Promoting Team-Based Exercise Among African American Breast Cancer Survivors

Physical activity benefits the health and well-being of breast cancer survivors (BCS). Yet, many African American survivors do not routinely exercise and have increased risk of poor outcomes. The purpose of this mixed-method study was to identify motivational factors compelling African American BCS to participate in a 14-week team walking program and to intend to continue exercise after the intervention concluded. Focus groups were held with participants (n = 12) before and after training. Content analysis discovered themes before the intervention: Not wanting to go at it alone, exercise not a life or treatment priority, cancer treatment affected activity, advocates to exercise, and can exercise really help? Four themes postintervention themes included: In the same boat, changed mind-set, improved weight and activity, and overcoming barriers. Physical data verified improvements. Results suggest that a team-based exercise training program may assist in overcoming a sedentary behavior tendency and subsequently improve health among survivors

Survivors Speak: A Qualitative Analysis of Motivational Factors Influencing Breast Cancer Survivors’ Participation in a Sprint Distance Triathlon

Aims and Objectives To examine motivational factors influencing breast cancer survivors to participate in triathlon training, complete a triathlon and maintain an exercise thereafter. Background Routine exercise has been shown to improve quality of life and reduce recurrence for breast cancer survivors. Yet physical and psychological factors present barriers for initiating and maintaining an exercise routine. Research is limited in exploring factors of exercise motivation from the survivor\u27s perspective. Design Qualitative design using focus groups and individual follow-up phone interviews to explore motivation for exercise initiation and maintenance. Methods One to two weeks after completing a triathlon, 11 breast cancer survivors who trained together participated in one of three focus groups to discuss their experience. Five months post triathlon 6 of the 11 participants were successfully contacted and phone interviews were conducted to explore exercise maintenance. Focus groups and interviews were analysed using content and thematic analysis. Results Five themes emerged (1) Champion for Exercise, (2) Part of a Team, (3) Everyone Had a Story, (4) Not Really Exercise and (5) What Do We Do Now? Overall, survivors recognised their need for lifestyle change (e.g. moving from a sedentary lifestyle to a more active one). More importantly, they identified the team approach to exercise initiation was crucial in their success in sustaining a behavioural change. Conclusions Emphasis needed on developing team exercise training programmes for survivors. Nurses can play a critical role in discussing with survivors, the benefits of exercise initiation and maintenance. Relevance to clinical practice Breast cancer survivors are hesitant to initiate routine exercise. Training with women who share a common lived experience increases the likelihood of success. Nurses are in a position to encourage breast cancer survivors to participate in group exercise programmes as a way to improve quality of life

Subtype-associated differences in HIV-1 reverse transcription affect the viral replication

Background: The impact of the products of the pol gene, specifically, reverse transcriptase (RT) on HIV-1 replication, evolution, and acquisition of drug resistance has been thoroughly characterized for subtype B. For subtype C, which accounts of almost 60% of HIV cases worldwide, much less is known. It has been reported that subtype C HIV-1 isolates have a lower replication capacity than B; however, the basis of these differences remains unclear. Results: We analyzed the impact of the pol gene products from HIV-1 B and C subtypes on the maturation of HIV virions, accumulation of reverse transcription products, integration of viral DNA, frequency of point mutations in provirus and overall viral replication. Recombinant HIV-1 viruses of B and C subtypes comprising the pol fragments encoding protease, integrase and either the whole RT or a chimeric RT from different isolates of the C and B subtypes, were used for infection of cells expressing CXCR4 or CCR5 co-receptors. The viruses carrying different fragments of pol from the isolates of B and C subtypes did not reveal differences in Gag and GagPol processing and viral RNA incorporation into the virions. However, the presence of the whole RT from subtype C, or the chimeric RT containing either the polymerase or the connection and RNase H domains from C isolates, caused significantly slower viral replication regardless of B or C viral backbone. Subtype C RT carrying viruses displayed lower levels of accumulation of strong-stop cDNA in permeabilized virions during endogenous reverse transcription, and decreased accumulation of both strong-stop and positive strand reverse transcription products in infected cells and in isolated reverse transcription complexes. This decreased accumulation correlated with lower levels of viral DNA integration in cells infected with viruses carrying the whole RT or RT domains from subtype C isolates. The single viral genome assay analysis did not reveal significant differences in the frequency of point mutations between the RT from B or C subtypes. Conclusions: These data suggest that the whole RT as well as distinct polymerase and connection-RNase H domains from subtype C HIV-1 confer a lower level of accumulation of reverse transcripts in the virions and reverse transcription complexes as compared to subtype B, resulting in a lower overall level of virus replication

Survivors speak: a qualitative analysis of motivational factors influencing breast cancer survivors\u27 participation in a sprint distance triathlon

