The Contribution of Dragon Boat Racing to Women's Health and Breast Cancer Survivorship

Abstract

Survivorship is one of the least studied and thus least understood aspects of a breast cancer experience. Defined as a life-long, dynamic process, survivorship begins when people have completed medical treatment for breast cancer, yet live with the memories of their treatment and the possibility of a cancer reoccurrence. The numbers of women surviving breast cancer are growing, which means research on survivorship is imperative. In this article, I examine dragon boat racing (DBR) for breast cancer survivors. DBR has been adapted to a woman-centered, community-based leisure pursuit focused on life after medical treatment for breast cancer. Active interviews with 11 participants revealed that DBR contributes to women's social, emotional, physical, spiritual, and mental health. In turn, feeling healthy in these five dimensions enhanced the women's survivorship of breast cancer. The findings demonstrate the roles of leisure in the health and well-being of women who are breast cancer survivors.

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Qualitative Health Research
DOI: 10.1177/1049732307312304
2008; 18; 222 Qual Health Res
Diana C. Parry
The Contribution of Dragon Boat Racing to Women's Health and Breast Cancer Survivorship
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222
The Contribution of Dragon Boat Racing to
Women’s Health and Breast Cancer
Survivorship
Diana C. Parry
University of Waterloo, Waterloo, Ontario, Canada
Survivorship is one of the least studied and thus least understood aspects of a breast cancer experience. Defined as a
life-long, dynamic process, survivorship begins when people have completed medical treatment for breast cancer, yet
live with the memories of their treatment and the possibility of a cancer reoccurrence. The numbers of women sur-
viving breast cancer are growing, which means research on survivorship is imperative. In this article, I examine
dragon boat racing (DBR) for breast cancer survivors. DBR has been adapted to a woman-centered, community-
based leisure pursuit focused on life after medical treatment for breast cancer. Active interviews with 11 participants
revealed that DBR contributes to women’s social, emotional, physical, spiritual, and mental health. In turn, feeling
healthy in these five dimensions enhanced the women’s survivorship of breast cancer. The findings demonstrate the
roles of leisure in the health and well-being of women who are breast cancer survivors.
Keywords: breast cancer; feminism; leisure pursuits; quality of life; medicalization; women’s health; survivorship;
healing
B
reast cancer remains the most frequently diagnosed
cancer in North American women. Within Canada
alone, an estimated 22,300 women will develop breast
cancer in 2007 (Canadian Breast Cancer Foundation,
2007). Breast cancer is perceived as fatal (Kearney,
2006), but women are increasingly surviving the life-
threatening disease. That is, mortality rates are at their
lowest since 1986, as the 5-year survival rate for breast
cancer is approximately 76% (Oh et al., 2004). These
statistics demonstrate that although breast cancer is a
serious health issue for many North American women
and others around the world, so, too, is survivorship.
Defined as a life-long, dynamic process, survivorship
begins when people have completed medical treatment
for breast cancer yet live with the memories of their
treatment and the possibility of a cancer reoccurrence
(Pelusi, 1997; Thomas-MacLean, 2004). Even though
survivorship is considered the most important outcome
of a breast cancer experience, it is one of the least stud-
ied and thus least understood aspects of the disease.
Toward this end, Thomas-MacLean (2004) argued,
“The growing population of breast cancer survivors
affirms that research on [survivorship]...is imperative”
(p. 628).
The purpose of this study was to address the gap in
literature on survivorship through an examination of a
leisure pursuit, namely, dragon boat racing, for breast
cancer survivors. Dragon boat racing has been adapted
as a woman-centered, community-based leisure pursuit
focused on life after medical treatment for breast can-
cer. Although dragon boat racing has been identified
anecdotally by many women with breast cancer as a
key factor in their survivorship, scant research has
explored the broad health benefits of the pursuit or how
it might positively contribute to survivorship. Thus,
this study sought to understand how participation
in dragon boat racing contributes to women’s health,
broadly defined, throughout their lived experiences
with survivorship.
Literature Review
Dragon boat racing originated in China, where drag-
ons are a symbol of guardians against evil spirits (Sofield
& Sivan, 2003). No longer limited to China, dragon boat
racing currently boasts international participation with
Qualitative Health Research
Volume 18 Number 2
February 2008 222-233
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Author’s Note: Correspondence concerning this article should
be sent to Diana C. Parry, Department of Recreation and Leisure
Studies, University of Waterloo, 200 University Avenue, Waterloo,
ON, Canada N2L 3G1; e-mail: dcparry@healthy.uwaterloo.ca.
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both competitive and recreational teams. The sport of
dragon boat racing involves the “strenuous, repetitive
upper body activity of 18 to 20 paddlers propelling a 40-
60 foot craft along a race course of 500 to 650 meters”
(Harris & Niesen-Vertommen, 2000, p. 95). The bow of
the boat is carved into the form of a dragon and partici-
pants paddle in unison to the rhythm of a drummer
(McNicoll & Doyle, in press). “To achieve high racing
speeds,” Unruh and Elvin (2004) explained, “the blade of
the paddle must hit the water in a horizontal position with
a quick, backward pull, an action that requires consider-
able trunk and upper extremity muscle strength” (p. 139).
A well trained and experienced team has a rate of
approximately 70 to 80 strokes per minute, which is an
impressive accomplishment given that boats weigh up to
2,250 kilograms when fully loaded with participants
(Unruh & Elvin, 2004).
