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 reported 34ational Cancer Institute% +,--5* Ho)ever% death rates fro' &reast 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 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 3A&raha'son et al*% +,,6< Pierce et al*% +,,@5* E8ercise 'i(ht therefore 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% Ao((in(% resistance trainin( and &icyclin( are all factors that have &een loo=ed at to i'prove oneBs 9uality of life in &reast cancer survivors 3"o(er L et al*% +,,@< Par= > "ecreation% +,,@< ;cGuire% alt'an > Ci''er'an% +,-,< #'ith > ?ilty% +,-,: De4ysschen % Cho >

Dodd% +,--< ?no&f% Inso(na% DiPierto% :ennie > Tho'pson% +,,05* In addition% lo) intensity activities have also &een )idely researched* OBclair 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 ;ustian% ?atual > Chao 3+,,65 reported &enefits in &reast cancer patients usin( a tai7chi 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* Do(a )as found to have positive effect on physical% 'ental and spiritual )ell &ein( on patients* 3Aaronson% +,,@< ;cGoni(al% +,,1< Her'an% +,,05* These studies have sho)n to help 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 oneBs health* :or instance% studies have sho)n that patients )ho participated in an intervention that incorporated &oth intensities have reported to sho) i'prove'ents in physical% 'ental and spiritual health 3Ada'sen et al*% +,,@< Groff% Batta(lini% #ipe% OB?eefe > Peppercorn% +,,1< "o(ers% Courneya% Eerhulst% ;ar=)ell > ;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 G )hich is a result of ly'phede'a* In a study perfor'ed &y ?i'% #i'% Heon( > ?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.@*2I5 then the intervention (roup 3--*-I5* #i'ilar results )ere found on fati(ue and physical activity G the e8peri'ental (roup reported reduced fati(ue and an8iety in co'parison to the 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% 4D5% #t* HosephBs Hospital 3#yracuse% 4D5% #tron( ;e'orial Hospital 3"ochester% 4D5% and "os)ell Par= Cancer Institute 3Buffalo% 4D5* 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 G 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 #ta(e of Breast Cancer: III% IE% > 'etastasis Level of Physical Activity: K . days a )ee= Other cancers

Instrumentation Each of the four hospitals )ill &e enrollin( +2 patients each% )ith a total of -,, 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 that )ill help rando'iFe our selection* In addition% this research )ill use a &lind7setup )here participants do not =no) )hich (roup they are in* This )ill help control threats to our 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 3pilates5 activities* The final hospital )ill act as a control (roup and follo) the doctorsB 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 participants* :ollo)in(% a &aseline 9uestionnaire that )ill act as a pre7test and )hich had already &een previously piloted on a sa'ple of +, participants 32Lhospital5 )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% and self7efficacy* After )e receive the &aseline 9uestionnaire% the participants )ill en(a(e in a .7'onth intervention in . of the / hospitals* The one hospital )ill continue to follo) the doctorBs

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&Aected to a -2, 'inutes of physical activity that is reco''ended &y the A'erican Colle(e of #ports ;edicine 3AC#;5 G reco''ended (uidelines for cancer patients 3Tho'pson% Gordon > Pescatello% +,,15* Listed &elo) is an e8a'ple of a )ee=Bs )orth intervention for all three e8peri'ental (roups*

Group A )ays *i'h+ intensit y trainin' ,ime ;onday Tread'ill 3)al=in(LAo((in(5 6, 'inutes Tuesday Off ednesday Tread'ill 3)al=in(LAo((in(5 ., 'inutes Thursday Off :riday Tread'ill 3)al=in(LAo((in(5 6, 'inutes

Group B )ays ;onday Tuesday Off ednesday Pilates ., 'inutes Thursday Off :riday Pilates 6, 'inutes

Low+ Pilates intensity trainin' 6, 'inutes ,ime

Group C )ays "om-inatio n o$ trainin' ,ime ;onday Tread'illLPilates 6, 'inutes 3.,'inL.,'in5 Tuesday ednesday Tread'ill .,'in Thursday :riday Tread'illLPilates 6, 'inutes 3.,'inL.,'in5

Throu(hout the intervention% there )ill &e three =inesiolo(ists )ho ad'inister the test in order to 'easure the participantBs 'a8i'u' heart rate* The ?arvonean :or'ula 3Tho'pson% Gordon > Pescatello% +,,15 )ill serve as a tool to 'easure the individual participantBs 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( .,I to 2,I 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,I to @,I 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 re9uests* 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 .,I to 6,I 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,I to @,I durin( their hi(h7intensity physical activity on the tread'ill for ., 'inutes and convert to a 'a8i'u' heart rate ran(e of .,I to 6,I 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 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 participantBs 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 )hich )ill further stren(then our study* Alon( )ith the 9uestionnaires the statistics 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*

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