Breast Cancer Recovery: Quality of Life and Exercise

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.

REFERENCES:

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.

Cognitive Approaches to Athlete Rehabilitation

WHAT: A volleyball player has just had surgery to repair a torn ACL and will be out of practice for 6-8 weeks.  The athletes main issues are dealing with her injury and how it may affect her future performance and skills as a volleyball player when she returns to practice.  She is aware that the ACL surgery is complex and requires a specific rehabilitation process to help with healing and reconditioning her leg.  She has questions running through her head wondering how she can successfully get through rehab and progress through the re-conditioning with her athletic trainer.  She wonders what the best approaches are for her to complete rehab and be healthy enough to return to practice and play as a volleyball athlete.

SO WHAT:  Having a rehab period of 6-8 weeks with an athletic trainer will require establishing goal setting (mainly short-term) to assure she is able to successfully get through the rehabilitation process.  Gill (2008) examines Locke and Latham’s goal setting model which includes attributes of effective goals.  Of these, specificity, difficulty, and valence are three aspects that can relate to our injured volleyball player.  Our athlete is experiencing a serious injury and recovery from surgery on her ACL, and wants to return to practice as soon as possible. To assure her return to the same athletic level and strength within her leg, she must establish firm and difficult goals throughout her rehab process that will guide her back into practice and play within the 6-8 week time period.  She must think about the progress she wants to seek at the end of each week, such as the strength and mobility of her leg during exercises and daily activity.  According to Naoi (2003), self-talk and home exercise completion in ACL injured athletes had a positive relationship.  The volleyball player needs to practice positive self-talk with herself throughout the rehab process.  Use of self-talk will also help her successfully complete her goals that she sets at the beginning of the rehab process.  If our athlete is having problems coping with the injury overall, we can utilize imagery to help them get through that process.  Gill (2008) shares that Ievleva and Orlick (1991) found imagery helpful with being motivated throughout the rehab process. 

NOW WHAT: Initially, we must find out from our athlete their perception of the injury and what they are thinking as they go into the rehab process.  Obviously, she wants to heal quickly and effectively so she can return to practice and play.  The first objective as the athletic trainer will be to set up short-term goals with our athlete that help guide her through rehab.  Gill (2008) states Weinberg’s goal-setting principles, which include specific, realistic and challenging.  These tie in with Locke and Latham’s model in that goals must be both specific and challenging.  Our athlete must set specific goals that relate to her reconditioning day by day.  Although they are short term goals in rehab, they must be challenging to our athlete to assure that she is ready to return within 6-8 weeks to practice with her teammates.  According to Carson and Polman (2008, p.82), “goal setting was a principle coping strategy used during rehabilitation.”  The first few weeks may involve simple stretches and light weight on machines to help strengthen her leg.  After the initial few weeks, the goals will transition into actual floor movement with the leg and movement that will simulate that of her position in volleyball.  Setting up initial goals for her will give guidance in the rehab process.  In a study by Carson and Polman (2008), self-talk was used as an emotion-focused strategy with a rugby player who had also torn their ACL and was in rehab.  They expressed that using this approach allows the athlete control in their rehab process.  Finally, imagery will be used in the rehab process to help our athlete visualize themselves back on the practice or game court, with a fully rehabilitated knee.  Gill (2008, p.75) states that “imagery can be effective for practicing other psychological skills such as modifying self-talk, practicing concentration, and building confidence.”  Imagery will be practiced when our athlete struggles to use self-talk effectively or if they experience negative self-talk during the rehab process.  Imagery will mainly focus on reflecting on past practice or competitive experiences when the athlete was completely healthy to help give her guidance and also complete goals to regain what she once had.  Imagery will be help her want to accomplish goals and will develop self-talk so that it is always positive.  Once our athlete has fully rehabilitated her knee at the end of the 6-8 weeks, we will congratulate and confirm this to her.  We will encourage continued self-talk and imagery during her initial return to practice.  Goal setting can also continue to be utilized as she returns, assuming that some limitations or adjustments due to the injury may still exist. 

CONCLUSION:  Our volleyball athlete is about to begin her 6-8 weeks of rehabilitation on her knee.  We are aware of the cognitive thoughts and feeling going through her head about her injury and how she believes the rehab process will go.  Once we know how she is feeling, we can begin the rehab process.  We will begin immediately with short-term goal setting as guidance for her through the rehab of her knee.  Research has shown that goal setting is a key factor in athlete rehabilitation.  Throughout our 6-8 weeks, we will also focus on the use of positive self-talk that will assist our athlete in completing her goals and also focusing on returning to practice.  If she struggles with self-talk and begins to have negative self-talk experiences, we will introduce the use of imagery to help adjust self-talk to a more positive aspect and also to help her visualize getting through the rehab process, accomplishing her goals, and ultimately returning to practice after completing rehabilitation.  When her knee is rehabilitated, we will congratulate our athlete and encourage continued use of goal setting throughout her volleyball season, as well as self-talk to guide her back into the season and ability to play as she did before the injury. 

REFERENCES:

Carson, F. & Polman, C.J. (2008). ACL injury rehabilitation: a psychological case study of a professional rugby union player. Journal of Clinical Sport Psychology, 2, 71-90.

