Rethinking Exercise Identity: a Qualitative Study of Physically Inactive Cancer Patients' Transforming Process While Undergoing Chemotherapy

Overview

Journal BMJ Open

Specialty General Medicine

Date 2017 Aug 26

PMID 28838897

Citations 11

Authors

Lis Adamsen

Christina Andersen

Christian Lillelund

Kira Bloomquist

Tom Moller

Affiliations

Soon will be listed here.

Abstract

Objective: To explore physically inactive breast and colon cancer patients' prediagnosis exercise history and attitudes to physical activity (PA) and experiences in initiating PA while undergoing adjuvant chemotherapy.

Design: An explorative qualitative study guided the interpretive analysis of semistructured, open-ended interviews conducted at initiation of chemotherapy and after 12 weeks. The study was embedded in a pilot randomised controlled trial.

Setting: Participants were recruited from the Oncological Department at a hospital in Copenhagen, Denmark.

Participants: 33 patients with cancer, median age 49 years: 25 patients with breast cancer and 8 with colon cancer, 72% with a low cardiac respiratory fitness level and the majority with a high level of education. Patients received adjuvant chemotherapy, oncologist's PA recommendation and exercise, cancer nurse specialist's counselling prior to allocation to PA interventions or waitlist control group.

Results: Prediagnosis exercise had been excluded from patients' daily lives due to perceptions of exercise as boring, lack of discipline and stressful work conditions for both genders. Recommendations from oncologists and nurses inspired the patients to reconsider their attitudes and behaviour by accepting recruitment and participation in PA interventions during chemotherapy. Despite extensive side effects, most patients adhered to their PA commitment due to their perception of the bodily, emotional and social benefits and support of healthcare professionals, peers and family.

Conclusion: The patients' attitude towards exercise transformed from having no priority in patients' daily lives prediagnosis to being highly prioritised. This study identified four important phases in the exercise transformation process during the patients' treatment trajectory of relevance to clinicians in identifying, motivating and supporting physically inactive patients with cancer at long-term risk. Clinicians should address young, highly educated patients with cancer at onset of adjuvant chemotherapy due to their specific risk of a sedentary lifestyle resulting from being in stressful, ambitious careers.

Trial Registration Number: Current Controlled Trials (ISRCTN24901641), Stage: Qualitative results.

Citing Articles

Patient attitudes and experiences towards exercise during oncological treatment. A qualitative systematic review.

Finch A, Benham A Support Care Cancer. 2024; 32(8):509.

PMID: 38992238 PMC: 11239782. DOI: 10.1007/s00520-024-08649-2.

"I have to get up and exercise because that's how I'm going to get over this": a qualitative exploration of exercise identity and behavior in early cancer survivorship.

Roach J, Tabaczynski A, Goodman W, Trinh L Cancer Causes Control. 2024; 35(8):1111-1121.

PMID: 38582809 DOI: 10.1007/s10552-024-01875-3.

Lifestyle counselling as secondary prevention in patients with minor stroke or transient ischemic attack: a randomized controlled pilot study.

Liljehult J, Molsted S, Moller T, Overgaard D, Christensen T Pilot Feasibility Stud. 2024; 10(1):50.

PMID: 38519983 PMC: 10958836. DOI: 10.1186/s40814-024-01478-4.

Qualitative exploration of the perceptions of exercise in patients with cancer initiated during chemotherapy: a meta-synthesis.

Andersen C, Adamsen L, Damhus C, Piil K, Missel M, Jarden M BMJ Open. 2023; 13(12):e074266.

PMID: 38086582 PMC: 10729187. DOI: 10.1136/bmjopen-2023-074266.

The Effect of High-Intensity Interval Exercise on Short-Term Glycaemic Control, Serum Level of Key Mediator in Hypoxia and Pro-Inflammatory Cytokines in Patients with Type 1 Diabetes-An Exploratory Case Study.

Hall B, Zebrowska A, Sikora M, Siatkowski S, Robins A Nutrients. 2023; 15(17).

PMID: 37686781 PMC: 10490106. DOI: 10.3390/nu15173749.

References

Herman D, Ganz P, Petersen L, Greendale G . Obesity and cardiovascular risk factors in younger breast cancer survivors: The Cancer and Menopause Study (CAMS). Breast Cancer Res Treat. 2005; 93(1):13-23. DOI: 10.1007/s10549-005-2418-9. View

Browall M, Mijwel S, Rundqvist H, Wengstrom Y . Physical Activity During and After Adjuvant Treatment for Breast Cancer: An Integrative Review of Women's Experiences. Integr Cancer Ther. 2016; 17(1):16-30. PMC: 5950941. DOI: 10.1177/1534735416683807. View

Fong D, Ho J, Hui B, Lee A, Macfarlane D, Leung S . Physical activity for cancer survivors: meta-analysis of randomised controlled trials. BMJ. 2012; 344:e70. PMC: 3269661. DOI: 10.1136/bmj.e70. View