“Abreast in a Boat,” located in British Columbia,
Canada, was the first team of dragon boat racers for
breast cancer survivors. The pursuit originated with a
small research project designed to study the impact of
paddling on lymphedema (McKenzie, 1998). At the end
of the study, which concluded dragon boat racing did
not increase lymphedema, the team was expected to
disband. The participants, however, were so enthusias-
tic about their involvement, that the team continued to
paddle. Moreover, the participants talked to others
about their involvement in dragon boat racing. Word
spread throughout the breast cancer community, initiat-
ing a social movement as participation rates in dragon
boat racing for survivors climbed across Canada and
the world. Thus, what started as a small, empirical
study has grown to include 93 dragon boat racing teams
for breast cancer survivors worldwide, including
Canada, the United States, Australia, China, England,
Italy, Malaysia, New Zealand, Poland, Singapore, and
South Africa. Worldwide, the pursuit seems popular
because dragon boat racing is open to all survivors who
are 6 months posttreatment and attracts women of all
ages, including women from underserved ethnocultural
groups. Training for dragon boat racing can take place
on a lake, river, or pool, and can involve dryland train-
ing, making it accessible to urban and rural women
alike. Training for dragon boat racing takes place year-
round and thus requires an ongoing commitment to the
team (Mitchell & Nielsen, 2002). Corporate sponsor-
ship and fund-raising frequently offset the financial
burden of participation. If dragon boat racing is shown
to provide a range of health benefits, it could be an
important component of survivorship for many breast
cancer survivors.
Although dragon boat racing for breast cancer sur-
vivors has the potential to affect various components of
health, previous research has focused on its physiolog-
ical benefits. Harris and Niesen-Vertommen (2000)
studied exercise-induced lymphedema following breast
cancer. Physiotherapists, health professionals, and sur-
geons had previously warned women who had had aux-
iliary lymph nodes removed for the management of
breast cancer to avoid vigorous, repetitive, or excessive
upper body exercise, believing such activity would
induce lymphedema (Bogan, Powell, & Dudgeon,
2007). In addition to the original study by McKenzie
(1998), mentioned above, the study by Harris and
Niesen-Vertommen also showed that dragon boat rac-
ing did not induce lymphedema. A more recent study
(Warburton et al., 2004) demonstrated the physiological
benefits of dragon boat racing for transplant patients.
Moreover, dragon boat racing has been studied with
respect to exercise adherence demonstrating the
physiological benefits of regular exercise for breast
cancer patients (Courneya, Blanchard, & Laing,
2001). Taken together, these studies reveal that
much of the research on dragon boat racing has
demonstrated its physiological benefits, whereas
scant research has examined how this leisure pursuit
addresses other health benefits relevant to breast can-
cer survivorship. Consequently, despite the popular-
ity of this leisure pursuit for breast cancer survivors,
little is known about the broader health benefits of
participation in dragon boat racing.
Closely linked to the need for studies on a wider
range of health benefits is the lack of research exam-
ining dragon boat racing from a survivor’s standpoint.
Bredin (1999) noted the paucity of research on breast
cancer directly quoting women affected by the dis-
ease. In so doing, Bredin stated the need for research
focused on a woman’s private perspective and results
presenting a woman’s own words. Similarly, Loveys
and Klaich (1991) argued women’s experiences with
breast cancer need to be studied as women describe
them, as opposed to following traditional or standard-
ized models of research. Perhaps Thomas-MacLean
(2004) summed up this perspective best when she
noted that much can be learned from women speak-
ing directly about their own experiences with breast
cancer. Undoubtedly, there is a need for research, not
only on the broad health benefits of dragon boat rac-
ing for breast cancer survivors, but from a woman’s
private and personal perspective.
In one of the few studies examining the psychosocial
impacts of dragon boat racing for breast cancer
Parry / Contribution of Dragon Boat Racing 223
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224 Qualitative Health Research
survivors, Mitchell and Nielsen (2002) demonstrated
the positive influence of dragon boat racing. More
specifically, these researchers studied the meaning and
psychological impact of dragon boat racing for breast
cancer survivors in a qualitative study with two teams
in Ontario, Canada. Their research identified the posi-
tive influence of dragon boat racing on the psychologi-
cal recovery from the fear associated with diagnosis
and treatment for breast cancer. Specifically, Mitchell
and Nielsen found “all of the participants spoke of
increased physical and emotional health, and a sense of
aliveness, of living life to the limits” (p. 56). Similarly,
Unruh and Elvin (2004) conducted a qualitative study
with three women involved in dragon boat racing for
breast cancer survivors. Their research also showed that
dragon boat racing enhanced the physical and emo-
tional well-being for participants and “was a positive
medium through which women promote an energizing
approach to life after a diagnosis of breast cancer”
(Unruh & Elvin, 2004, p. 148).
These studies make a significant contribution to
scholarship. First, both studies demonstrated that
dragon boat racing can be a meaningful and powerful
component of survivorship that serves to positively
affect physical and emotional health. Second, both
studies utilized qualitative research designs establishing
the appropriateness of qualitative methods for expand-
ing knowledge in breast cancer research. Although
these studies represent an important first step in demon-
strating the value and health benefits of dragon boat
racing for breast cancer survivors, both projects were
small pilot studies with a total of 9 participants from
three of the 18 different dragon boat teams in Ontario.
