Breast Cancer

 

ITHACA COLLEGE

Graduate Proposal: Different Intensities of Physical Activity and Their Effects on Breast Cancer Patients hich is the Best! Jessica Borsuk & Smritee Bajracharya 12/7/2011

 

"E#EA"CH P"OPO#AL Introduction

In the $nited #tates% &reast cancer is one of the 'ost co''only occurrin( cancers in )o'en* ithin the year of +,--% +.,%/0, ne) cases and .1%2+, deaths related to &reast cancer )ere report rep orted ed 34atio 34ational nal Cancer Cancer Insti Institut tute% e% +,--5* +,--5* Ho)ever Ho)ever%% death death rates rates fro' fro' &reast &reast cancer cancer have declined steadily since -11,% resultin( in an increase in survivors* The A'erican Cancer society reported in +,--% that there )ere around +*6 'illion &reast cancer survivors in the $nited #tates 3A'erican Cancer #ociety% +,--5* Therefore% preventin( lon(7ter' health7related issues are of a  particular concern for patients )ho survive for 'any years% especially after &reast cancer dia(nosis* Literature Review

The e8haustin( treat'ents that cancer patients endure can often result in a si(nificant decrease in their 9uality of life* The role of physical activity in enhancin( lon(evity in cancer survivors has  &een docu'ented &y 'any studies* indin(s fro' a recent revie) of the effects of e8ercise on  &reast cancer can cer patients and survivors su((est that physical activity is an effective intervention to i'prove 9uality of life% cardio respiratory fitness% physical functionin( and fati(ue 3;c4eely et al*% +,,6< Pasta=ia > ?u'ar% +,--5* ;oreover% studies have found that a (reater level of physical activity is associated )ith i'proved overall survival fro' cancer )ith reduction in reoccurrence rates rates 3A&rah 3A&raha's a'son on et al*% al*% +,,6< +,,6< Pierce Pierce et al*% al*% +,,@5* +,,@5* E8erci E8ercise se 'i(ht 'i(ht theref therefore ore prove to &e valua&le and of (reat i'portance to survivors* ;any studies have loo=ed at the role of physical activity and its relationship to &reast cancer* ?ru= 3+,-,5 loo=ed at intensity and ti'in( in life of recreational physical activity in relation to &reast

 

cancer ris= a'on( pre7 and post'enopausal )o'en and found that )o'en involved in physical activity of any intensity have a reduced ris= of developin( &reast cancer*  Hi(h intensity activities such as

aero&ics% o((in(% resistance trainin( and &icyclin( are all factors that have &een loo=ed at to i'prove ones 9uality of life in &reast cancer survivors 3"o(er L et al*% +,,@< Par= > "ecreation% +,,@< ;cGuire% ;cGuire% alt'an alt'an > i''er'an% i''er'an% +,-,< #'ith > ?ilty% ?ilty% +,-,: De4ysschen De4ysschen % Cho > Dodd% +,--< ?no&f% Inso(na% DiPierto% ennie > Tho'pson% +,,05* In addition% lo) intensity activities have also &een )idely researched* Oclair 3+,,05 reported the i'prove'ent in overall health of &reast cancer patients follo)in( a pilates intervention* #i'ilarly% study perfor'ed &y ;ustia ;us tian% n% ?atual ?atual > hao hao 3+,,65 3+,,65 report reported ed &enefit &enefitss in &reast &reast cancer cancer patien patients ts usin( usin( a tai tai7ch 7chii intervention* #u&tle dancin( has also sho)n to have a positive effect on overall health for &reast cancer survivors 3#andel et al*% +,,25* The use of yo(a has also &een e8tensively docu'ented* o(a )as found to have positive effect on physical% 'ental and spiritual )ell &ein( on patients* 3Aaronson% 3Aaro nson% +,,@< ;cGoni(al% +,,1< Her'an% +,,05* These studies have sho)n to help holistic holistic healin( and i'prove perception of )ell7&ein( in &reast cancer patients* #i'ilarly% a co'&ination of &oth hi(h7intensity and lo)7intensity e8ercise interventions have also &een loo=ed at* ;any have supported the theory that &oth% hi(h7intensity used consecutively )ith lo)7intensity e8ercise )ill help sustain ones health* or instance% studies have sho)n that  patients )ho participated in an intervention that incorporated &oth intensities have reported to sho) sho ) i'pro i'prove' ve'ents ents in physic physical% al% 'ental 'ental and spiri spiritua tuall health health 3Ada's 3Ada'sen en et al*% al*% +,,@< +,,@< Groff% Groff% Batta( Bat ta(lin lini% i% #ipe% #ipe% O?eef O?eefee > Pepperc Peppercorn orn%% +,,1< +,,1< "o(ers "o(ers%% Courney Courneya% a% erhul erhulst% st% ;ar=)el ;ar=)elll > ;cAuley% +,,05* Other studies e'phasiFed the i'portance of physical activity in relation to other conse9uences of  &reast cancer% such as ly'phede'a* This is defined as a &loc=a(e in the one7)ay ly'phatic