Ingram C, Wessel J, Courneya K . Women's perceptions of home-based exercise performed during adjuvant chemotherapy for breast cancer. Eur J Oncol Nurs. 2010; 14(3):238-43. DOI: 10.1016/j.ejon.2010.01.027. View

Bourke L, Homer K, Thaha M, Steed L, Rosario D, Robb K . Interventions for promoting habitual exercise in people living with and beyond cancer. Cochrane Database Syst Rev. 2013; (9):CD010192. DOI: 10.1002/14651858.CD010192.pub2. View

Andersen C, Rorth M, Ejlertsen B, Adamsen L . Exercise despite pain--breast cancer patient experiences of muscle and joint pain during adjuvant chemotherapy and concurrent participation in an exercise intervention. Eur J Cancer Care (Engl). 2014; 23(5):653-67. DOI: 10.1111/ecc.12192. View

Schmidt M, Wiskemann J, Ulrich C, Schneeweiss A, Steindorf K . Self-reported physical activity behavior of breast cancer survivors during and after adjuvant therapy: 12 months follow-up of two randomized exercise intervention trials. Acta Oncol. 2017; 56(4):618-627. DOI: 10.1080/0284186X.2016.1275776. View

Lee I, Shiroma E, Lobelo F, Puska P, Blair S, Katzmarzyk P . Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012; 380(9838):219-29. PMC: 3645500. DOI: 10.1016/S0140-6736(12)61031-9. View

Tong A, Sainsbury P, Craig J . Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007; 19(6):349-57. DOI: 10.1093/intqhc/mzm042. View

10.

Bulmer S, Howell J, Ackerman L, Fedric R . Women's perceived benefits of exercise during and after breast cancer treatment. Women Health. 2012; 52(8):771-87. DOI: 10.1080/03630242.2012.725707. View

11.

Hawkes A, Lynch B, Owen N, Aitken J . Lifestyle factors associated concurrently and prospectively with co-morbid cardiovascular disease in a population-based cohort of colorectal cancer survivors. Eur J Cancer. 2010; 47(2):267-76. DOI: 10.1016/j.ejca.2010.10.002. View

12.

Mishra S, Scherer R, Snyder C, Geigle P, Berlanstein D, Topaloglu O . Exercise interventions on health-related quality of life for people with cancer during active treatment. Clin Otolaryngol. 2012; 37(5):390-2. DOI: 10.1111/coa.12015. View

13.

Moller T, Lillelund C, Andersen C, Bloomquist K, Christensen K, Ejlertsen B . The challenge of preserving cardiorespiratory fitness in physically inactive patients with colon or breast cancer during adjuvant chemotherapy: a randomised feasibility study. BMJ Open Sport Exerc Med. 2016; 1(1):e000021. PMC: 5117008. DOI: 10.1136/bmjsem-2015-000021. View

14.

Clausen T, Christensen K, Borg V . Positive work-related states and long-term sickness absence: a study of register-based outcomes. Scand J Public Health. 2010; 38(3 Suppl):51-8. DOI: 10.1177/1403494809352105. View

15.

Shang J, Wenzel J, Krumm S, Griffith K, Stewart K . Who will drop out and who will drop in: exercise adherence in a randomized clinical trial among patients receiving active cancer treatment. Cancer Nurs. 2012; 35(4):312-22. PMC: 3326216. DOI: 10.1097/NCC.0b013e318236a3b3. View

16.

Emslie C, Whyte F, Campbell A, Mutrie N, Lee L, Ritchie D . 'I wouldn't have been interested in just sitting round a table talking about cancer'; exploring the experiences of women with breast cancer in a group exercise trial. Health Educ Res. 2007; 22(6):827-38. DOI: 10.1093/her/cyl159. View

17.

Adamsen L, Andersen C, Midtgaard J, Moller T, Quist M, Rorth M . Struggling with cancer and treatment: young athletes recapture body control and identity through exercise: qualitative findings from a supervised group exercise program in cancer patients of mixed gender undergoing chemotherapy. Scand J Med Sci Sports. 2008; 19(1):55-66. DOI: 10.1111/j.1600-0838.2007.00767.x. View

18.

Oh H, Seo W . Systematic review and meta-analysis of the correlates of cancer-related fatigue. Worldviews Evid Based Nurs. 2011; 8(4):191-201. DOI: 10.1111/j.1741-6787.2011.00214.x. View

19.

Jones L, Haykowsky M, Swartz J, Douglas P, Mackey J . Early breast cancer therapy and cardiovascular injury. J Am Coll Cardiol. 2007; 50(15):1435-41. DOI: 10.1016/j.jacc.2007.06.037. View

20.

Courneya K, Friedenreich C . Relationship between exercise pattern across the cancer experience and current quality of life in colorectal cancer survivors. J Altern Complement Med. 1998; 3(3):215-26. DOI: 10.1089/acm.1997.3.215. View