Physical problems, functional limitations, and preferences for physical therapist-guided exercise programs among Dutch patients with metastatic breast cancer: a mixed methods study

  • M. R. ten Tusscher
  • W. G. Groen
  • E. Geleijn
  • G. S. Sonke
  • I. R. Konings
  • M. J. Van der Vorst
  • A. van Zweeden
  • N. K. Aaronson
  • Martijn M. StuiverEmail author
Original Article



In this study we aimed (1) to identify the most prevalent physical symptoms and functional limitations that limit physical activity of patients with palliative treatment for metastatic breast cancer (MBC) and (2) to identify their preferences for exercise-based physical therapy programs, as a first step towards the development of physical therapist (PT)-guided exercise programs for patients with MBC.


We performed a mixed-method study that comprised a cross-sectional survey and two focus group sessions among patients with MBC. Survey results were analyzed using descriptive statistics. The focus groups were audio-taped, transcribed verbatim, and analyzed independently by two researchers, using directed content analysis.


A total of 114 women (response rate 61%) completed the survey (mean age 63.5, SD 10.2). Eighty-six percent of the women reported at least some level of physical problems limiting their ability to be physically active, of whom 46% reported substantial problems. The most prevalent problems were fatigue, painful joints, painful muscles, and shortness of breath. Uptake of exercise appeared to be limited. Exercise preferences varied strongly. Fifty-three percent indicated a preference for some form of PT-supervision, and 34% for a prolonged period of time (> 8 weeks). Focus group results clarified that patients’ preferences for supervision, by PTs with special qualifications in oncology, were related to feelings of insecurity about their ability to self-manage physical functioning.


Patients with MBC experience a broad range of physical health problems that limit their ability to be physically active. While preferences vary strongly, patients with MBC would value the availability of high quality, PT-guided, tailored exercise programs.


Metastatic breast cancer Exercise Physical therapy Functional limitations Quality of life 



We thank Adriënne Veraart, Rachel Verbeek, and Fleurine van Beek for their contributions to the project and Pink Ribbon for supporting this research.

Compliance with ethical standards

Conflict of interest

Dr. Aaronson, Dr. Stuiver, and E. Geleijn report a grant from the Dutch Cancer Foundation KWF/Pink Ribbon supporting this study. Dr. Sonke reports unrelated grants from Astra-Zeneca, Novartis, Roche, and Merck.

We have full control of all primary data and agree to allow the journal to review the data if requested.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • M. R. ten Tusscher
    • 1
  • W. G. Groen
    • 2
  • E. Geleijn
    • 3
  • G. S. Sonke
    • 4
  • I. R. Konings
    • 5
  • M. J. Van der Vorst
    • 5
    • 6
  • A. van Zweeden
    • 5
    • 7
  • N. K. Aaronson
    • 2
  • Martijn M. Stuiver
    • 1
    • 3
    • 8
    Email author
  1. 1.Center for Quality of LifeThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  2. 2.Division of Psychosocial Research and EpidemiologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  3. 3.Department of Rehabilitation Medicine, Amsterdam Movement SciencesAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
  4. 4.Department of Medical OncologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  5. 5.Department of Medical OncologyAmsterdam UMC, Vrije Universiteit Amsterdam/Cancer Center AmsterdamAmsterdamThe Netherlands
  6. 6.Department of Internal MedicineRijnstate HospitalArnhemthe Netherlands
  7. 7.Department of Internal MedicineAmstelland HospitalAmstelveenThe Netherlands
  8. 8.ACHIEVE Centre of Applied Research, Faculty of HealthUniversity of Applied Sciences AmsterdamAmsterdamThe Netherlands

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