What: As the director of an exercise program for breast cancer survivors, it is up to me to develop a program that improves not only the participant’s physical health, but also their mental health and Quality of Life (QoL). The physical activity will incorporate yoga, tai chi, as well as various aerobic and anaerobic exercises. The participants undoubtedly have experienced great amounts of stress, anxiety, pain, and possibly depression in the recent past; therefore it is imperative for this exercise program to avoid all of these negative aspects of emotion and to promote positive ones in their daily lives.
So What: The overall goal of this program is to use exercise to decrease the amount of stress, anxiety, and depression these breast cancer survivors may be experiencing. Gill and Williams (2008) discuss many different ways that exercise can benefit people mentally, and that those who are physically fit respond less to stress and can prevent injury and illness in the future. Gill and Williams (2008) also mention that physical activity can serve as a coping mechanism in rehabilitation, something that can probably assist most of these breast cancer survivors.
One vital aspect to keep in mind is that emotions vary greatly from person to person. Gill and Williams (2008) point out that “the emotion process is different for everyone, even in the same situation” and that “the importance of individualizing training and intervention is a key element of stress management in addition to the cognitive-psychological skills” (Gill and Williams, p.167). Knowing this, I suggest that it may be very beneficial to address each breast cancer survivor’s plan individually. Each member will still participate in the same general program (using yoga, tai chi, aerobic and anaerobic exercises), but each person will have their program tailored to their own individual differences and needs to benefit them both mentally and physically.
Now What: Gill and Williams (2008) spent the better part of chapter eleven explaining that various forms of physical activity have been shown to benefit people by: decreasing cardiovascular disease, increasing immune function, making someone less responsive to stress, preventing illness and injury, reduces depression following prolonged life stress and reduces anxiety. All of these things would be desirable for anyone, especially someone recovering from breast cancer. Drop out in the early stages would be very detrimental to the cancer patient’s long term health. According to Gill and Williams (2008) “moderate-intensity exercise is likely to make people feel better and thus keep them coming back. On the other hand, if the trainer pushes high-intensity exercise, clients may feel worse and soon drop out” (Gill and Williams, p.169). I feel this is especially true for someone who has already endured great amounts of stress. Knowing this, I would do my best not to overwork any of the patients in the first week or two and possibly observe them to see where they are in terms of strength and endurance.
It is important to remember that the patients are probably at different levels of their recovery, vary in age, athletic ability, and exercise experience. Some patients may have taken part in yoga, tai chi, aerobic and anaerobic exercises before, during and after their cancer so it would be very important to have different levels of these exercise programs available.
It would be at this point where I would sit down with each patient and design a personal program. Visovsky and Dvorak (2005) mention that low intensity aerobics, such as walking or tai chi, have been shown to decrease levels of fatigue in cancer patients. If I observe that certain patients became easily fatigued I would start their program with low intensity aerobics until they exhibited more endurance. On the other hand, if a patient already showed good levels of endurance, they should start with moderate-intensity aerobics as well as various anaerobic exercises. Also, I would assign patients to yoga and tai chi classes based on their how experienced they are at these exercises.
In regards to Quality of Life and physical health, I would expect to see both of these increase over time. QoL, according to Gill and Williams (2008), includes the person’s perceived physical, social, and psychological well-being. The patients may be weak at first due to their cancer treatment, and have low levels of physical well-being. This will hopefully increase due to the anaerobic workout as they build muscle. The social and psychological well-being of the patients will hopefully increase due to not only the workouts themselves, but also from being with other cancer survivors. Courneya et al (2003) conducted a study in which cancer survivors participated in not only ten weeks of exercise, but also group psychotherapy and the results were promising as the participants had significantly higher QoL than did the control group which did not take part in exercising. This suggests that it may be beneficial to have the cancer survivors take part in group therapy with a qualified counselor regularly in addition to regular exercise at the cancer clinic.
Conclusion: In conclusion, there are many factors to think about when designing an exercise program for breast cancer survivors. First off, individual differences vary greatly in regards to emotions, so it is important to design specific programs for each patient in order for them to best benefit both physically and mentally. Secondly, research shows that exercise along with group psychotherapy can be very successful in increasing QoL in cancer survivors; therefore having the patients take part in group therapy would also help their rehabilitation.
Courneya, K. S., Friedenreich, C. M., Sela, R. A., Quinney, H. A., Rhodes, R. E. and Handman, M. (2003), The group psychotherapy and home-based physical exercise (group-hope) trial in cancer survivors: Physical fitness and quality of life outcomes. Psycho-Oncology, 12: 357–374. doi: 10.1002/pon.658.
Gill, D.L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd Ed.).
Champaign, IL: Human Kinetics
Visovsky, V., Dvorak, C. (2005), Exercise and cancer recovery. Online Journal of Issues in Nursing. Kent State University College of Nursing.