Utilising a Combined Exercise and Counselling Program to Examine the Relationship Between Emotional Self-Efficacy and Physiological Improvements in Breast Cancer Survivors

Breast cancer diagnosis in women has increased in recent years, though medical progress has helped more patients become survivors rather than victims. With cancer diagnosis and treatment, however, comes a host of psychological and physical side effects that must be addressed. Research has found exercise and counselling may decrease the detrimental effects of breast cancer, but programs have typically utilised these modalities separately. As psychosocial issues appear correlated with physical health, it is imperative to examine the mind-body connection and explore the benefits of a combination exercise and counselling program. One psychological variable of interest is emotional self-efficacy, which relates to how capable one is of recognising and regulating emotions and may influence overall well-being and survival. This study explored if participation in such a program improved emotional self-efficacy and physiological health, and if self-efficacy levels correlated with other variables. A 20-week intervention was utilised, consisting of two phases. During the first eight weeks, participants (n=19) were randomised among four groups: exercise-only (Ex; n=5), counselling-only (C; n=5), exercise and counselling (ExC; n=5), or usual care control (UsC; n=4). After these 8 weeks in separate intervention groups, all women were enrolled in exercise and counselling for the remaining 12 weeks of the 20-week study. Emotional self-efficacy and physiological parameters (cardiorespiratory endurance, upper and lower body strength, and flexibility) were assessed at baseline, 8 weeks, and 20 weeks. Non-parametric testing was utilised to examine betweengroup and within-group changes in the variables of interest. Results indicated all groups were balanced at baseline for all parameters except age and radiation treatment. Eight-week findings indicated C, E, and ExC all improved emotional self-efficacy when compared to UsC (p=0.052), with the greatest score improvement observed in ExC (median=17.3). This finding suggests a program utilising both exercise and counselling may be most beneficial for improving selfefficacy. Additionally, both Ex and ExC improved in the physiological variables of interest compared to C and UsC, though only the increase in upper-body strength reached statistical significance (p=0.010). At the end of the 20 weeks, once all participants had undertaken at least 12 weeks of exercise and counselling, no significant differences remained between groups. These results indicate a catch-up effect occurred, with 12 weeks of exercise and counselling sufficient to produce beneficial changes. No correlations were observed between adherence and emotional self-efficacy, while negative correlations were observed between baseline emotional self-efficacy scores and both overall self-efficacy changes and flexibility changes. No adverse effects or new or worsened cases of lymphoedema resulted from participation in the 20-week program. Results from this study suggested combining exercise and counselling benefits both physical and psychosocial parameters, improving emotional self-efficacy more than exercise or counselling alone, with significant improvements achieved in a short time. Additionally, those with low emotional self-efficacy may have the most to gain from such an intervention. Findings from this study increased knowledge on the efficiency of a combined exercise and counselling program on addressing both physical and psychological side-effects of breast cancer. These findings can provide guidance for the implementation of such programs in the healthcare setting. Assisting post-treatment breast cancer patients to strengthen both their minds and bodies may help improve their overall quality of life and, ultimately, survivorship. This thesis is submitted in partial fulfilment of the requirement for the degree of Master of Health Sciences of the University of Notre Dame Australia, Fremantle Campus, School of Health Science

Identifying factors affecting work-integrated learning opportunities in exercise science and exercise physiology

Support from industry professionals is essential to meet the increasing demand for high-quality work-integrated learning (WIL) that forms a core component of university curriculum in various health professions. This qualitative study used an online survey to investigate the current landscape of exercise science and physiology WIL opportunities in Australia, building from a previous 2013 study. Factors were identified from 76 practicum supervisors that restrict and promote willingness to provide WIL opportunities, with recommendations made on how to better support and engage current and future supervisors. Fifteen factors were identified that influenced supervisor WIL engagement, with four factors reported as ‘promote’, six factors reported as ‘restrict’ and five factors identified as promoting and restricting. Using these findings, recommendations were made around five key issues related to supporting sustainable, engaging future WIL opportunities. An update was also provided on status of recommendations resulting from the 2013 research and remaining areas for action

An analysis of exercise science and exercise physiology work-integrated learning supervision in Australia