AIMS AND OBJECTIVES: To examine motivational factors influencing breast cancer survivors to participate in triathlon training, complete a triathlon and maintain an exercise thereafter. BACKGROUND: Routine exercise has been shown to improve quality of life and reduce recurrence for breast cancer survivors. Yet physical and psychological factors present barriers for initiating and maintaining an exercise routine. Research is limited in exploring factors of exercise motivation from the survivor\u27s perspective. DESIGN: Qualitative design using focus groups and individual follow-up phone interviews to explore motivation for exercise initiation and maintenance. METHODS: One to two weeks after completing a triathlon, 11 breast cancer survivors who trained together participated in one of three focus groups to discuss their experience. Five months post triathlon 6 of the 11 participants were successfully contacted and phone interviews were conducted to explore exercise maintenance. Focus groups and interviews were analysed using content and thematic analysis. RESULTS: Five themes emerged (1) Champion for Exercise, (2) Part of a Team, (3) Everyone Had a Story, (4) Not Really Exercise and (5) What Do We Do Now? Overall, survivors recognised their need for lifestyle change (e.g. moving from a sedentary lifestyle to a more active one). More importantly, they identified the team approach to exercise initiation was crucial in their success in sustaining a behavioural change. CONCLUSIONS: Emphasis needed on developing team exercise training programmes for survivors. Nurses can play a critical role in discussing with survivors, the benefits of exercise initiation and maintenance. RELEVANCE TO CLINICAL PRACTICE: Breast cancer survivors are hesitant to initiate routine exercise. Training with women who share a common lived experience increases the likelihood of success. Nurses are in a position to encourage breast cancer survivors to participate in group exercise programmes as a way to improve quality of life

Psychosocial and physiological effects of triathlon training in breast cancer survivors

Exercise is known to improve quality of life and physical function in breast cancer survivors. PURPOSE: The overall objective of this study was to determine the effectiveness of a unique goal-orientated triathlon training program on improving physiological and psychosocial health outcomes on a diverse and overweight female breast cancer survivor patient population. METHODS: Twenty-nine female breast cancer survivors (age= 52(7) yr, BMI =29 (6)) having undergone systemic breast cancer treatment, participated in a 14 wk individualized triathlon training program. Training comprised two supervised group sessions and three home-based sessions per week. The program culminated with participation in a sprint triathlon (Athleta Iron Girl, 0.5 mi swim, 12 mi bike, 3.1 mi run). Pre- and post-training outcome measures included: quality of life (FACT-B), cancer related fatigue (FACIT-F), isokinetic peak knee extensor and flexor torque at 60, 180, and 300 degrees/sec, peak arm flexor and extensor torque at 60, and 120 degrees/sec), six-minute walk test (6MWT), and body composition (bioelectrical impedance). Focus groups were used post-training to assess common themes related to training participation. Analyses were by paired t-tests and Wilcoxon Signed Ranks (questionnaires). RESULTS: Data are mean (SD) from 23 subjects who completed pre and post intervention measurements. FACT-B improved (pre = 115 (14), post = 127 (8), p = 0.001) as did FACIT-F (pre = 41 (10), post = 48 (4), p CONCLUSIONS: Goal oriented triathlon training in breast cancer survivors can improve functional capacity, improve quality of life and lessen fatigue. Feeling like part of a team with a common goal may have facilitated successful participation. Thus, goal-oriented training could lead to better health in breast cancer survivors

“Surgery-chemotherapy-radiation, followed by a different kind of triathlon”: medically directed group exercise program is unique and effective among overweight and obese breast cancer survivors

Background: Structured exercise is a potential adjunct therapy following a cancer diagnosis associated with improvements in treatment-related side effects, including fatigue, deconditioning and quality of life. However, despite published exercise guidelines for cancer patients, breast cancer survivors struggle to initiate regular exercise into their lifestyles, particularly if already overweight or obese. Purpose: To determine if a medically recommended and supervised team triathlon training program focusing on self-efficacy, observational learning and reinforcements improved exercise capacity and quality of life for overweight and obese (body mass index [BMI]: 25-40) breast cancer survivors. Methods: A breast cancer surgeon and cancer rehabilitation physical therapist recruited 18 overweight to obese survivors [mean age: 52(7) years, mean BMI: 32(4)] who underwent local and systemic treatment to participate in a 14-week triathlon training program adjusted for common treatment- related side effects. Training consisted of 2 weekly group sessions supervised by medical and athletic coaches, and 3 days of prescribed activities that patients completed independently or with their peers. The program culminated in an organized sprint-distance triathlon. Quality of life (FACT-B), cancer-related fatigue (FACIT-F), and six-minute walk test (6MWT) were measured pre- and postintervention. Focus groups elucidated motivational factors. Results: 14 patients with complete datasets were compared pre- and postintervention. FACT-B improved [pre: 120(11), post: 128(6); P=0.01]. FACIT-F improved [pre: 42(8), post: 47(5); PConclusion: Medically directed group training of overweight and obese breast cancer survivors with the goal of completing a sprint-distance triathlon is a unique and effective model addressing motivation, endurance and quality of life after treatment