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Effects of Exercise on QOL in Women Living with Breast Cancer: A Systematic Review Bicego, Deanna 2006

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Authors: Deanna Bicego, BSc, Kathy Brown, BSc, Moraine Ruddick, BSc, Dara Storey, BSc, Corinne Wong, BSc. Supervisor:  Susan R. Harris, PhD, PT • Literature review- ‘Exercise for Women with or at Risk for Breast Cancer Related-Lymphedema’ •Accepted for publication in October 2006 in Physical Therapy • In 2006, 1 in 9 women will develop breast cancer and 1/3 of them will succumb to the disease • Improved screening has resulted in increased survivorship • More women are coping with the changes that may accompany the disease and its treatment • Quality of life (QOL) is the overall pleasure, comfort and enjoyment in someone’s life • QOL is often affected in women with breast cancer • Improves overall health • Affects mood and QOL To examine the effect of exercise on QOL in women living with breast cancer • Initial Search strategy performed in November 2005 •Electronic databases searched: MEDLINE, EMBASE, CINAHL, PubMed, and PEDro •Keywords: ‘breast cancer’ and ‘quality of life’ or ‘QOL’ and ‘exercise’ or ‘physical activity’ 1)  Females diagnosed with breast cancer 2) Physical activity or exercise 3) Quality of life 4) Standardized QOL measurement tool 5) Randomized control trials (RCT) 6) Published in a peer-reviewed journal 1) They were review articles, descriptive, co- relational, observational or survey studies, unpublished dissertations, or abstracts 2) Physical activity or exercise was related to a person’s occupation, 3) Physical activity or exercise intervention was carried out for less than four weeks, 4) They did not use a standardized QOL outcome measurement tool •Methodological Quality: -van Tulder Criteria List for the Methodological Quality Assessment (2003) •Levels of Evidence: -Centre for Evidence-Based Medicine (CEBM) MEDLINE 79 EMBASE 167 CINAHL 53 410 PubMed 93 PEDro 18 178 232 155 excluded post title and abstract screening 77 71 excluded due to inclusion/ exclusion criteria 3 new alerts included 9 Excluded duplicates 6 •Segal et al. (2001) Structured Exercise Improves Physical Functioning in Women with Stages I and II Breast Cancer: Results of a Randomized Control Trial •Courneya et al. (2003) Randomized Controlled Trial of Exercise Training in Postmenopausal Breast Cancer Survivors: Cardiopulmonary and Quality of Life Outcomes •McKenzie & Kalda (2003) Effect of Upper Extremity Exercise on Secondary Lymphedema in Breast Cancer Patients: A Pilot Study •Headley et al. (2004) The Effect of Seated Exercise on Fatigue and Quality of Life in Women With Advanced Breast Cancer •Mustian et al. (2004) Tai Chi Chuan, health-related quality of life and self- esteem: A randomized trial with breast cancer survivors •Campbell et al. (2005) A pilot study of a supervised group exercise programme as a rehabilitation treatment for women with breast cancer receiving adjuvant treatment •Sandel et al. (2005) Dance and Movement Program improves Quality-of-Life Measures in Breast Cancer Survivors •Ohira et al. (2006) Effects of Weight Training on Quality of Life in Recent Breast Cancer Survivors •Herrero et al. (2006) Combined Aerobic and Resistance Training in Breast Cancer Survivors: A Randomized, Controlled Pilot Trial LEVEL SCORE STUDIES Poor 0-3 n/a Moderate 4-6 McKenzie, Mustian, Campbell, Headley High 7+ Segal, Courneya, Sandel, Ohira, Herrero •Broad range of exercise protocols including: •Aerobic •Resistance training •Gentle arm exercises •Dance and movement therapy •Tai Chi-Chuan •Functional Assessment of Cancer Therapy- Breast (FACT-B) •The Functional Assessment of Cancer Therapy- General (FACT-G) •Satisfaction with Life Scale (SWLS) •Functional Assessment of Chronic Illness Therapy-Fatigue Version IV (FACIT-F) •Medical Outcomes Trust 36- Item Short Form Survey (SF-36) •Cancer rehabilitation evaluation system short form (CARES- SF) •European Organization for Research and Treatment of Cancer Questionnaire (EORTC QLQ-C30) McNeely et al. (2006) ‘Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis’ • Examined the effects of exercise on QOL, fatigue, physical functioning and body composition in women living with breast cancer = • Baseline characteristics noted were age, weight, height, race, education, marital status, stage of disease, treatment type and initial