Development of an exercise adherence program for breast cancer survivors with cancer-related fatigue—an intervention mapping approach

  • Sue Kim
  • Yun Hee Ko
  • Yoonkyung Song
  • Min Jae Kang
  • Hyojin Lee
  • Sung Hae Kim
  • Justin Y. Jeon
  • Young Up Cho
  • Gihong Yi
  • Jeehee HanEmail author
Original Article



Cancer-related fatigue (CRF) is the most common and distressing symptom in breast cancer survivors (BCS), with severe impact on quality of life. CRF can be reduced through exercise, but conversely, is also a barrier to exercising. The aim of this article was to apply the intervention mapping protocol (IMP) to develop an exercise adherence intervention for BCS with CRF.


The program was developed using the IMP, which consists of six steps. Based on the data from focus group interviews and literature review, we produced a logic model of change.


Two performance objectives (survivors adopt and maintain exercise and survivors cope with fatigue) and 17 change objectives were generated. Also, we designed theory-based methods of change, and strategies for practical application. A structured program plan that includes intervention content and methods, ranges, and program data was proposed. Finally, an implementation and evaluation plan was developed.


The IMP provided a useful framework to systematically plan an exercise adherence program. This study resulted in a theory and practice-based exercise adherence program, based on behavioral change theories, and practice-based knowledge that fits the needs of BCS with CRF.


Breast cancer survivor Cancer-related fatigue Intervention mapping protocol Exercise adherence Social capital 



cancer-related fatigue


breast cancer survivors


Intervention Mapping Protocol


Theory of Planned Behavior



This research was supported by the Basic Science Research Program through the National Research Foundation for Korea (NRF) funded by the Ministry of Education (grant number 2015R1D1A1A01059846).

Compliance with ethical standards

Ethics approval and consent to participate

An institutional review board exemption was obtained from Severance Hospital, Korea (IRB 4–2017–0164).

Competing interests

The authors declare that they have no competing interests.


