Theoretical Explanation of Upper Limb Functional Exercise and Its Maintenance in Postoperative Patients With Breast Cancer

Abstract

Background: Upper limb functional exercise (ULFE) has a positive effect on promoting the rehabilitation of upper limb function. However, little is known, about what drives postoperative patients to engage in and even maintain the advised exercises. This study integrated the health action process approach (HAPA) and the theory of planned behavior theory (TPB) to investigate the psychosocial determinants on the initiation and maintenance of ULFE in breast cancer patients. In addition, this study also tests key hypotheses relating to reasoned and implicit pathways to ULFE and its maintenance among postoperative patients with breast cancer.Methods: Purposive sampling was used to recruit patients from two breast cancer wards in a provincial hospital in Jiangsu, China. Patients (N = 430) completed self-reported questionnaire about constructs from integrated theories concerning ULFE at an initial time point (T1): task self-efficacy, positive outcome expectations, negative outcome expectations, risk perception, attitude behavior, subjective norm, perceived behavioral control, behavioral intention, and ULFE-in hospital (ULFE-IH). Three months later (T2), patients self-reported: maintenance self-efficacy, action planning, coping planning, recovery self-efficacy, and ULFE-maintenance (ULFE-M).Results: The model has a good fit (GoF = 0.48). For behavioral intention of ULFE, subjective norm (β = 0.35) and perceived behavioral control (β = 0.61) were positively directly related to behavioral intention. Regarding the initiation of ULFE, perceived behavioral control (β = 0.47) and behavioral intention (β = 0.42) had a direct positive relation to ULFE-IH. In the maintenance of ULFE, action planning (β = 0.30), coping planning (β = 0.21), maintenance self-efficacy (β = 0.32), and recovery self-efficacy (β = 0.09) all had significant positive relation on ULFE-M. In addition, maintenance self-efficacy had a significant positive association on action planning (β = 0.80), coping planning (β = 0.74), and recovery self-efficacy (β = 0.67). Coping planning was significantly predicted by behavioral intention (β = 0.07). Additionally, behavioral intention is a mediator of subjective norm (β = 0.14) and perceived behavioral control (β = 0.25) to ULFE-IH. Action planning, coping planning, and recovery self-efficacy are mediators of maintaining self-efficacy to ULFE-M (β = 0.46).Conclusions: This study presents the first attempt to integrate the health behavior model in ULFE in postoperative patients with breast cancer. The study has shown that the HAPA-TPB integrated model has good applicability and effectiveness to explain and predict ULFE initiation and maintenance. Future work can be considered to develop appropriate intervention strategies based on this integrated behavioral theory.

Predictive Model of Functional Exercise Compliance of Patients with Breast Cancer Based on Decision Tree

“…Previous researches are consistent with our outcomes about time after surgery. 4 , 34 , 35 On the one hand, we have shown that with the progression of time and the recovery of upper limb functions, the functional exercise compliance of patients can gradually drop. On the other hand, we have pointed out that at 3 months after surgery, the functional exercise compliance of patients has started to decrease.…”

“…Studies also show that it is necessary for patients with breast cancer to do upper limb functional exercise within 6 months after surgery, so as to promote upper limb functional rehabilitation. 3 , 4 Besides, according to the study of Zhou et al, a better upper limb function recovery through functional exercise might be helpful for health-related quality of life improvement and reduce the chance for post-surgery breast cancer patient populations to experience pain-induced negative psychological states, fatigue, sleep disturbance, as well as upper limb function disabilities during the rehabilitation process. 2 However, Zhang et al, 4 pointed out that the level of compliance with doing upper limb functional exercise was only moderate.…”

“…3 , 4 Besides, according to the study of Zhou et al, a better upper limb function recovery through functional exercise might be helpful for health-related quality of life improvement and reduce the chance for post-surgery breast cancer patient populations to experience pain-induced negative psychological states, fatigue, sleep disturbance, as well as upper limb function disabilities during the rehabilitation process. 2 However, Zhang et al, 4 pointed out that the level of compliance with doing upper limb functional exercise was only moderate. According to the study of Chang et al, functional exercise has been shown effective and beneficial for improving the physical and physiological health outcomes of patients with breast cancer after surgery.…”

Understanding physical exercise among individuals with substance use disorders using an integrated theoretical perspective of the health action process approach and theory of planned behavior

“…The HAPA has also been used in numerous research studies on patients’ physical exercise. Similarly, the HAPA has several limitations; for example, studies have shown that risk perception does not explain the variance of behavior and intention well ( Schwarzer et al, 2007 ; Kaczynski et al, 2008 ; Zhang et al, 2022 ), which means that risk perception is a negligible variable because most exercisers do not necessarily engage in or withdraw from exercise because they perceive the presence of risk. Another limitation is that the HAPA does not include social factors that influence exercise behavior or behavioral intentions ( Chow and Mullan, 2010 ).…”

“…The construction of an integrated HAPA-TPB model could improve the prediction of exercise behavior and clarify the specific roles of each moderating variable. Several researchers have integrated and revised the TPB and HAPA in the context of Chinese culture ( Shen et al, 2010 ) and have been able to better explain the relationships among the variables involved in the various stages of physical exercise behavior among Chinese people ( Zhou, 2014 ; Zhang et al, 2022 ).…”