 

transport syste' in the affected area caused &y sur(ery or radiation in &reast cancer patient* ;ost studies have sho)n that physical activity has a positive effect on i'provin( 9uality of life and reducin( accu'ulation of e8tracellular fluid  )hich is a result of ly'phede'a* In a study  perfor'ed &y ?i'% #i'% eon( > ?i' 3+,-,5 there )as a si(nificant i'prove'ent in physical and (eneral health in the resistive e8ercise (roup% as co'pared )ith that of the non active resistive e8ercise (roup * This findin( )as also supported &y Bice(o et al*% 3+,,65 and ;cClure% ;cClure% Day > Brufs=y 3+,-,5* In addition% e8ercise has also proven to positively affect the feelin(s of depression and fati(ue* indin(s fro' *; Perna et* al*% 3+,-,5 had noted that a structured intervention that involves e8ercise 'ay&e an effective co'pli'entary treat'ent to i'prove 'ental and physical health in  &reast cancer patients )ith depression* urther% an e8a'ination of intervention at a .7'onth follo)7up revealed a hi(her depression rate in the control (roup 3.@*25 then the intervention (roup 3--*-5* #i'ilar results )ere found on fati(ue and physical activity  the e8peri'ental (roup reported reported reduced fati(ue and an8iety an8iety in co'parison co'parison to the control control (roup in another study  perfor'ed &y atson > ;oc= 3+,,/5* Althou(h 'any studies have reported positive effects 3reducin( ly'phede'a and i'prove'ent in the di'ensions of health such as physical% 'ental and spiritual5 resultin( fro' all intensities of  physical e8ercise 3lo) intensity% hi(h intensity and co'&ination of &oth5 in &reast cancer  patients% they lac= to specify )hich of the three e8ercise intervention pro(ra's is the 'ost effective in i'provin( overall health and )ell7&ein(* Therefore this 9uantitative research paper ai's to ans)er the follo)in( 9uestion* hat is the &est e8ercise intervention pro(ra' 3hi(h intensity% lo) intensity% or co'&ination of &oth5 for patients )ith &reast cancer!

 

ethods!

Prior to initiatin( the different levels of physical activity interventions% our pri'ary step is to o&tain per'ission fro' the hospitals in order to (ain access to &e(in our study at their institutes* "onte#t o$ the study

The hospitals )e )ill try and (ain access to )ill &e Cayu(a ;edical Center 3Ithaca% 45% #t* osephs Hospital 3#yracuse% 45% #tron( ;e'orial Hospital 3"ochester% 45% and "os)ell Par= Cancer Institute 3Buffalo% 45* Sam%in'

Once per'ission is (ranted% )e )ill then )or= )ith the 'edical doctors to advise the' a&out our inclusion criteria for participants to actively enroll in our study* ith their help in selectin( ade9uate% ne)ly dia(nosed patients% )e hope to (ain a )ide array of participants* The sa'plin( techni9ue that )ill &e used is purposive sa'plin(* (artici%ants

 

Inclusion Criteria: •

Gender: e'ale

•

A(e: -0  62 years

•

Ethnicity: ;i8ed race

•

#ta(es of Breast Cancer: I > II ne)ly dia(nosed

•

Level of Physical Activity: J . days a )ee= 

 

E8clusion Criteria •

#t #ta( a(ee of Br Brea east st Canc Cancer er:: II III% I% I% I% > 'etastasis

•

Level of Physical Activity: K . days a )ee= 

•

Other cancers

 