Moreover, both pilot studies were limited to studying
physical and emotional health, which means there
remains a paucity of research that has explored how
dragon boat racing might positively affect other com-
ponents of health, including social and spiritual well-
being. Based on the limitations of their study, Mitchell
and Nielsen (2002) concluded,
Further investigation of the findings of psychosocial
impact is needed with a larger sample of dragon
boaters....Further research is required to test the
hypothesis that dragon boating as a team sport pro-
vides a powerful communal context to engage in
adult play while enhancing the physical and emo-
tional health of breast cancer survivors. (pp. 56-57)
Unruh and Elvin (2004) echoed the need for further
research into dragon boat racing in their concluding
remarks but also noted the valuable role of participation
in leisure pursuits as a coping mechanism for stressful
life events, such as breast cancer. Leisure is defined as
those experiences that are freely chosen, pleasant in
anticipation, experience, or recollection, and that are
intrinsically motivating (Iwasaki, 2003; Kelly, 1996;
Mannell & Kleiber, 1997). Previous research has
demonstrated that leisure pursuits, experiences, and sat-
isfactions play an important role in promoting health
and maintaining well-being in daily life. A considerable
body of research suggests that exercise or physically
active leisure has numerous health benefits for the pop-
ulation in general, including improved cardiovascular
health and reduced risk of diabetes and osteoporosis
(Bouchard, Shephard, & Stephens, 1994; Bouchard,
Shephard, Stephens, Sutton, & McPherson, 1990).
Apart from these physical health benefits, leisure in gen-
eral, whether physically active or not, is also believed to
be beneficial in other ways. In particular, leisure is
thought to lead to improved psychological well-being
through such mechanisms as stress reduction, improved
mood, and increased self-esteem (Driver, Brown, &
Peterson, 1991; Iwasaki & Schneider, 2003; Mannell &
Kleiber, 1997). Some of the positive outcomes that have
been associated with leisure participation are especially
relevant to women who are survivors of breast cancer,
including the role of leisure in the promotion of self-
determination, a sense of personal entitlement, and
resistance to prescribed gender roles (Freysinger &
Flannery, 1992; Henderson & Bialeschki, 1991; Shaw,
2001). Leisure has also been found to positively enhance
spiritual well-being (Heintzman & Mannell, 2003) and
to reduce anxiety (Szabo, 2003). Moreover, Henderson
and Ainsworth (2002) stated the connection between
leisure and health is manifested through involvement
in enjoyable and meaningful activity, which is particu-
larly relevant to dragon boat racing for breast cancer
survivors.
Despite the research into leisure outcomes and bene-
fits, there has been relatively little research on the effect
of leisure participation on women’s health throughout
the course of an illness. Insel and Roth (2006) argue
that holistic conceptualizations of health, including
physical, psychological, social, and environmental
attributes, work together along with a woman’s personal
characteristics and social world to determine and man-
age her personal health and well-being. Research that
has examined the role of leisure in women’s psychoso-
cial health from a holistic perspective suggests leisure
plays a powerful and positive role in women’s health
encounters. For example, Parry and Shaw (1999)
explored the roles of leisure in women’s experiences of
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Parry / Contribution of Dragon Boat Racing 225
menopause and mid-life. They found physically active
leisure enhanced health through physical and emotional
well-being. In addition, some leisure activities provided
women with a sense of familiarity, security, and conti-
nuity, yet other practices allowed women to develop new
interests, to focus on themselves, and to improve their
self-attitudes. Finding an appropriate balance among
these pursuits helped women negotiate their journey
through the transitional years of menopause and midlife.
Similarly, Parry (2005) demonstrated how leisure is a
source of empowerment throughout women’s experi-
ences with infertility, thereby facilitating a sense of well-
being and positively enhancing women’s quality of life.
Although limited in number, these studies suggest the
relevance of leisure pursuits, experiences, and satisfac-
tions to women’s psychosocial health throughout a neg-
ative health experience.
Perhaps most surprising is the lack of research on the
relationship between leisure and breast cancer. Breast
cancer has generated a large and significant body of
research on the medical aspects of the disease, includ-
ing its causes, diagnosis, treatment options, and preven-
tative measures (Boston Women’s Health Collective,
2005). Nonmedical aspects of the disease have also
been studied. For example, previous research has
explored the psychosocial aspects of breast cancer,
including topics such as the personal impact of chemi-
cally induced menopause (Carter, 1997), quality of life
throughout medical treatments (Roberts et al., 2006),
emotional and psychological suffering (Polinsky,
1994), and psychosocial adjustment to breast cancer
(Dow & Lafferty, 2000). Although some research on
the nonmedical aspects of breast cancer makes passing
reference to leisure pursuits, “these studies do not focus
on or provide a clear understanding of the leisure expe-
riences or choices of women living with breast cancer”
(Shannon & Shaw, 2005, p. 196). Shannon and Shaw
(2005) studied the ways that breast cancer alters a
woman’s leisure experiences and choices post-treatment.
