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Physical activity level, exercise behavior, barriers, and preferences of patients with breast cancer–related lymphedema

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Supportive Care in Cancer Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 16 September 2021

The Original Article was published on 16 September 2021

Abstract

Purpose

To identify physical activity level, exercise behavior, barriers, and preferences in female patients with breast cancer–related lymphedema (BCRL).

Methods

Patients with BCRL consulted to physical therapy to receive lymphedema treatment were included. Age, gender, body mass index matched healthy controls (HC) were included to identify differences. The transtheoretical model was used to determine exercise behavior. Physical activity level was assessed by the International Physical Activity Questionnaire-Short Form (IPAQ-SF). The exercise barriers and preferences of patients with BCRL were recorded using a checklist based on the previous studies.

Results

A total of 48 female patients with BCRL and 38 female HC participated in the study. Physical activity level was significantly lower in patients with BCRL when compared to HC (p ˂ 0.05). However, the number of participants who engaged in regular exercise was significantly higher in patients with BCRL than HC (33.2% vs 7.9%, p ˂ 0.05). The most common exercise barriers were fatigue (64.5%), having other responsibilities (60.4%), and weather-related factors (56.2%). Majority of the participants preferred to participate in a supervised (79.1%), structured (66.6%), combined-type (77.1%), and moderate intensity (79.1%) exercise program, and they preferred to be informed at the time of the cancer diagnosis (45.8%) by a physiotherapist (66.6%). Moreover, the most preferred exercise type was walking/jogging (66.6%).

Conclusion

The present study showed inadequate physical activity and exercise behavior in patients with BCRL. Supportive care interventions are needed to overcome barriers for patients with BCRL. Preferences of patients and exercise enjoyment should also be taken into consideration to increase the participation in exercises.

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References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394–424. https://doi.org/10.3322/caac.21492

    Article  PubMed  Google Scholar 

  2. Sant M, Francisci S, Capocaccia R, Verdecchia A, Allemani C, Berrino F (2006) Time trends of breast cancer survival in Europe in relation to incidence and mortality. Int J Cancer 119(10):2417–2422. https://doi.org/10.1002/ijc.22160

    Article  CAS  PubMed  Google Scholar 

  3. Abrahams HJ, Gielissen MF, Schmits IC, Verhagen CA, Rovers MM, Knoop H (2016) Risk factors, prevalence, and course of severe fatigue after breast cancer treatment: a meta-analysis involving 12 327 breast cancer survivors. Ann Oncol: Off J Eur Soc Med Oncol 27(6):965–974. https://doi.org/10.1093/annonc/mdw099

    Article  CAS  Google Scholar 

  4. Verbelen H, Gebruers N, Eeckhout FM, Verlinden K, Tjalma W (2014) Shoulder and arm morbidity in sentinel node-negative breast cancer patients: a systematic review. Breast Cancer Res Treat 144(1):21–31. https://doi.org/10.1007/s10549-014-2846-5

    Article  PubMed  Google Scholar 

  5. Ewertz M, Jensen AB (2011) Late effects of breast cancer treatment and potentials for rehabilitation. Acta Oncol (Stockholm, Sweden) 50(2):187–193. https://doi.org/10.3109/0284186x.2010.533190

    Article  Google Scholar 

  6. Hayes SC, Janda M, Cornish B, Battistutta D, Newman B (2008) Lymphedema after breast cancer: incidence, risk factors, and effect on upper body function. J Clin Oncol: Off J Am Soc Clin Oncol 26(21):3536–3542. https://doi.org/10.1200/jco.2007.14.4899

    Article  Google Scholar 

  7. DiSipio T, Rye S, Newman B, Hayes S (2013) Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol 14(6):500–515. https://doi.org/10.1016/s1470-2045(13)70076-7

    Article  PubMed  Google Scholar 

  8. Cormier JN, Askew RL, Mungovan KS, Xing Y, Ross MI, Armer JM (2010) Lymphedema beyond breast cancer: a systematic review and meta-analysis of cancer-related secondary lymphedema. Cancer 116(22):5138–5149. https://doi.org/10.1002/cncr.25458

    Article  PubMed  Google Scholar 

  9. Kangas M, Bovbjerg DH, Montgomery GH (2008) Cancer-related fatigue: a systematic and meta-analytic review of non-pharmacological therapies for cancer patients. Psychol Bull 134(5):700–741. https://doi.org/10.1037/a0012825

    Article  PubMed  Google Scholar 

  10. Winningham ML, MacVicar MG (1988) The effect of aerobic exercise on patient reports of nausea. Oncol Nurs Forum 15(4):447–450