  1. 1.
    Bower JE (2014) Cancer-related fatigue-mechanisms, risk factors, and treatments. Nat Rev Clin Oncol 11(10):597–609CrossRefGoogle Scholar
  2. 2.
    Meneses-Echávez JF, González-Jiménez E, Ramírez-Vélez R (2015) Effects of supervised exercise on cancer-related fatigue in breast cancer survivors: a systematic review and meta-analysis. BMC Cancer 15(1):77CrossRefGoogle Scholar
  3. 3.
    Blaney J, Lowe-Strong A, Rankin J, Campbell A, Allen J, Gracey J (2010) The cancer rehabilitation journey: barriers to and facilitators of exercise among patients with cancer-related fatigue. Phys Ther 90(8):1135–1147CrossRefGoogle Scholar
  4. 4.
    Huang H-P, Wen F-H, Tsai J-C, Lin Y-C, Shun S-C, Chang H-K, Wang JS, Jane SW, Chen MC, Chen ML (2015) Adherence to prescribed exercise time and intensity declines as the exercise program proceeds: findings from women under treatment for breast cancer. Support Care Cancer 23(7):2061–2071CrossRefGoogle Scholar
  5. 5.
    Kampshoff CS, Jansen F, van Mechelen W, May AM, Brug J, Chinapaw MJ et al (2014) Determinants of exercise adherence and maintenance among cancer survivors: a systematic review. Int J Behav Nutr Phys Act 11(1):80CrossRefGoogle Scholar
  6. 6.
    Husebø AML, Dyrstad SM, Søreide JA, Bru E (2013) Predicting exercise adherence in cancer patients and survivors: a systematic review and meta-analysis of motivational and behavioural factors. J Clin Nurs 22(1–2):4–21CrossRefGoogle Scholar
  7. 7.
    Courneya KS, Friedenreich CM, Reid RD, Gelmon K, Mackey R, Ladha AB et al (2009) Predictors of follow-up exercise behavior 6 months after a randomized trial of exercise training during breast cancer chemotherapy. Breast Cancer Res Treat 114(1):179–187CrossRefGoogle Scholar
  8. 8.
    Vrieling A, Kampman E (2010) The role of body mass index, physical activity, and diet in colorectal cancer recurrence and survival: a review of the literature. Am J Clin Nutr 92(3):471–490CrossRefGoogle Scholar
  9. 9.
    Villalonga-Olives E, Kawachi I (2015) The measurement of bridging social capital in population health research. Health Place 36:47–56CrossRefGoogle Scholar
  10. 10.
    Fang J, Wang JW, Li J, Li H, Shao C (2017) The correlates of social capital and adherence to healthy lifestyle in patients with coronary heart disease. Patient Prefer Adherence 11:1701–1707CrossRefGoogle Scholar
  11. 11.
    Kamimura A, Tabler J, Nourian MM, Assasnik N, Wright L, Ashby J (2017) Prevention and management of hypertension and diabetes using social capital and physical activity among socioeconomically disadvantaged populations. Fam Community Health 40(3):205–211CrossRefGoogle Scholar
  12. 12.
    Duijts SFA, Faber MM, Oldenburg HSA, van Beurden M, Aaronson NK (2011) Effectiveness of behavioral techniques and physical exercise on psychosocial functioning and health-related quality of life in breast cancer patients and survivors: a meta-analysis. Psycho-Oncology 20(2):115–126CrossRefGoogle Scholar
  13. 13.
    Bartholomew Eldredge LK, Markham CM, Ruiter RAC, Fernandez ME, Kok G, Parcel GS (2016) Planning health promotion programs: an intervention mapping approach, 4th edn. Jossey-Bass, San FranciscoGoogle Scholar
  14. 14.
    Brug J, Oenema A, Ferreira I (2005) Theory, evidence and intervention mapping to improve behavior nutrition and physical activity interventions. Int J Behav Nutr Phys Act 2(1):2CrossRefGoogle Scholar
  15. 15.
    Brown LF, Kroenke K (2009) Cancer-related fatigue and its associations with depression and anxiety: a systematic review. Psychosomatics 50(5):440–447CrossRefGoogle Scholar
  16. 16.
    Kim S, Han JH, Lee MY, Jang MK. Breast cancer survivors’ experience of cancer-related fatigue, exercise, and exercise adherence: Insights from focus group interviews. (under review)Google Scholar
  17. 17.
    Kok G, Gottlieb NH, Peters G-JY, Mullen PD, Parcel GS, Ruiter RAC, Fernández ME, Markham C, Bartholomew LK (2016) A taxonomy of behaviour change methods: an intervention mapping approach. Health Psychol Rev 10(3):297–312CrossRefGoogle Scholar
  18. 18.
    Elsman EB, Leerlooijer JN, Ter Beek J, Duijzer G, Jansen SC, Hiddink GJ et al (2014) Using the intervention mapping protocol to develop a maintenance programme for the SLIMMER diabetes prevention intervention. BMC Public Health 14(1):1108CrossRefGoogle Scholar
  19. 19.
    Zeng Y, Huang M, Cheng ASK, Zhou Y, So WKW (2014) Meta-analysis of the effects of exercise intervention on quality of life in breast cancer survivors. Breast Cancer 21(3):262–274CrossRefGoogle Scholar
  20. 20.
    Glanz K, Bishop DB (2010) The role of behavioral science theory in development and implementation of public health interventions. Annu Rev Public Health 31:399–418CrossRefGoogle Scholar
  21. 21.
    Ajzen I (1991) The theory of planned behavior. Organ Behav Hum Decis Process 50(2):179–211CrossRefGoogle Scholar
  22. 22.
    Woolcock M, Narayan D (2000) Social capital: implications for development theory, research, and policy. World Bank Rese Obs 15(2):225–249CrossRefGoogle Scholar
  23. 23.
    Kok G, Schaalma H, Ruiter RA, Van Empelen P, Brug J (2004) Intervention mapping: protocol for applying health psychology theory to prevention programmes. J Health Psychol 9(1):85–98CrossRefGoogle Scholar
  24. 24.
    Oosterom-Calo R, te Velde SJ, Stut W, Brug J (2015) Development of motivate4change using the intervention mapping protocol: an interactive technology physical activity and medication adherence promotion program for hospitalized heart failure patients. JMIR Res Protoc 4(3):e88CrossRefGoogle Scholar
  25. 25.
    Park M, Kim S, Cho E, Park SM, Kang HC (2013) A study on the development of a self-regulated exercise maintenance program for osteoporotic elderly women: using intervention mapping protocol. J Korean Gerontol Soc 33(2):419–437Google Scholar
  26. 26.
    De Craemer M, De Decker E, De Bourdeaudhuij I, Verloigne M, Duvinage K, Koletzko B et al (2014) Applying the I ntervention M apping protocol to develop a kindergarten-based, family-involved intervention to increase E uropean preschool children's physical activity levels: the ToyBox-study. Obes Rev 15:14–26CrossRefGoogle Scholar
  27. 27.
    Cherrington A, Martin MY, Hayes M, Halanych JH, Andreae SJ, Safford M et al (2011) Intervention mapping as a guide for the development of a diabetes peer support intervention in rural Alabama. Prev Chronic Dis 9Google Scholar
  28. 28.
    Désiron HAM, Crutzen R, Godderis L, Van Hoof E, de Rijk A (2016) Bridging health care and the workplace: formulation of a return-to-work intervention for breast cancer patients using an intervention mapping approach. J Occup Rehabil 26(3):350–365CrossRefGoogle Scholar

Copyright information

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

Authors and Affiliations

  1. 1.Mo-Im Kim Nursing Research Institute, College of NursingYonsei UniversitySeoulSouth Korea
  2. 2.College of NursingYonsei UniversitySeoulSouth Korea
  3. 3.Department of Sports Industry StudiesYonsei UniversitySeoulSouth Korea
  4. 4.Department of Sports Industry StudiesYonsei UniversitySeoulSouth Korea
  5. 5.Exercise Medicine Center for Diabetes and Cancer Patients, ICONSYonsei UniversitySeoulSouth Korea
  6. 6.Division of Breast Surgery, Department of SurgeryYonsei University College of MedicineSeoulSouth Korea
  7. 7.Department of SociologyHallym UniversityChuncheonSouth Korea

Personalised recommendations