Their research demonstrated that as a result of breast
cancer, leisure is more meaningful and a new priority in
life. Moreover, Shannon and Shaw found leisure is a
context in which women who are survivors of breast
cancer seek out health-promoting activities. Clearly, the
psychosocial health benefits of dragon boat racing, a
popular leisure pursuit for breast cancer survivors, war-
rants further investigation. A review of the literature
demonstrates the need for research on the roles of leisure,
namely, dragon boat racing, and survivors’ psychosocial
health from a holistic and personal perspective—a gap
addressed by the current study.
Theoretical Framework
Because all “illness experiences are mediated by
gender” (Klawiter, 2004, p. 851), feminist theory pro-
vided the guiding theoretical framework in the current
research. Although a variety of feminist epistemologies
exists (Thompson, 1992), like many feminist scholars,
I sought to “enhance the voices of women who have
been overlooked in previous...research” (Ambert,
Adler, Adler, & Detzner, 1995, p. 882). Similar to
Thompson (1992), I agree that
(a) all inquiry is value-sustaining, and feminist work is
politicized inquiry; (b) separation between researcher
and researched does not ensure objectivity, and a closer
connection between the two may reconcile objectivity
and subjectivity; (c) women’s experience can be con-
sidered a source and justification of knowledge; and
(d) there may be no such thing as truth and objectivity.
(p. 9)
In sum, the feminist epistemology I adopted was
underpinned by a philosophical framework in which
there was a desire to focus on the voices of research
participants from a holistic perspective, taking into
account the broader social and cultural context of their
lives. Moreover, I was concerned that the research
process enabled women to speak with their own voices
and explain their own experiences. In addition, I was
concerned that the research process facilitate personal
empowerment and positive social change, as well as
improved theoretical understanding (Parry & Shaw,
1999).
Methods
Applying this theoretical framework to the proposed
study led to the adoption of in-depth, face-to-face
active interviews. Active interviews are conversational
in nature and allow for open-ended questions about the
details of women’s everyday lives after medical treat-
ment for breast cancer and their participation in dragon
boat racing. As part of the conversational nature of
the active interviews, a dynamic interplay between
researchers and respondents is fostered (Dupuis,
1999). In this way, the active interviews enabled emer-
gent ideas to be probed and followed-up on. Thus,
active interviews created a space where the women
could share their own experiences with breast cancer
survivorship and dragon boat racing (Kaufman,
1992). Accordingly, “knowledge was generated
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226 Qualitative Health Research
through dialogue, listening, and talking” (Thompson,
1992, p. 10). The generation of knowledge through
active interviews was important because “women
speaking for themselves, about their own experiences,
can contribute much knowledge about the complexity
of life after breast cancer” (Thomas-MacLean, 2004,
p. 629).
Participants for the study were recruited through a
dragon boat racing team located in a large city in
Southern Ontario, Canada. Members of the dragon boat
racing team were sent an information letter about the
study and were encouraged to contact me through
e-mail or the telephone if they wished to participate.
A total of 11 people volunteered for the study. The
interviews lasted between 1 and 2 hours. They were
arranged for a day, time, and place that were convenient
for the participants. One participant asked to be inter-
viewed at a coffee shop, whereas the others asked to be
interviewed in their homes.
Although the interview process was flexible, each
participant was first asked a question regarding diag-
nosis and treatment for breast cancer because I real-
ized from previous research that it would “be difficult
for women to share their current experiences without
first addressing diagnosis and treatment” (Thomas-
MacLean, 2004, p. 631). Participants were also asked
broad questions about the links between dragon boat
racing and their physical health (i.e., What are some
of the physical rewards of participation in dragon
boat racing?), emotional health (i.e., What are some
of the emotional benefits you notice from dragon boat
racing?), social health (i.e., How has dragon boat rac-
ing contributed to your sense of social well-being?),
and spiritual health (i.e., How does dragon boat rac-
ing contribute to the meaning of your life?). Other
topics of conversation included where/how women
gained information about dragon boat racing (i.e.,
How did you hear about dragon boat racing for breast
cancer survivors?), factors that affect the decision to
join or not (i.e., How did you decide to get involved
in dragon boat racing?), and motivations and expec-
tations for participation, and barriers, if any, that pre-
vent participation (i.e., What did you expect to get out
of the experience? Did anything make your decision
to get involved with dragon boat racing difficult?).
Many women discussed the importance of dragon
boat racing in their lives and the social context of
each woman’s involvement in dragon boat racing.
My procedures for collecting, analyzing, and storing
data were approved by the appropriate institutional
review board. More specifically, to ensure confidential-
ity, I received written consent from each participant to
tape-record the interviews and to use anonymous quo-
tations in any article or report stemming from the inter-
view. In addition, each participant was informed that a
paid transcriptionist would transcribe the interview and
none objected to this process. To keep the data confi-
dential, each participant was assigned a pseudonym and
all other identifying information (including names of
partners, family members, friends, doctors, nurses) was
changed in any written document. Finally, the data and
field notes were stored in a locked cabinet in my office,
which, again, was approved by each participant in the
study.
Data Analysis
The data were analyzed through the constant com-
parison method (Glaser & Strauss, 1967). That is, the
data were coded inductively, and each segment of the
data was compared to other categories and other seg-
ments of data within the same category. This helped
to ensure relevance and consistency and allowed for
new categories and relationships to develop as appro-
priate. Specifically, each interview transcript was first
analyzed using open categories to develop initial
descriptive categories, such as physical rewards of
dragon boat racing. Axial coding was then used to
compare categories both within and between inter-
views and to look for emerging conceptual themes.