Instrumentation

Each of the four hospitals hospitals )ill &e enrollin( enrollin( +2 patients patients each% )ith a total of -,, participants participants for the )hole study* One of the four hospitals )ill act as a control (roup )hereas the others )ill &e initiatin( the physical activity interventions* Participants )ill &e rando'ly selected fro' the  &reast clinic of each hospital usin( a co'puter &ased pro(ra' called "esearch "ando'iFer "ando 'iFer that )illl help )il help rando' rando'iFe iFe our select selection ion** In additi addition% on% this this resear research ch )ill )ill use a &li &lind7s nd7setu etup p )here )here  participants do not =no) )hich (roup they are in* This )ill help control threats to our study* study* The interventions )ill consist of one hospital only enrollin( patients that )ill en(a(e in hi(h7 intensity physical activity% such as a tread'ill test* Another institute )ill enroll participants for a  pilates class )hich is considered a lo)7intensity physical activity* The last hospital )ill include an intervention that )ill enroll patients for &oth hi(h7intensity 3tread'ill test5 and lo)7intensity 3pilat 3pi lates5 es5 activiti activities* es* The final final hospit hospital al )ill )ill act as a contro controll (roup (roup and follo) follo) the doctor doctors s reco''endations% 'a=in( sure they do not (ive advice on a detailed description of an e8ercise re(i'en that can s=e) our data* Once doctors &e(in to reco''end patients onto this study% initial consent )ill &e received fro' the participant participants* s* ollo)in(% ollo)in(% a &aseline &aseline 9uestionnaire 9uestionnaire that )ill act as a pre7test pre7test and )hich had already &een previously piloted on a sa'ple of +, participants 32hospital5 )ill &e (iven to the  patients to fill out* The 9uestionnaire )ill consist of -2 9uestions &ased on a ,7-, li=ert7scale* The 9uestions )ill &e &ased on the health &elief 'odel in order to identify the constructs of  perceived &arriers% &enefits% severity% suscepti&ility% suscepti&ility% and self7efficacy* Af Afte terr )e rece receiv ivee the the &a &ase seli line ne 9u 9ues esti tion onna nair ire% e% the the pa part rtic icip ipan ants ts )i )ill ll en en(a( (a(ee in a .7 .7'o 'ont nth h intervention in . of the / hospitals* The one hospital )ill continue to follo) the doctors

 

reco''endations and act as a control (roup 3nM+25* Group A 3nM+25 )ill participate in a hi(h7 intensity tread'ill test that )ill ensure they reach their 'a8i'u' heart rate per session * Group B 3nM+25 )ill parta=e in 'ultiple pilates sessions that )ill too 'easure their 'a8i'u' heart rate* Lastly% Group C 3nM+25 )ill ta=e part in &oth% the tread'ill test and pilates sessions* All (roups )ill &e su&ected to a -2, 'inutes of physical activity that is reco''ended &y the A'erican Colle(e of #ports ;edicine 3AC#;5  reco''ended (uidelines for cancer patients 3Tho'pson% Gordon > Pescatello% +,,15* Listed &elo) is an e8a'ple of a )ee=s )orth intervention for all three e8peri'ental (roups*

Group A )ays

;onday

Tuesday

ednesday

Thursday

riday

*i'h+ intensit y trainin'

Tread'ill

Off

Tread'ill

Off

Tread'ill

3)al=in(o((in(5

3)al=in(o((in(5

3)al=in(o((in(5

,ime

6, 'inutes

., 'inutes

6, 'inutes

Group B )ays

;onday

Tuesday

ednesday

Thursday

riday

Low+ intensity trainin'

Pilates

Off

Pilates

Off

Pilates

,ime

6, 'inutes

., 'inutes

6, 'inutes

 

Group C )ays

;onday

"om-inatio n o$ trainin'

Tread'illPilates

Tread'ill

Tread'illPilates

6, 'inutes

.,'in

6, 'inutes

,ime

Tuesday

ednesday

Thursday

3.,'in.,'in5

riday

3.,'in.,'in5

Throu(hout the intervention% there )ill &e three =inesiolo(ists )ho ad'inister the test in order to 'easure the participants 'a8i'u' heart rate* The ?arvonean or'ula 3Tho'pson% Gordon > Pescatello% +,,15 )ill serve as a tool to 'easure the individual participants heart rate reserve at the &e(innin( of the intervention% after 6 )ee=s% and at conclusion of the . 'onths* Before data is collected% each =inesiolo(ist )ill &e evaluated &y &oth principle investi(ators throu(h a pilot test in order to 'a=e sure they re'ain ho'o(enous durin( data o&servation and collection* This )ill help eli'inate the chance of collectin( &ias data% =eepin( all =inesiolo(ists at a neutral stance and practice trian(ulation* Durin( the tread'ill test% all participants )ill &e advised to do a 2 'inute )al= as a )ar'7up reachin( ., to 2, of their 'a8i'u' heart rate &efore the physical activity increases* Once the participant reaches this Fone% they )ill &e advised to increase their heart rate to a 'oderate aero&ic Fone of 2, to @, 3Tho'pson% Gordon > Pescatello% +,,15* They should re'ain in this Fone for the total a'ount of ti'e that the a&ove chart A re9ue re9uests* sts* Group B )ill follo) so'e)hat of a different criteria for their lo)7intensity physical activity in their pilates sessions* Each session )ill re9uire participants to &e )ithin ., to 6, of their