    CAS  PubMed  Google Scholar 

  11. Mustian KM, Griggs JJ, Morrow GR, McTiernan A, Roscoe JA, Bole CW, Atkins JN, Issell BF (2006) Exercise and side effects among 749 patients during and after treatment for cancer: a University of Rochester Cancer Center Community Clinical Oncology Program Study. Support Care Cancer: Off J Multinatl Assoc Support Care Cancer 14(7):732–741. https://doi.org/10.1007/s00520-005-0912-6

    Article  Google Scholar 

  12. Duijts SF, Faber MM, Oldenburg HS, 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):115–126. https://doi.org/10.1002/pon.1728

    Article  PubMed  Google Scholar 

  13. Furmaniak AC, Menig M, Markes MH (2016) Exercise for women receiving adjuvant therapy for breast cancer. Cochrane Database Syst Rev 9(9):Cd005001. https://doi.org/10.1002/14651858.CD005001.pub3

    Article  PubMed  Google Scholar 

  14. Fairey AS, Courneya KS, Field CJ, Mackey JR (2002) Physical exercise and immune system function in cancer survivors: a comprehensive review and future directions. Cancer 94(2):539–551. https://doi.org/10.1002/cncr.10244

    Article  PubMed  Google Scholar 

  15. Chen X, Lu W, Zheng W, Gu K, Matthews CE, Chen Z, Zheng Y, Shu XO (2011) Exercise after diagnosis of breast cancer in association with survival. Cancer Prev Res (Phila) 4(9):1409–1418. https://doi.org/10.1158/1940-6207.Capr-10-0355

    Article  Google Scholar 

  16. Irwin ML, Crumley D, McTiernan A, Bernstein L, Baumgartner R, Gilliland FD, Kriska A, Ballard-Barbash R (2003) Physical activity levels before and after a diagnosis of breast carcinoma: the Health, Eating, Activity, and Lifestyle (HEAL) study. Cancer 97(7):1746–1757. https://doi.org/10.1002/cncr.11227

    Article  PubMed  Google Scholar 

  17. Ridner SH, Dietrich MS, Kidd N (2011) Breast cancer treatment-related lymphedema self-care: education, practices, symptoms, and quality of life. Support Care Cancer: Off J Multinatl Assoc Support Care Cancer 19(5):631–637. https://doi.org/10.1007/s00520-010-0870-5

    Article  Google Scholar 

  18. Carter BJ (1997) Women’s experiences of lymphedema. Oncol Nurs Forum 24(5):875–882

    CAS  PubMed  Google Scholar 

  19. Gebruers N, Verbelen H, De Vrieze T, Vos L, Devoogdt N, Fias L, Tjalma W (2017) Current and future perspectives on the evaluation, prevention and conservative management of breast cancer related lymphoedema: a best practice guideline. Eur J Obstet Gynecol Reprod Biol 216:245–253. https://doi.org/10.1016/j.ejogrb.2017.07.035

    Article  PubMed  Google Scholar 

  20. De Vrieze T, Gebruers N, Nevelsteen I, Tjalma WAA, Thomis S, De Groef A, Dams L, Van der Gucht E, Devoogdt N (2020) Physical activity level and age contribute to functioning problems in patients with breast cancer-related lymphedema: a multicentre cross-sectional study. Support Care Cancer: off J Multinatl Assoc Support Care Cancer. https://doi.org/10.1007/s00520-020-05375-3

  21. Sander AP, Wilson J, Izzo N, Mountford SA, Hayes KW (2012) Factors that affect decisions about physical activity and exercise in survivors of breast cancer: a qualitative study. Phys Ther 92(4):525–536. https://doi.org/10.2522/ptj.20110115

    Article  PubMed  Google Scholar 

  22. Cormie P, Pumpa K, Galvão DA, Turner E, Spry N, Saunders C, Zissiadis Y, Newton RU (2013) Is it safe and efficacious for women with lymphedema secondary to breast cancer to lift heavy weights during exercise: a randomised controlled trial. J Cancer Surviv: Res Pract 7(3):413–424. https://doi.org/10.1007/s11764-013-0284-8

    Article  Google Scholar 

  23. Paramanandam VS, Roberts D (2014) Weight training is not harmful for women with breast cancer-related lymphoedema: a systematic review. J Phys 60(3):136–143. https://doi.org/10.1016/j.jphys.2014.07.001

    Article  Google Scholar 

  24. Rogers LQ, Courneya KS, Robbins KT, Malone J, Seiz A, Koch L, Rao K (2008) Physical activity correlates and barriers in head and neck cancer patients. Support Care Cancer: Off J Multinatl Assoc Support Care Cancer 16(1):19–27. https://doi.org/10.1007/s00520-007-0293-0