Gill, D. L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd Ed.). Champaign, IL:Human Kinetics.

Naoi, A. (2003). The effects of cognitive and relaxation interventions on injured athletes’ mood, pain, optimism, and adherence in rehabilitation. Unpublished doctoral dissertation, West Virginia University, Morgantown, West Virginia. Retrieved September 16, 2010 from http://wvuscholar.wvu.edu:8881//exlibris/dtl/d3_1/apache_media/6598.pdf

Application of Self-Efficacy to Physical Activity

WHAT: Jordan’s doctor has advised her to engage in physical activity to prevent being placed on medication due to increased levels of blood pressure and cholesterol.  Jordan is disappointed that she didn’t continue her physical activity after being a college athlete.  The main issues faced by Jordan include having bad self-perception/concept, and not having self-efficacy to regain her previously held physical activity levels.  In order to be successful with her personal trainer, Jordan must work through these issues she is faced with and build her self-efficacy and self-perception to a level that supports her goals in her personal training program.

SO WHAT: Analysis of Jordan’s scenario shows that she has poor self-efficacy regarding returning to a physically active lifestyle.  Gill (2008) describes Bandura’s self-efficacy theory as a “situation-specific form of self-confidence, or belief that one is competent and can do whatever is necessary to achieve expected outcomes.”  Jordan struggles with believing that she can return to the level of physical activity that she exhibited during her years as a college athlete.  According to Bandura, poor efficacy will affect effort and persistence, which are required for Jordan to succeed with her trainer.  In a review of Bandura’s research, “social-cognitive theory of self-efficacy was particularly useful in explaining physical exercise behavior among older adults in the United States” (Perkins, et al., 2008).  The clear relationship between self-efficacy and physical activity adherence reflects that Jordan has developed poorer self-efficacy since her college years, and therefore now struggles to be physically active.  Jordan’s self-perception seems to be the bigger picture of her disbelief to become physically active again.  Self-efficacy and self-confidence are descriptive explanations within overall self-perception.  Gill explains that self-perceptions include feelings about one’s abilities in a specific domain, such as exercise.  She shows feelings of guilt for neglecting her health and fitness, and isn’t confident in regaining her health and fitness levels she had in her younger years.

NOW WHAT: As Jordan’s personal trainer, it will be important to address her self-efficacy issues and poor self-perception that she is experiencing during the initial personal training meeting.  Jordan feels that because she has let her health and fitness levels go, that she will be unable to regain activity and health levels she had in college.  The use of imagery is one way to help improve Jordan’s self-efficacy and confidence to become physically active again.  As the trainer, ask Jordan to envision herself exercising with the same confidence and competence as she had when she was a collegiate athlete.  Summarizing Bandura’s research on self-efficacy, Perkins (2008) states that “people will choose a course of action based on their expectation about their own ability to perform a given behavior.”  Therefore, if Jordan can imagine and visualize performing a specific exercise or behavior, she will be more likely to adhere to her personal training program and continue staying physically active.  Also, during a new exercise, ask Jordan to imagine herself performing the exercise with the correct posture/form and completing the required repetitions.  Initially, completing training sessions with her personal trainer alone will aid in performance accomplishments, one of six ways of developing efficacy expectations as described by Gill.  Vicarious experiences are another step for development of efficacy, which involves watching another individual model the activity before doing so yourself.  The personal trainer has a great opportunity here to model and show Jordan specific cardiovascular and weight lifting exercises that will improve her health and increase her physical activity level.  Finally, verbal persuasion and self-talk have been shown to increase self-efficacy.  As the trainer, encouraging Jordan to complete a cardiovascular run, or finish the last repetition of an exercise will persuade Jordan to be successful and complete the specific activity she is performing with the trainer.  Self-talk is another way Jordan can be successful with her trainer.  An example of self-talk would be Jordan telling herself she will get through her entire training session without stopping or resting excessively.  Self-talk could also be used during cardiovascular work-outs, where Jordan can tell herself that continuing her work-outs may very well prevent her from going on medications for her health problems she is facing.

CONCLUSION: The analysis of Jordan’s main issues revolves around poor self-perception; specifically the constructs of self-efficacy which relate to self-perception.  Research on self-efficacy and exercise consistently shows positive correlation between the two variables.  When one’s self-efficacy is higher, so is there level of physically active.  Also, those who participate in more vigorous levels of exercise report having higher levels of self-efficacy.  Increasing Jordan’s self-perception and self-efficacy are important to help her be competent in completing a personal training program and increasing her fitness levels.  Bandura’s research on self-efficacy and exercise lays a foundation for how to address the issues Jordan faces.  By working with imagery, self-talk, and having vicarious experiences, Jordan will continue to progress through her personal training sessions and as a result, increase her self-efficacy and self-perception. 

REFERENCES

Gill, D. L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd Ed.).                                               Champaign, IL:Human Kinetics.

Perkins, J.M., Multhaup, K.S., Perkins, W., et al. (2008). Self-efficacy and participation in physical and social activity among older adults in Spain and the United States. The Gerontologist, 48(1), 51-58.