Currently, 33 Universities in Australia offer exercise science (ES) and/or exercise physiology (EP) programs linked to Exercise and Sports Science Australia (ESSA). Within these programs, work-integrated learning (WIL) is a mandated component for all enrolled students. Paramount to successful delivery of WIL is adequate, competent practicum supervision. This, in turn, is essential to evidence-based practice training and development of work-ready ES and EP students. However, while these industry professionals are key leaders in WIL, there is significant variability in supervisory practice, including experience, training and approach to supervision. This research aims to identify characteristics and demographic profile of supervisors in this setting, as well as capture their experience and perceived needs to better support ES and EP students on WIL placement. It builds on previous research, a report published by researchers from four Australian Universities on the state of EP placement supervision across Australia (Sealey et al., 2013). While this research provided a valuable starting point from which to develop evidence-based support, the industry has since changed and grown exponentially. For example, 4,481 students in 2018 alone commencing an ES, EP or combined degree, making collection of such data imperative to forecast industry ability to provide sufficient WIL and areas for expansion. Additionally, earlier studies did not include ES-related WIL, which is a prerequisite and provides foundation clinical WIL for those students progressing to EP. Survey data collected captured both quantitative and qualitative information to gain a broader perspective of the supervision landscape. This information will provide crucial base-line data of the current WIL environment across Australia and enable the development and delivery of targeted support and training for supervisors, and ultimately the students placed under their leadership

Secondary lymphoedema following cancer: Association with exercise barriers self-efficacy, and benefits of resistance and aerobic-based exercise

This research provides valuable insight into exercise barriers and prescription for individuals with cancer-related lymphoedema, particularly following breast cancer. Findings from this work demonstrate that by identifying and addressing exercise barriers, exercise confidence improves and, as such, enables longer-term exercise participation. Further, the findings demonstrating similar lymphoedema-related and physical and psychosocial benefits are achieved through participation in either resistance- or aerobic-based exercise highlights that exercise programs can be individualised, taking into consideration participants' interests, without jeopardising a woman's recovery and longer-term function, health, quality of life and survival

Exercise barriers self-efficacy: development and validation of a subcale for individuals with cancer-related lymphedema

Background No tool exists to measure self-efficacy for overcoming lymphedema-related exercise barriers in individuals with cancer-related lymphedema. However, an existing scale measures confidence to overcome general exercise barriers in cancer survivors. Therefore, the purpose of this study was to develop, validate and assess the reliability of a subscale, to be used in conjunction with the general barriers scale, for determining exercise barriers self-efficacy in individuals facing lymphedema-related exercise barriers. Methods A lymphedema-specific exercise barriers self-efficacy subscale was developed and validated using a cohort of 106 cancer survivors with cancer-related lymphedema, from Brisbane, Australia. An initial ten-item lymphedema-specific barrier subscale was developed and tested, with participant feedback and principal components analysis results used to guide development of the final version. Validity and test-retest reliability analyses were conducted on the final subscale. Results The final lymphedema-specific subscale contained five items. Principal components analysis revealed these items loaded highly (> 0.75) on a separate factor when tested with a well-established nine-item general barriers scale. The final five-item subscale demonstrated good construct and criterion validity, high internal consistency (Cronbach’s alpha=0.93) and test-retest reliability (ICC=0.67, p< 0.01). Conclusions A valid and reliable lymphedema-specific subscale has been developed to assess exercise barriers self-efficacy in individuals with cancer-related lymphedema. This scale can be used in conjunction with an existing general exercise barriers scale to enhance exercise adherence in this understudied patient group

A multimodal physiotherapy programme plus deep water running for improving cancer-related fatigue and quality of life in breast cancer survivors

The aim of the study was to assess the feasibility and effectiveness of aquatic‐based exercise in the form of deep water running ( DWR ) as part of a multimodal physiotherapy programme ( MMPP ) for breast cancer survivors. A controlled clinical trial was conducted in 42 primary breast cancer survivors recruited from community‐based P rimary C are C entres. Patients in the experimental group received a MMPP incorporating DWR , 3 times a week, for an 8‐week period. The control group received a leaflet containing instructions to continue with normal activities. Statistically significant improvements and intergroup effect size were found for the experimental group for P iper F atigue S cale‐ R evised total score ( d = 0.7, P = 0.001), as well as behavioural/severity ( d = 0.6, P = 0.05), affective/meaning ( d = 1.0, P = 0.001) and sensory ( d = 0.3, P = 0.03) domains. Statistically significant differences between the experimental and control groups were also found for general health ( d = 0.5, P < 0.05) and quality of life ( d = 1.3, P < 0.05). All participants attended over 80% of sessions, with no major adverse events reported. The results of this study suggest MMPP incorporating DWR decreases cancer‐related fatigue and improves general health and quality of life in breast cancer survivors. Further, the high level of adherence and lack of adverse events indicate such a programme is safe and feasible