Subsequently, patterns of relationships among themes
were also examined. Consistent with the constant
comparison method, the data analyses and coding
processes proceeded simultaneously with the data
collection process. In this sense, the process was itera-
tive so that emergent ideas from the analysis of the first
interviews were used to provide direction for later inter-
views, so that interesting ideas were followed-up on
(Rubin & Rubin, 1995).
Although individual transcripts were analyzed
through the development of themes, the group of tran-
scripts was also analyzed as a whole. More specifically,
once the interviews were complete the individual analy-
sis from each interview was compared and contrasted to
develop patterns of relationships among the women’s
comments and experiences. In this regard, the themes
were inclusive of data across the interviews. Also,
member checks were completed in which participants
were sent their transcript and overall findings of the
research project to solicit their input. That is, each par-
ticipant was assigned a pseudonym and sent her
individual transcript, along with my analysis, for review
and comment. In addition, on completion of the data
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Parry / Contribution of Dragon Boat Racing 227
collection, all the participants were sent the overall find-
ings of the research project to solicit their input, which
allowed them to make certain the data represented their
stories and experiences.
About half of the participants responded and pro-
vided feedback. The respondents had minor corrections
to the findings, mostly focused on the chronological
order of their experiences, as opposed to any substan-
tive changes. For example, one woman commented, “I
liked what you wrote. I found it very interesting and
realistic. Thank you for sending me the entire article!
Please let me know if I can give you more inside infor-
mation for your research. Focus in the boat! Paddles up!
Take it away!” Another woman replied, “I have updated
slightly below . . . and attached a picture of my last
chemo...so ya know I didn’t make it up!! Ha! Oh, and
did I tell you...it is beautiful! You did a wonderful
job capturing and combining our thoughts and feel-
ings.” Finally, one other participant replied, “What a
wonderful treat to hear from you. Thank you so much
for sending the analysis. Didn’t realize I used the
words ‘breast cancer’ so many times! Your study has
so much content, I plan to read in more detail when I
have more leisure time—unfortunately not in the
immediate future. You have been so creative with ‘nom
de plume.’ Call me anything you want but, please,
please, please, NOT Fannie—Absolutely the top of the
list of names I hate to be called! Be well.” All of the
changes were incorporated into the findings and sent
back to the participants for final approval.
Profile of the Participants
Five of the participants were in their first or second
season of dragon boat racing, whereas the others had
been involved for a number of years. The participants
ranged in age from mid-40s to early 60s. Although all
of the participants had been employed full-time before
their diagnosis of breast cancer, few had returned to
their previous workload. More specifically, 3 of the
participants were employed full-time, 1 was working
part–time and the others were on leaves of absence
from their positions. All of the participants were at
least 6 months post–medical treatment for breast can-
cer. Eight of the participants were married and the
other 3 participants were divorced. All of the partici-
pants had children, most of whom had left home to
pursue educational and employment opportunities.
Findings
The women were remarkably enthusiastic about
their involvement in dragon boat racing. They
described the pursuit as “physically challenging,” but
nonetheless “fun,” “rewarding,” and “enjoyable.” One
participant stated, “Dragon boat racing is the high-
light of my week. The 4 hours I spend each week
dragon boat racing is wonderful. I can’t wait to go, I
have a great time once I am there, and I leave already
looking forward to the next practice.” Similarly,
another participant remarked, “I love dragon boat rac-
ing. I just love it. I have even joined the national team
and gone to training camps in Florida. I just love pad-
dling.” Clearly, these women enjoyed their participa-
tion in dragon boat racing and freely initiated
additional involvement in the pursuit. These types of
comments were common across the participants. The
quotes reflect the intrinsic motivation and sense of
perceived freedom the women associated with dragon
boat racing, which are considered central determi-
nants of a leisure experience (Iwasaki, 2003; Kelly,
1996; Mannell & Kleiber, 1997).
Even though the women viewed dragon boat racing
as a leisure pursuit and gained considerable enjoyment
from their involvement, they were serious about their
participation. Specifically, the women viewed dragon
boat racing as a key component of a holistic approach
to health. For example, one woman described her belief
system as focused on “healing, not treating.” In her
words,
I’m into healing. I’m treating my cancer naturally so
I’ve been to the naturopathic clinic and I’m into holis-
tic medicine. So I believe in healing. I don’t believe in
treatments. I don’t believe in allopathic medicine. I
believe in the whole. I deliberately sought out an emo-
tional connection with other dragon boat racers who
had breast cancer.
Dragon boat racing, for this woman, was a key
component of her healing process. She felt so
strongly about the contribution of dragon boat racing
to her health that she described it as the “only forum
for me that was viable, meaningful.” This woman was
the only participant who was treating her cancer nat-
urally. All of the other participants had been involved
in medical treatments for breast cancer, but still
viewed dragon boat racing as an essential component
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228 Qualitative Health Research
of their health. Most importantly, the participants
viewed dragon boat racing as a way they could posi-
tively contribute to their own health. For example,
one woman remarked,
Things that are not medical that I can do for myself
are really important to me, to help myself. Rather
than just relying on the medical profession and giv-
ing myself over to them, saying, “here I am, fix me.”