    Article  Google Scholar 

  25. Clifford BK, Mizrahi D, Sandler CX, Barry BK, Simar D, Wakefield CE, Goldstein D (2018) Barriers and facilitators of exercise experienced by cancer survivors: a mixed methods systematic review. Support Care Cancer: Off J Multinatl Assoc Support Care Cancer 26(3):685–700. https://doi.org/10.1007/s00520-017-3964-5

    Article  Google Scholar 

  26. Fisher A, Wardle J, Beeken RJ, Croker H, Williams K, Grimmett C (2016) Perceived barriers and benefits to physical activity in colorectal cancer patients. Support Care Cancer: Off J Multinatl Assoc Support Care Cancer 24(2):903–910. https://doi.org/10.1007/s00520-015-2860-0

    Article  Google Scholar 

  27. Rogers LQ, Courneya KS, Shah P, Dunnington G, Hopkins-Price P (2007) Exercise stage of change, barriers, expectations, values and preferences among breast cancer patients during treatment: a pilot study. Europ J Cancer Care 16(1):55–66. https://doi.org/10.1111/j.1365-2354.2006.00705.x

    Article  CAS  Google Scholar 

  28. Buchan J, Janda M, Box R, Rogers L, Hayes S (2015) Exercise barriers self-efficacy: development and validation of a subcale for individuals with cancer-related lymphedema. Health Qual Life Outcomes 13:37. https://doi.org/10.1186/s12955-015-0223-7

    Article  PubMed  PubMed Central  Google Scholar 

  29. Nieto-García FJ, Bush TL, Keyl PM (1990) Body mass definitions of obesity: sensitivity and specificity using self-reported weight and height. Epidemiology (Cambridge, Mass) 1(2):146–152

    Article  Google Scholar 

  30. Saglam M, Arikan H, Savci S, Inal-Ince D, Bosnak-Guclu M, Karabulut E, Tokgozoglu L (2010) International physical activity questionnaire: reliability and validity of the Turkish version. Percept Mot Skills 111(1):278–284. https://doi.org/10.2466/06.08.Pms.111.4.278-284

    Article  PubMed  Google Scholar 

  31. Prochaska JJ, Nigg CR, Spring B, Velicer WF, Prochaska JO (2010) The benefits and challenges of multiple health behavior change in research and in practice. Prev Med 50(1-2):26–29. https://doi.org/10.1016/j.ypmed.2009.11.009

    Article  PubMed  Google Scholar 

  32. Ottenbacher AJ, Day RS, Taylor WC, Sharma SV, Sloane R, Snyder DC, Kraus WE, Demark-Wahnefried W (2011) Exercise among breast and prostate cancer survivors--what are their barriers? J Cancer Surviv: Res Pract 5(4):413–419. https://doi.org/10.1007/s11764-011-0184-8

    Article  Google Scholar 

  33. Satia JA, Walsh JF, Pruthi RS (2009) Health behavior changes in white and African American prostate cancer survivors. Cancer Nurs 32(2):107–117. https://doi.org/10.1097/NCC.0b013e3181982d4c

    Article  PubMed  PubMed Central  Google Scholar 

  34. Hojman P, Gehl J, Christensen JF, Pedersen BK (2018) Molecular mechanisms linking exercise to cancer prevention and treatment. Cell Metab 27(1):10–21. https://doi.org/10.1016/j.cmet.2017.09.015

    Article  CAS  PubMed  Google Scholar 

  35. Ecker BL, Lee JY, Sterner CJ, Solomon AC, Pant DK, Shen F, Peraza J, Vaught L, Mahendra S, Belka GK, Pan TC, Schmitz KH, Chodosh LA (2019) Impact of obesity on breast cancer recurrence and minimal residual disease. Breast Cancer Res: BCR 21(1):41. https://doi.org/10.1186/s13058-018-1087-7

    Article  PubMed  PubMed Central  Google Scholar 

  36. Pudkasam S, Polman R, Pitcher M, Fisher M, Chinlumprasert N, Stojanovska L, Apostolopoulos VJM (2018) Physical activity and breast cancer survivors: importance of adherence, motivational interviewing and psychological health. Maturitas 116:66–72

    Article  Google Scholar 

  37. Meiklejohn J, Heesch K, Janda M, Hayes SCJL (2012) Physical activity in the lives of those living with lymphoedema following cancer treatment. Lymphology 44(Sup):131–137

