased post-operative morbidity. Exercise training can stimulate skeletal muscle adaptations such as increased mitochondrial content and improved oxygen uptake capacity, both of which are contributors to physical fitness. The aims of the EMPOWER trial are to assess the effects of neoadjuvant CRT and an in-hospital exercise training programme on physical fitness, health-related quality of life (HRQoL), and physical activity levels, as well as post-operative morbidity and cancer staging.Methods/DesignThe EMPOWER Trial is a randomised controlled trial with a planned recruitment of 46 patients with locally advanced rectal cancer and who are undergoing neoadjuvant CRT and surgery. Following completion of the neoadjuvant CRT (week 0) prior to surgery, patients are randomised to an in-hospital exercise training programme (aerobic interval training for 6 to 9 weeks) or a usual care control group (usual care and no formal exercise training). The primary endpoint is oxygen uptake at lactate threshold (V·o2

Patients' perceptions of quality of life during active treatment for locally advanced rectal cancer: the importance of preoperative exercise

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