WHAT: A group of breast cancer survivors are participating in an exercise program through the cancer center. The main issues among the group include overall quality of life and also their physical health. Although it is important to incorporate physical fitness activities to enhance these breast cancer survivor’s physical health status, emotional and mental health are also key challenges which will help to promote their quality of life. The physical health of individuals in the group will vary depending on their recovery status from chemotherapy, surgery, etc. Quality of life issues often focus on negative emotions, but it will be important to reflect on positive emotions with these breast cancer survivors as well.
SO WHAT: Due to the exercise setting, this program should focus on enhancing health-related quality of life among the group members and strengthen physical health through aerobic and anaerobic activities each session. Gill & Williams (2008) suggest that research continues to accumulate on the promotion of quality of life through physical activity. Since quality of life is a concern among group members, use of a QoL model along with program exercises will be helpful. Regarding stress and poor health, Gill & Williams (2008) mention Crews and Landers meta-analysis in which exercise reduced depression and stress over prolonged periods. Due to recovery and sedentary behavior, physical health is important to enhance among group members. Courneya, Mackey, Bell, et al (2003) suggest that cardiopulmonary function decreases in breast cancer survivors after surgery and treatment. The researcher’s link decreased cardiopulmonary function with lower QoL. Wenzel, Fairclough, Brady, et al (1999) note that individuals receiving more chemotherapy for breast cancer treatment show slower improvements in QoL immediately following completion of treatment. Knowing the differences in treatment methods and length will help the director to focus more attention to QoL issues with specific individuals within the group. Those remaining with less invasive treatments may utilize the physical component more than those with serious QoL issues. Allowing short discussion activities where the group shares QoL issues and struggles with their recovery may help with mental health and the ability to relate to others in the program.
NOW WHAT: We must establish the specific QoL issues faced by individuals in the group to determine how we will approach them and what QoL aspects seem to suffer over others. Also, the physical health status will vary among the group, so aerobic and anaerobic exercises may be limited for some individuals, while others are not limited. Participants will work on improving physical health through the use of treadmills and stationary bicycles, during the first 20 minutes of the exercise class. Then the exercise staff will work with mobility and strength through resistance training to improve physical health that may have been affected during chemotherapy or in surgery. Those who have recently undergone surgery may be limited in their physical functions. Courneya, Mackey, Bell, et al (2003) found validity using the Functional Assessment of Cancer Therapy-Breast to measure QoL, so this same instrument will be used to measure QoL among these exercise participants. It is assumed that with higher levels of exercise intensity, QoL will improve, as will physical health. The FACT-B will be given at the end of the exercise program to assess if any improvements occur in the group. Another way in which QoL will be addressed is through group discussion in which participants will share their QoL concerns and physical limitations with other group members. Gill & Williams (2008) discuss Lee & Russell’s work on physical activity and mental health. The researchers discovered that the higher levels of physical activity related with better mental health variables in their study. Improvements in mental health are one way to improve the overall QoL of these group members. Gill & Williams (2008) QoL hierarchy model will be used, with a focus on physical and emotional well-being throughout the program. The groups will be informed of ways in which social, cognitive, and spiritual well-being can enhance QoL as well, however physical and emotional well-being will remain the central focus for the group. The exercise staff will use heart rate to measure physical health improvements, specifically the time it takes for an individual’s exercise heart rate to return to their resting heart rate. Also, group members will be asked to share improvements in mobility at home and in everyday activities as their physical health improves throughout the exercise program. After the initial group discussion on QoL concerns relating to recovery from breast cancer, groups will get together again and discuss coping methods and strategies they use to improve the concerns they have had. Wenzel, Fairclough, Brady, et al (1999) suggest that younger breast cancer survivors may have more diminished QoL due to aggressive forms of chemotherapy and other treatment, compared to older survivors. Older members in the group can help younger members with QoL issues and share their experiences with one another.
CONCLUSION: A group of breast cancer survivors are about to begin an exercise program in order to improve their physical health. Other concerns within the group include QoL after surgery and treatment, which may be different for younger group members. The main QoL issues will be established and group members will get together to discuss the QoL issues they are facing during recovery from treatment and surgery. The exercise program will consist of 20-minute aerobic exercise on a treadmill or stationary bicycle. Following this, the group will be involved with resistance training with weights to improve strength and ability to perform daily tasks that may have been compromised due to surgery or aggressive chemotherapy treatments that left them sedentary. Improvements in physical health will be measured by individual’s changes in return to resting heart-rate levels from exercise heart rates. Improvements to QoL will be assessed in the FACT-B sheet at the end of the exercise program. The research states that higher levels of physical activity seem to improve QoL while reducing stress, anxiety and depression. Therefore, recommendations to continue regular exercise after the program will be given to all participants. At the end of the program, group members will be congratulated by exercise staff for improving physical health and group members will be allowed to share QoL aspects they have seen improvement in through the duration of the program.
Courneya, K.S., Mackey, J.R., Bell, G.J., et al (2003). Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: cardiopulmonary and quality of life outcomes. Journal of Clinical Oncology, 21, 1660-68.
Gill, D. L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd Ed.). Champaign, IL:Human Kinetics.
Wenzel, L.B., Fairclough, D.L., Brady, M.J., et al (1999). Age-related differences in the quality of life of breast carcinoma patients after treatment. Cancer, 86, 1768-74.