activity level • For the majority, control and intervention groups in each study did not statistically differ •Exception: Headley et al. (2004) and Mustian et al. (2004) • Heterogeneity of Exercise Intervention and QOL outcome measures used • Poor generalizability • Stages of breast cancer • Inability to blind subjects • Small sample sizes • Physical activity and exercise are safe for women with breast cancer to perform •Exercise is consistently found to be a positive predictor of QOL following breast cancer diagnosis and treatment •Most beneficial exercise regime is still unknown due to lack of consensus and the number of studies •Clinicians must remain up to date on current research findings •Special thanks to Susan Harris and the various authors who contributed to our review (1) Canadian Cancer Society. Breast Cancer Statistics. 2006; Available at: s%2Finternet%2Ffrontdoor%2F0%2C%2C3278%5F%5F%5FlangId%2Den%2C00%2Ehtml&site=1&lang =EN&log=28050. Accessed July 12, 2006, 2006. (2) Gosselin C, Taylor A. Exercise as a stress management tool. Stress News 1999;11(4):[1 screen]. Available from:  Accessed July 9, 2006. (3) Schulz KH, Gold SM, Witte J, Bartsch K., Lang U.E., Hellweg R., et al. Impact of aerobic training on immune-endocrine parameters, neurotrophic factors, quality of life and coordinative function in multiple sclerosis. J Neurol Sci 2004;225((1-2)):11-18. (4) McNeely ML, Campbell KL, Rowe BH, Klassen TP, Mackey JR, Courneya KS. Effects of exercise on breast cancer patients and survivors:  a systematic review and meta-analysis. CMJA 2006;175(1):34-41. (5) Herrero F, San Juan AF, Fleck SJ, Balmer J, Perez M, Canete S, et al. Combined aerobic and resistance training in breast cancer survivors: a randomized, controlled pilot trial. Int J Sports Med 2006;27(7):573-580. (6) Ohira T, Schmitz KH, Ahmed RL, Yee D. Effects of weight training on quality of life in recent breast cancer survivors:  the weight training for breast cancer survivors study. Cancer 2006;106(9):2076-2083. (7) van Tulder M, Furlan A, Bombardier C, Bouter L. Updated method guildelines for systematic reviews in the cochrane collaboration back review group. Spine 2003;28(12):1290-1299. (8) Centre for Evidence-based Medicine. 2001; Available at: Accessed November 15, 2005. (9) McKenzie DC, Kalda AL. Effect of upper extremity exercise on secondary lymphedema in breast cancer patients: a pilot study. J Clin Oncol. 2003 Feb 1;21(3):463-466. (10) Courneya KS, Mackey JR, Bell GJ, Jones LW, Field CJ, Fairey AS. Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: cardiopulmonary and quality of life outcomes. J Clin Oncol. 2003 May 1;21(9):1660-1668. (11) Mustian KM, Katula JA, Gill DL, Roscoe JA, Lang D, Murphy K. Tai Chi Chuan, health-related quality of life and self-esteem: a randomized trial with breast cancer survivors. Support Care Cancer 2004 Dec;12(12):871-876. (12) Sandel SL, Judge JO, Landry N, Faria L, Ouellette R, Majczak M. Dance and movement program improves quality-of-life measures in breast cancer survivors. Cancer Nurs. 2005;28(4):301-309. (13) Segal R, Evans W, Johnson D, Smith J, Colletta S, Gayton J, et al. Structured exercise improves physical functioning in women with stages I and II breast cancer: results of a randomized controlled trial. J Clin Oncol. 2001 Feb 1;19(3):657-665. (14) Campbell A, Mutrie N, White F, McGuire F, Kearney N. A pilot study of a supervised group exercise programme as a rehabilitation treatment for women with breast cancer receiving adjuvant treatment. Eur J Oncol Nurs. 2005 Mar;9(1):56-63. (15) Headley JA, Ownby KK, John LD. The effect of seated exercise on fatigue and quality of life in women with advanced breast cancer. Oncol Nurs Forum 2004 Sep;31(5):977-983. (16) Courneya KS. Exercise in cancer survivors: an overview of research. [Review] [69 refs]. Med Sci Sports Exerc. 2003 Nov;35(11):1846-1852. (17) Francis K. Physical activity in prevention and rehabilitation of breast cancer. Crit Rev Phys Rehabil Med. 1996;8(4):323-341. (18) Francis K. Exercise and the breast cancer patient. Ala Med. 1995 Jun;64(12):18-21. (19) Pinto, B M Maruyama,N C. Exercise in the rehabilitation of breast cancer survivors. Psychooncology. 1999;8(3):191. (20) Porzsolt F, Leonhardt-Huober H, Stephens R. Systematic review of the relationship between quality of life and survival in cancer patients. Breast 2001;10(SUPPL. 3):171-181. 


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