Yes I need you (the medical professionals), we’re a
team here. I’m the main part of this team and you’re
on my committee and I need information from you,
but at the same time I need these other inputs over
here. Dragon boat racing is what I do to look after
myself healthwise.
When asked how dragon boat racing contributed to
their health, the women described three main dimen-
sions. These dimensions will be discussed under the
following themed categories: (a) solidary and emo-
tional benefits, (b) physicality and stress coping, and
(c) spiritual awakening.
Solidary and Emotional Benefits
Many of the participants joined dragon boat racing
out of a desire to connect with other women who were
also breast cancer survivors. Almost all of the women
stated they were “looking to connect with others like
me.” For 1 participant, participating in dragon boat rac-
ing was “really just such a lovely thing to do for social
reasons, to meet new people, and meet people in the
same situation as you’re in as well.” Not only did she
seek out a social experience, but she did so with the
intent to share the company of other survivors. The com-
mon experience with breast cancer allowed other partic-
ipants to bridge social divides that might otherwise have
mitigated the possibility for relationship building. A par-
ticipant explained,
Connecting with other people of different walks of
life, every walk of life is attached to breast cancer.
So, meeting new people in different circumstances,
them enriching your life, you touching theirs. I feel I
could do that with every single woman on that team.
And who’d have thought you could have 68 new
friends?
The shared experience of breast cancer and a
shared interest in dragon boat racing brought these
women together and facilitated many new friend-
ships, which brought their own rewards.
Many of the participants described how their emo-
tional connections with other survivors contributed
positively to their well-being. For example, a partici-
pant discussed “deliberately seeking out an emotional
connection” with other breast cancer survivors. In her
words,
I needed some emotional support. When you’re diag-
nosed [with breast cancer] I guess some people
might isolate themselves, but other people think
omigod, I gotta find more ladies like me. I joined
[dragon boat racing] recognizing the need for emo-
tional support and the emotional support is huge. I
mean, the girls in my group, a certain number of the
girls in my group are my best friends.
Social connections with other survivors meant
establishing an empathetic support network that made
the participants “feel normal.” As another participant
explained,
I think you go through more emotional strain after the
treatments than you do during them. During the treat-
ments you’re too busy trying to get better. And after-
wards you’re just left with this life that you have to
rebuild from scratch, that you’re so weak and so tired
from everything that you’ve just been through. During
that time it’s hard to feel normal because everything has
changed, but with dragon boat racing I just felt so, so
normal. And from my everyday life, that was so uncom-
fortable for so long, for this 2 hours that I’m with them
[teammates], twice a week, it was a reprieve. It was 4
hours a week that made me feel normal, 4 hours a week
that I felt so good and felt a little bit like I could cope.
It’s so important to feel normal [throughout breast can-
cer survivorship]. I think it helps you recover a lot faster
and better. I think if I wasn’t doing the dragon boat rac-
ing I think I would be in really bad shape emotionally.
And no matter how bad I’m feeling physically, emo-
tionally I feel really happy.
Dragon boat racing helped normalize the experience
of breast cancer and created an empathetic environment
in which participants could be themselves. In this
regard, it functioned as an effective coping strategy for
most of the women (more on this below). Participation
in dragon boat racing also represented a form of resis-
tance against the dominant cultural narrative of the sick,
disabled cancer patient. As one participant explained,
“We go out there [to race] to show that breast cancer
people can survive, even we can be happy and healthy
and whole.” In other words, dragon boat racing was a
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Parry / Contribution of Dragon Boat Racing 229
demonstration that the women were capable of thriving
in their everyday living, despite their association with
breast cancer.
Part of the emotional support the women received
from the other dragon boat racers was feeling uncondi-
tionally supported by their teammates. For example, one
woman stated,
When you’re diagnosed [with breast cancer], you lose
some friends. Then when you begin treatment, more
friends leave. They’re frightened for themselves, they
don’t know how to speak to you. And when you finish
the treatment, finally after you know your 8 months or
however long you have it, um, then they [your remain-
ing friends] want you to stop talking about it. But the
dragon boaters are always there for you...it’s uncon-
ditional support and it is amazing.
Again, empathy was fundamental to the benefits of
dragon boat racing. That teammates could understand
and appreciate the experiences each woman had
undergone was instrumental in forging a supportive
environment for all participants.
Unconditional support was so integral to dragon
boat racing that 1 participant described the team as a
“floating support group.” She explained,
Any crisis in my life, and there have been a few, I’ve
always joined a support group. I don’t know, it’s just
the way I am. I’m an extrovert and I get a lot of
energy from people and it’s always helped me just to
talk about it.
“Getting energy” within a team environment was
emphasized by other participants, as well. The team
served as an important source of motivation for the
women. As one participant explained, “The emo-
tional support you get from your teammates, the
friendship, um, the feeling of not being alone, the
feeling of ah, encouragement that you feel that you’re
doing well, ah, [teammates] make you feel that way.”
Another participant reiterated this point by stating,
“To be part of a team of women is very powerful,
extremely powerful.”
In sum, many of the women deliberately sought
and enjoyed a social and emotional connection with
other survivors through dragon boat racing. Through
dragon boat racing, the women connected with other
survivors, felt normal and emotionally supported, and
viewed their teammates as a source of motivation.
Physicality and Stress Coping
Many of the participants underscored the physical
benefits of their participation in dragon boat racing.