    Google Scholar 

  38. Green HJ, Steinnagel G, Morris C, Laakso EL (2014) Health behaviour models and patient preferences regarding nutrition and physical activity after breast or prostate cancer diagnosis. Europ J Cancer Care 23(5):640–652. https://doi.org/10.1111/ecc.12190

    Article  CAS  Google Scholar 

  39. Harrington JM, Schwenke DC, Epstein DR (2013) Exercise preferences among men with prostate cancer receiving androgen-deprivation therapy. Oncol Nurs Forum 40(5):358–367. https://doi.org/10.1188/13.ONF.E358-E367

    Article  Google Scholar 

  40. Kwan ML, Cohn JC, Armer JM, Stewart BR, Cormier JN (2011) Exercise in patients with lymphedema: a systematic review of the contemporary literature. J Cancer Surviv: Res Pract 5(4):320–336. https://doi.org/10.1007/s11764-011-0203-9

    Article  Google Scholar 

  41. Cormie P, Galvão DA, Spry N, Newton RU (2013) Neither heavy nor light load resistance exercise acutely exacerbates lymphedema in breast cancer survivor. Integr Cancer Ther 12(5):423–432. https://doi.org/10.1177/1534735413477194

    Article  PubMed  Google Scholar 

  42. Arndt V, Stegmaier C, Ziegler H, Brenner H (2008) Quality of life over 5 years in women with breast cancer after breast-conserving therapy versus mastectomy: a population-based study. J Cancer Res Clin Oncol 134(12):1311–1318. https://doi.org/10.1007/s00432-008-0418-y

    Article  PubMed  Google Scholar 

  43. Tait RC, Zoberi K, Ferguson M, Levenhagen K, Luebbert RA, Rowland K, Salsich GB, Herndon C (2018) Persistent post-mastectomy pain: risk factors and current approaches to treatment. J Pain: Off J Am Pain Soc 19(12):1367–1383. https://doi.org/10.1016/j.jpain.2018.06.002

    Article  Google Scholar 

  44. Baron RH, Fey JV, Raboy S, Thaler HT, Borgen PI, Temple LK, Van Zee KJ (2002) Eighteen sensations after breast cancer surgery: a comparison of sentinel lymph node biopsy and axillary lymph node dissection. Oncol Nurs Forum 29(4):651–659. https://doi.org/10.1188/02.ONF.651-659

    Article  PubMed  Google Scholar 

  45. Ridner SH, Montgomery LD, Hepworth JT, Stewart BR, Armer JM (2007) Comparison of upper limb volume measurement techniques and arm symptoms between healthy volunteers and individuals with known lymphedema. Lymphology 40(1):35–46

    CAS  PubMed  Google Scholar 

  46. Nijs J, Leysen L, Pas R, Adriaenssens N, Meeus M, Hoelen W, Ickmans K, Moloney N (2018) Treatment of pain following cancer: applying neuro-immunology in rehabilitation practice. Disabil Rehabil 40(6):714–721. https://doi.org/10.1080/09638288.2016.1261418

    Article  PubMed  Google Scholar 

  47. Tatrow K, Montgomery GH (2006) Cognitive behavioral therapy techniques for distress and pain in breast cancer patients: a meta-analysis. J Behav Med 29(1):17–27

    Article  Google Scholar 

  48. Koca C, Henderson KA, Asci FH, Bulgu N (2009) Constraints to leisure-time physical activity and negotiation strategies in Turkish women. J Leis Res 41(2):225–251

    Article  Google Scholar 

  49. Wong JN, McAuley E, Trinh L (2018) Physical activity programming and counseling preferences among cancer survivors: a systematic review. Int J Behavl Nutr Phys Act 15(1):48. https://doi.org/10.1186/s12966-018-0680-6

    Article  Google Scholar 

  50. Jones LW, Courneya KS (2002) Exercise counseling and programming preferences of cancer survivors. Cancer Pract 10(4):208–215. https://doi.org/10.1046/j.1523-5394.2002.104003.x

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey

    Vesile Yildiz Kabak, Ceren Gursen, Turkan Akbayrak & Tulin Duger

  2. Vocational School of Health Sciences, Baskent University, Ankara, Turkey

    Ayca Aytar

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  1. Vesile Yildiz Kabak
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Correspondence to Vesile Yildiz Kabak.

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Yildiz Kabak, V., Gursen, C., Aytar, A. et al. Physical activity level, exercise behavior, barriers, and preferences of patients with breast cancer–related lymphedema. Support Care Cancer 29, 3593–3602 (2021). https://doi.org/10.1007/s00520-020-05858-3

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