 

'a8i'u' heart rate for the ti'e that it slotted in Chart B 3Tho'pson% Gordon > Pescatello% +,,15* The co'&ination Group C )ill &e advised to stay )ithin 2, to @, durin( their hi(h7intensity  physical activity on the tread'ill for ., 'inutes and convert to a 'a8i'u' heart rate ran(e of ., to 6, durin( the lo)7intense pilates session 3Tho'pson% Gordon > Pescatello% +,,15* The individual =inesiolo(ist on site )ill serve as (uidance if additional help is needed durin( all the interventions* Research )esi'n

Once the intervention is co'plete% )e )ill send a post7test 9uestionnaire to the participants that )ill consist of the sa'e -2 9uestions &ased on a ,7-, li=ert7scale that )as previously done at  &aseline* In addition% the final heart hea rt rate reserve )ill &e ta=en too at the final conclusion of the intervention* Our hope is to loo= at &oth the pre7and post7test and the heart rate reserve statistics of each physical activity intervention to &e a&le to reco''end an e8ercise re(i'en that &est helps &reast cancer patients durin( their survival years*

)ata .naysis

Dependent t7test )ill &e used to assess the difference in the characteristics &et)een the different levels of intervention (roups* urther% repeated 'easures analysis of 'a8i'u' heart rate )ill &e used throu(hout the intervention to assess the participants 9uality of life* aidity and Reia-iity

 

T)o researchers )ill &e used alon( )ith three =inesiolo(ists to ensure trian(ulation throu(hout the study* Participants )ill &e rando'iFed )hen (rouped into separate interventions usin( a &lind setup set up )hich )hich )ill )ill furthe furtherr str stren(t en(then hen our study* study* Alon( Alon( )ith )ith the 9uesti 9uestionna onnaire iress the statis statisti tics cs recorded &y the =inesiolo(ist )ill also &e used for trian(ulation of data* "oncusion

The results of our study can &e very valua&le% as this )ill &e the first study to loo= at all intensities of physical activity a'on( &reast cancer patients and deter'ine the &est intervention for i'provin( lon(evity and 9uality of life*

 References: Aaronson% 4* 3+,,@5* E8ercise for the &reast cancer can cer survivor ! IDEA Fitness Journal  /%  /% /% +17.+* A&raha'son% P* E*% Ga''on% ;* D*% Lund% ;* *% Britton% * A*% ;arshall% #**%  la((% la((% E**% * * * Coates% "* * 3+,,65* "ecreational physical activity and survival a'on( youn( )o'en )ith &reast cancer* Cancer% -,@% -@@@-@02* doi: -,*-,,+cncr*+++,-

 

Ada'sen* L*% Andersenard* C*% ;idt(aard% *% ;oller% T*% ;*% Nuist% ;* > "orth% ;* 3+,,@5* #tru((lin( )ith cancer and treat'ent: youn( athletes recapture &ody control and identity throu(h e8ercise: 9ualitative findin(s fro' a supervised (roup e8ercise pro(ra' in cancer  patients of 'i8ed (ender under(oin( che'otherapy* #candinavian ournal of ;edicine > #cience in #ports% -1% 22766* doi:-,*----*-6,,7,0.0*+,,@*,,@6@*8 A'erican Cancer #ociety% 3+,--5* hat are are the =ey statistics statistics a&out &reast cancer! "etrieved fro' http:)))*cancer*or(CancerBreastCancerDetailedGuide&reast7cancer7=ey7 statistics Bice(o% D*% Bro)n% ?*% "uddic=% ;*% #torey% D*% on(% C*% Harris% " 3+,,65* E8ercise for )o'en )ith or at ris= for &reast cancer related ly'phede'a* Physical Therapy% 06% -.107 -/,2* Cancer patients can &e easily 'otivated to e8ercise 3+,,@5* Par=s > "ecreation /+% 0% ++ De4ysschen% C* A*% Bro)n% * ?*% Cho% Ch o% ;* H*% Dodd% ;*  3+,--5* 4utritional sy'pto' and  &ody co'position outco'es of aero&ic e8ercise in )o'en )ith &reast cancer* Clinical  4ursin( "esearch% +, %-% +17/6% doi: -,*--@@-,2/@@.0-,.@1/,+ Groff% D*% Batta(lini% C*% #ipe% C*% O?eefe% C*% Peppercorn%  3+,,15* Lessons fro' &reast cancer survivors: the role of recreation therapy in facilitatin( spirituality and )ell7&ein(*  )ell7&ein(*  ournal of the Canadian Association for Leisure #tudies% ..%-% ./-7.62 Her'an% #* 3+,,05* Trainin( 3+,,05* Trainin( and teachin( reflection: yo(a for &reast cancer survivors* o(a survivors*  o(a Therapy in Practice %/%.%-67-0