Some of the women were surprised that dragon boat
racing actually improved physical aliments with
which they were dealing. For example, 1 participant
stated,
I found [dragon boat racing] actually improved my
physical condition. I used to have very severe osteo-
porosis, and I had lower back pain, and when I
started paddling, because you use your whole body
and you use your lower back, I was worried that it
would cause too much strain on my back and it
would be difficult, but it had the opposite effect.
After a while, my back pain actually went away, so it
was really beneficial.
A different participant offered a similar story: “I
have a very bad lower back. I have some discs that are
disintegrating and I found that doing the dragon boat-
ing, you know putting your body, top body forward
and paddling, it actually helped my back pain.” These
physical gains also combined with other benefits of
physical exercise to positively affect the women’s
health and well-being.
Most of the women discussed the associated bene-
fits of the fitness connected with dragon boat racing.
One participant said she enjoyed dragon boat racing
“on a physical level [because] it makes me feel chal-
lenged because there’s a lot of technique and you
require a lot of stamina.” When asked what she
enjoyed most about dragon boat racing, a participant
replied, “The physical activity ’cause I love being on
the water. I love when I paddle I don’t think about
anything else but moving the water, like you know,
moving that boat through the water.” In answer to the
same question, another participant said, “I just felt so
good, I felt like I was in great shape and I felt ener-
getic and I felt positive.” Similarly, a different partic-
ipant said she was drawn to dragon boat racing
for health. The fact that I would be able to overcome
a life-threatening illness to the point that I could
become physically fit and compete at a level that
would be like an international level, that for me was
like the carrot before the horse. So, if I get through
this, that’s my goal. And the thought was if I can
become as healthy as I can, be as fit as I can, to be
wanted on a team to compete at that level and to be
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230 Qualitative Health Research
successful and make a positive contribution, then,
whatever else life throws my way, I should be able to
handle.
The notion of “handling” other matters represented
the link many women made between dragon boat rac-
ing and stress coping.
Many women discussed the stress release that
accompanied the physical activity associated with
dragon boat racing. One participant explicitly said,
“Dragon boating for me fills a physical need through
stress relief.” Another explained that the “physical fit-
ness and endorphins helped me more than any drug
ever. I believe every woman, every man, everybody, if
you’re suffering from depression or you’re in a funk,
those are the days you most need to do something
physical.” Similarly, another woman talked about
how dragon boat racing fights depression:
At the end of the race there’s, I guess it’s a natural
high. You’re exhausted, they say paddle ’till you
puke! And, I mean, you’ve giving everything and
there’s a good physical, emotional, spiritual feeling,
when you’ve done that, when at the end of the race
when you hear let it run, you think oh thank God
because I can’t do another stroke. And that’s how
you’re supposed to be at the end of a race. Nothing
left. And when you really feel like that, it’s great. For
me it’s my own kind of a high.
This “natural high” was evidently effective in
countering the lows of living with cancer.
Perhaps the most powerful account of the connection
between dragon boat racing and stress coping came
from a woman who credited her involvement in dragon
boat racing with saving her life. In addition to her own
experience, her husband and son were battling cancer.
Given that she and her husband were both ill, they were
unable to work, which led to the loss of their business.
As a result, she was dealing with financial stress,
including the loss of their family home. Clearly, this
woman had major stress in her life, stress that led to
depression and suicidal thoughts. In discussing how she
battled her recurrence with cancer, she said,
My doctor said to me, “You’re going to have to go on
anti-depressants because physically, emotionally you
can’t cope with all this.” And since I started the dragon
boating, I have not had to take anything. No anti-
depressants. You get out there and you physically beat
the water, so you get out all your negative emotions
and it just brings all the, you know, the natural little
endorphins forward, so it fights actual depression.
That dragon boat racing would be credited with
addressing this woman’s depression speaks to its
powerful stress-coping properties.
In sum, the physicality of dragon boat racing con-
tributed to the women’s health by improving their
physical health, helping them feel positive, and increas-
ing their energy levels. Dragon boat racing also helped
the women feel physically healthy by reducing their
stress levels and helping them cope.
Spiritual Awakening
Dragon boat racing was not about solidary and
physical benefits alone. It also served to foster appre-
ciation for the everyday:
When we paddle out there at our practices and we’re
paddling along and we turn and head west we see those
sunsets, yeah we love that. And yes, we, we might not
paddle quite as aggressively while we’re watching. The
coach might say, “ladies,” and then we’re going, “well,
look at the sunset!” We’re the lucky ones.
Another woman described a similar scenario:
I was riding my bike home from practice. And, I
stopped [along the way] because I realized the sun
was setting and I was missing it. So I stopped with
my bike and I looked at the sunset that I wouldn’t
have appreciated or known it existed if I wasn’t
dragon boating, and I cried, because it was so amaz-
ing. And every night is amazing. Even on the shitti-
est night, you know, when I don’t really want to go
paddle, every time I think that it was the best night
out. And I know that sounds stupid or weird, and it is
but, we’ll either see the waves from the water and
two swans would come out, and truly every night it’s
magical.
Yet another participant explained,
I could live 30 years, I could live 2 years. And that’s
not, actually, it’s not that depressing ‘cause it forces
you to think, okay, I’m really enjoying this tea or I’m
really enjoying this conversation and then you sort of
think oh God, I feel great today, thank God, you
know.