Workplace movement: a qualitative study on office workers’ beliefs

ABSTRACTObjective Physical inactivity and long hours being sedentary are well documented as behaviours that contribute to ill health. Such behaviours are prevalent among office workers, who are at risk of diseases like metabolic dysfunction, reduced bone mineral density and heart disease. Using a theory of planned behaviour belief-based approach, the current paper qualitatively explores the behavioural, normative and control beliefs held by sedentary office workers towards physical activity within the work environment.Method Participants included 43 full-time office workers, who self-report as having a highly sedentary job and work from either a commercial office, home office, or a combination. The study used a semi-structured interview design following the theory of planned behaviour belief elicitation guidelines, and data analysed using a theoretical thematic analysis approach.Results Participants reported advantages of stress relief, improved focus and productivity and increased positive mood with moving. Disadvantages included feelings of guilt and frustration due to work disruptions from moving more. Mixed reports for others’ approval and disapproval were identified. Office layout was a commonly identified facilitator of workplace movement, with job restrictions identified as a common barrier.Conclusions Findings highlight the importance of workplace culture, organisational support and office layout as key considerations for future interventionalists

A randomized trial on the effect of exercise mode on breast cancer-related lymphedema

Purpose Breast cancer-related lymphedema is a common and debilitating side effect of cancer treatment. This randomized trial compared the effect of progressive resistance- or aerobic-based exercise on breast cancer-related lymphedema extent and severity, as well as participants' muscular strength and endurance, aerobic fitness, body composition, upper-body function, and quality of life. Methods Women with a clinical diagnosis of stable unilateral, upper-limb lymphedema secondary to breast cancer were randomly allocated to a resistance-based (n = 21) or aerobic-based (n = 20) exercise group (12-wk intervention). Women were assessed preintervention, postintervention, and 12 wk postintervention, with generalized estimating equation models used to compare over time changes in each group's lymphedema (two-tailed P < 0.05). Results Lymphedema remained stable in both groups (as measured by bioimpedance spectroscopy and circumferences), with no significant differences between groups noted in lymphedema status. There was a significant (P < 0.01) time-group effect for upper-body strength (assessed using four to six repetition maximum bench press), with the resistance-based exercise group increasing strength by 4.2 kg (95% confidence interval [CI] = 3.2-5.2) postintervention compared with 1.2 kg (95% CI = -0.1 to 2.5) in the aerobic-based exercise group. Although not supported statistically, the aerobic-based exercise group reported a clinically relevant decline in number of symptoms postintervention (-1.5, 95% CI = -2.6 to -0.3), and women in both exercise groups experienced clinically meaningful improvements in lower-body endurance, aerobic fitness, and quality of life by 12-wk follow-up. Discussion Participating in resistance- or aerobic-based exercise did not change lymphedema status but led to clinically relevant improvements in function and quality of life, with findings suggesting that neither mode is superior with respect to lymphedema effect. As such, personal preferences, survivorship concerns, and functional needs are important and relevant considerations when prescribing exercise mode to those with secondary lymphedema

Identifying factors affecting work-integrated learning opportunities in exercise science and exercise physiology

Support from industry professionals is essential to meet the increasing demand for high-quality work-integrated learning (WIL) that forms a core component of university curriculum in various health professions. This qualitative study used an online survey to investigate the current landscape of exercise science and physiology WIL opportunities in Australia, building from a previous 2013 study. Factors were identified from 76 practicum supervisors that restrict and promote willingness to provide WIL opportunities, with recommendations made on how to better support and engage current and future supervisors. Fifteen factors were identified that influenced supervisor WIL engagement, with four factors reported as 'promote', six factors reported as 'restrict' and five factors identified as promoting and restricting. Using these findings, recommendations were made around five key issues related to supporting sustainable, engaging future WIL opportunities. An update was also provided on status of recommendations resulting from the 2013 research and remaining areas for action. © 2023 International Journal of Work-Integrated Learning. All rights reserved

Cancer-related fatigue stratification system based on patient-reported outcomes and objective outcomes: A cancer-related fatigue ambulatory index.

Although breast cancer mortality is decreasing, morbidity following treatment remains a significant issue, as patients face symptoms such as cancer-related fatigue (CRF). The aim of the present study is to develop a classification system that monitors fatigue via integration of an objective clinical assessment with patient self-report. Forty-three women participated in this research. Participants were post-treatment breast cancer survivors who had been surgically treated for their primary tumour with no evidence of neoplastic disease at the time of recruitment. Self-perceived fatigue was assessed with the Spanish version of the Piper Fatigue Scale-Revised (R-PFS). Objective fatigue was assessed by the 30 second Sit-to-Stand (30-STS) test. Confirmatory factor analysis was done with Maximum Likelihood Extraction (MLE). Internal consistency was obtained by Cronbach's α coefficients. Bivariate correlation showed that 30-STS performance was negatively-inversely associated with R-PFS. The MANOVA model explained 54.3% of 30-STS performance variance. Using normalized scores from the MLE, a classification system was developed based on the quartiles. This study integrated objective and subjective measures of fatigue to better allow classification of patient CRF experience. Results allowed development of a classification index to classify CRF severity in breast cancer survivors using the relationship between 30-STS and R-PFS scores. Future research must consider the patient-perceived and clinically measurable components of CRF to better understand this multidimensional issue