CORVALLIS, Ore. – More than 40 percent of older breast cancer survivors are insufficiently active after leaving a supervised program. But new research shows that those women who developed behavioral skills such as self-confidence and motivation during their program were far more likely to continue exercising on their own.
Regular exercise may reduce the risk of breast cancer recurrence and breast cancer-related mortality, experts say, making it crucial to effectively target breast cancer survivors who do not engage in regular physical activity for interventions.
Researchers at Oregon State University partnered with researchers at Oregon Health and Science University who had conducted a clinical trial to understand the benefits of a 12-month supervised exercise program in 69 older breast cancer survivors. The goal was to discover what factors influenced participants' ability to follow-through and continue exercising after the supervised program ended.
They found that breast cancer survivors with higher self-efficacy, or confidence to overcome exercise-related barriers (such as being too tired), were far more likely to continue exercising on their own. Those with higher self-efficacy scores were 10 percent more likely to be physically active six months after the intervention than those with lower scores.
The results of the study are published in the October issue of the journal Supportive Care in Cancer. It is the first study to assess predictors of behavior after a supervised exercise program in older breast cancer survivors.
Paul Loprinzi, lead author of the study, was a doctoral student at OSU when he did the research. Loprinzi, who is now a faculty member at Bellarmine University, said the good news is that behavioral skills to increase self-efficacy can be taught.
"We can teach breast cancer survivors how to enlist the support of others and how to identify exercise-related barriers, as well as provide proven strategies for them to overcome those barriers," Loprinzi said.
The researchers said everyone should meet physical activity guidelines – and it can be even more crucial for breast cancer survivors. Loprinzi said exercise helps reduce common side effects of cancer treatment, such as fatigue, depression, decreased muscular strength and weight gain.
"Especially important is minimizing weight gain after breast cancer treatment because excessive weight gain can increase the risk of developing reoccurring breast cancer," he said.
Bradley Cardinal, professor of exercise science at OSU and one of the study's authors, said instructors who administer supervised exercise programs for breast cancer survivors can help by modeling behavior.
"When people who lead the classes are cancer survivors themselves, this can help because they become a role model," he said. "Also, they can help prepare the participants for that time when they have to exercise on their own."
Cardinal said in a past study done at his lab, he found several ways to develop behavioral skills that help people succeed at regular exercise. For instance, "counter-conditioning," or substituting a positive behavior for a problem behavior, such as taking a walk whenever feeling stressed, can be effective.
"In making the transition from group to being on your own, committing yourself by developing an activity schedule and identifying activities that are enjoyable, even signing a 'contract' with a social support partner would be useful," Cardinal said.
Also, having a network of friends, family or providers who provide encouragement and support is also a factor that helps people to stick with exercise.
"Rewarding yourself for small successes and gradually building on that is also important," he said. "It is critical to not expect too much too soon. And fitness instructors and future exercise scientists can help by preparing them before the last day of class on what to expect when they go from that group exercise environment to an individual setting."
In addition, Cardinal said he would like to see policy makers address the issue of support for cancer survivors.
"We know survivors of breast cancer are much more likely to stick with exercise if they have that structured, group support," Cardinal said. "Ideally, it would be great if insurance programs provided for that post-treatment supervised exercise longer than one year. But in lieu of that, we can help them build the skills to continue on their own successfully."
The exercise study which provided data for Loprinzi's publication was funded by the National Institutes of Health by a grant to the study's co-author, Kerri Winters-Stone of OHSU.
Journal
Supportive Care in Cancer