 

?i'% D* #*% #i'% * *% eon(% eon( % *% ?i'% C* 3+,-,5* Effect of active resistive e8ercise on &reast cancer related ly'phede'a: a rando'iFed controlled trial* Arch Phys ;ed "eha&il 1-% -0//7-0/0* doi: -,*-,-6*a'pr*+,-,*,1*,,0*

?no&f% ;* T*% Inso(na% ?*% DiPietro% DiPietro% L*% ennie% ?*% Tho'pson% #* 3+,,05* An aero&ic )ei(ht7 loaded e8ercise intervention for &reast cancer survivors: &one re'odelin( and &ody co'position outco'es* Biolo(ical "esearch for 4ursin(% -,% -% ./7/.* ?ru=% * 3+,-,5* Intensity and ti'in( in life of recreational physical activity in relation to &reast cancer ris= a'on( pre7 and post'enopausal )o'en* ournal of #ports #cience and ;edicine 1% .--7.-1* ;cClure% ;* ?*% ;cClure% "* *% Day% "*% "* % Brufs=y% A* ;* 3+,-,5* "ando'iFed controlled trial of the &reast cancer recovery pro(ra' for )o'en )ith &reast cancer related ly'phede'a* A'erican ournal of occupational therapy% 6/% 217@+* ;cGoni(al% ?* 3+,,15* o(a of a)areness pro(ra' for 'enopausal sy'pto's in &reast cancer survivors: results fro' a rando'iFed trial* Therapy Today% 2%.% ..7./* ;cGuire% "*% alt'an% 4*% i''er'an% L* 3+,--5* Intervention co'ponents pro'otin( adherence to stren(th trainin( e8ercise in &reast cancer survivors )ith &one loss* estern ournal of 4ursin( "esearch% ..% 2% 6@-7601% doi: -,*--@@,-1.1/21-,.@1,,/ ;c4eely% ;* L*% Ca'p&ell% ?* L*% "o)e% B* H*% ?lassen% T* P*% ;ac=ey% * "*% Courneya% ?erry% #* 3+,,65* Effects of e8ercise on &reast cancer patients and survivors: a syste'atic revie) and 'eta7analysis* Canadian ;edical Association ournal% -@2% -% ./7/-*

 

;ustian% ?* ;*% ?atula% * A*% > hao% H* 3+,,65* A pilot study to assess the influence of tai chi chuan on functional capacity a'on( &reast cancer survivors*  #upport Oncolo(y% /:-.1  -/2*

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"o(ers% L*N*% ;ar=)ell% #*% Hop=ins% P* P*% P *% icari% #*% Courneya% ?* #*% HoelFer* ?*% erhulst% #* 3+,--5* "educed &arriers 'ediated physical activity 'aintenance a'on( &reast cancer survivors* ournal of #port > E8ercise Psycholo(y% ..% +% +.27+2/*

#andel% #* L*% ud(e% * O*% Landry% 4*% aria% L*% Ouellette% "*% ;acFa=% ;* 3+,,25* Dance and 'ove'ent pro(ra' i'proves 9uality7of7life 'easures in &reast cancer survivors* Cancer  4ursin(% +0% /% .,-7.,1* #'ith% D*% ?ilty% ?* 3+,-,5* E8ercise psycholo(y: fro' theory to practice* International ournal of #port > E8ercise Psycholo(y 0%-% @71* Tho'pson% * "*% Gordon% 4* *% > Pescatello% L* #* 3+,,15* AC#;s (uidelines for e8ercise testin(* Balti'ore% ;D: Lippincott illia's > il=ins* atson% T*% ;oc=% * 3+,,/5* E8ercise as an intervention for cancer related fati(ue* Ph Physical ysical Therapy% 0/% 0%@.67@/.*