Exploring Social Cognitive Theory Constructs for Promoting Exercise Among Breast Cancer Patients

Abstract

Physical activity during breast cancer treatment can significantly reduce treatment-related fatigue and improve quality of life. Unfortunately, the majority of women with breast cancer either do not exercise at all or exercise below recommended levels. Little is known about how to enhance physical activity among breast cancer patients. The social cognitive theory, a useful framework for the design of physical activity interventions, has not been studied among breast cancer patients. Our study purpose was to explore physical activity knowledge, attitudes, and behaviors among breast cancer patients during adjuvant therapy utilizing social cognitive theory constructs in preparation for a larger, survey study and future intervention research. Twelve breast cancer patients attended 1 of 3 focus group sessions. Focus group questions were based on the social cognitive theory constructs of self-efficacy, environment, behavioral capability, expectations, expectancies, self-control and performance, observational learning, and reinforcement. The focus group participants generally felt confident in their ability to exercise during treatment if fatigue, time management, and social networking were addressed. The majority of participants had not been given information related to exercise by their physicians during treatment. The participants felt that exercise was more beneficial than harmful during treatment, with the 2 most important benefits identified as reduced fatigue and the potential for improved survival. The use of reinforcements by participants was minimal. The participants consistently expressed the desire for education and guidance by knowledgeable staff during an exercise program. Walking was the most acceptable exercise modality. Social cognitive theory may be a useful framework for future study of exercise behavior among breast cancer patients and measurement of constructs related to this theory should be included in such studies. Future exercise intervention studies should consider the unique barriers and program preferences of breast cancer patients while focusing on self-efficacy, outcome expectations/ expectancies, observational learning, and reinforcements.

Is bra discomfort a barrier to exercise for breast cancer patients?

“…The most common barriers to exercise for breast cancer patients in the present study included procrastination, a lack of self-discipline, fatigued by exercise, bra discomfort and exercise not being a priority. Apart from the inclusion of bra discomfort, the barriers to exercise for breast cancer patients in the present study were highly comparable to those previously reported in the literature [23]. It is notable that bra discomfort was the first barrier listed in the present study that can be externally influenced, such as via bra design modifications, making it an ideal option for intervention.…”

“…. Perceived benefits and barriers to exercise were assessed using an adapted Exercise Benefits and Barriers Scale incorporating barriers identified in the literature to be specific to breast cancer patients [11,20,23,26], and the inclusion of a question regarding exercise bra comfort.…”

“…It is most likely that a combination of these barriers exist. As such, literature attempting to identify barriers to exercise in this patient population has covered a variety of psychosocial or physical capacity themes [23]. Interestingly, due to the changes which occur to the breast during the disease and treatment, there is scope for the notion of inadequate breast support as a reason female breast cancer patients do not adhere to exercise.…”

Physical Activity and Cancer

“…In terms of favourable attitudes, the majority of cancer survivors appear to be well aware of the potential benefits of engaging in physical activity, and expect physical activity to improve heart/lung functioning, reduce disease risk, build muscle strength, aid weight loss, alleviate stress and improve state of mind (Craike et al, 2011;Rogers et al, 2004Rogers et al, , 2007. Blaney et al (2010) reported that cancer survivors with CRF also recognised that being active is a way of achieving a goal and regaining a sense of normality.…”

“…In contrast, motives are autonomous when the behaviour is inherently pleasurable and valued so that the behaviour will be undertaken without the need for external pressure or incentive, and the cause of the behaviour is perceived as internal. The majority of factors which cancer survivors report as motivating are controlling, such as improved physical functioning, aiding recovery from surgery, increasing self-esteem, social contact, improving body image and weight loss, although some survivors also report that they find physical activity relaxing (Blaney et al, 2010;Craike et al, 2011;Rogers et al, 2004Rogers et al, , 2007Schrop et al, 2007).…”