Taken together, these quotes reveal how dragon
boat racing reminded the women of the wonders of
everyday life and how fortunate they were to be alive.
“It just frees your spirit,” commented one woman.
The connection between dragon boat racing and spir-
itual awakening was evident in most of the women’s
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Parry / Contribution of Dragon Boat Racing 231
experiences. One participant explained, “I could make
[dragon boat racing] the most important thing in my life.
It’s like a religion almost. The whole purpose in my life
now is changing. I ask myself every day, ‘Well, what am
I doing here?’ I’m interacting with people. I’m going to,
um, maybe make somebody feel happier.” This woman
developed a new purpose in life through dragon boat
racing and, consequently, a new commitment to life.
Another participant discussed the role of dragon boat
racing in showing her that there was “life after breast
cancer”:
Even though we’ve had breast cancer, it hasn’t
stopped us from living and from enjoying life. I think
what it does, well for me personally, it um, changed
the outlook I have a life-threatening illness that could
kill me. I’ve been through it. Um, and it’s not going
to kill me. I’m going to overcome it and I am strong,
I know I’ll be strong, and I will show people that
there is life after breast cancer. And life is good after
breast cancer.
The mind-set that dragon boat racing “made [par-
ticipants] feel alive again” led several participants to
appreciate quality of life over quantity of life. As one
participant explained, “You know it’s not about
longevity now or, or length of life. It’s about being a
full participant in that life.” In short, the women felt
as though dragon boat racing contributed to the spiri-
tual dimensions of their life throughout breast cancer
survivorship.
In sum, dragon boat racing contributed to the
women’s health throughout breast cancer survivor-
ship through solidary and emotional benefits, physi-
cality and stress coping, and initiation into a spiritual
awakening. Although these three dimensions were
outlined separately, the themes are not discreet cate-
gories, but rather overlap. That is, the various dimen-
sions interact to positively contribute to the women’s
experiences with survivorship. One participant noted
how dragon boat racing contributes to various dimen-
sions of health: “You know it’s absolutely imperative
that you get into these things for your physical, emo-
tional, spiritual, everything, well-being.” When asked
how the three dimensions came together, the women
discussed how they positively enhanced their experi-
ences with survivorship. For example, one woman
stated, “I’m doing really well as a survivor. Through
my involvement in dragon boat racing, I demonstrate
an example of not just being a survivor, but a thriver.”
Discussion and Conclusion
The purpose of this research was to study women’s
lived experiences with dragon boat racing to understand
how this leisure pursuit contributes to their health and
survivorship of breast cancer. The findings demonstrate
that dragon boat racing contributed to social, emotional,
physical, mental, and spiritual dimensions of health. In
turn, feeling healthy in these five dimensions enhanced
the women’s survivorship of breast cancer. The signifi-
cance of the study lies not only in its investigation of a
leisure pursuit—namely, dragon boat racing—and its
link to health, but also in its focus on survivorship after
medical treatment. Moreover, the study is significant in
that the knowledge is grounded in women’s personal
and private perspectives of breast cancer survivorship,
thereby addressing the gap in knowledge on experiences
with survivorship as women describe them (Thomas-
MacLean, 2004).
The stories also reinforce that health is manifested
through involvement in enjoyable and meaningful
leisure activities (Henderson & Ainsworth, 2002).
Health, in this sense, is conceptualized holistically to
encompass a variety of dimensions. Insel and Roth
(2006) identify dimensions of health, including social,
emotional, spiritual, intellectual, environmental, and
physical dimensions. This multidimensional view of
health resists the separation of mind, body, and spirit
but does not necessarily preclude a biomedical per-
spective. It redefines health as the ability to live life
fully—with vitality and meaning (Insel & Roth, 2006).
Health is determined by decisions about living one’s
life, including one’s leisure decisions. The current
research extends this body of literature, however, by
demonstrating how individual dimensions of health can
cumulatively enhance health and, in particular, con-
tribute to life after a life-threatening illness such as
breast cancer. In doing so, the findings demonstrate the
importance of leisure pursuits such as dragon boat rac-
ing to health and well-being. In other words, the current
research reveals the social relevance of leisure in the
context of women’s health and well-being.
The health literature has tended to view leisure as
trivial, if not completely irrelevant, to health outcomes,
because of the medicalization of health. Medicalization
occurs when health experiences come to be understood
narrowly as questions of illness and are then subjected
to the authority of medical institutions (Thomas-
MacLean, 2004). Once a health experience becomes
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232 Qualitative Health Research
medicalized, it is then described in medical terminology,
treated in medical institutions, and people affected by it
are regarded as patients. Critics of a narrow medical
model argue that the biological and individualistic focus
of medicalization has provided few other ways for
people to understand or make sense of their health and
well-being (Woliver, 2002). Consequently, the general
trend toward the medicalization of health and the resul-
tant emphasis on medical research for solutions have
been widely criticized by scholars and activists alike for
failing to appreciate other factors and contexts that affect
health. Clearly, the current research demonstrates the
need to reframe health research so that a broader, more
holistic approach to health, including leisure pursuits, is
appreciated as also affecting women’s health. In short,
dragon boat racing demonstrates the role and impact of
leisure in women’s health.
The findings of the current study suggest four
areas for future research. First, the women in this
study were all located within Ontario, Canada. Given
that dragon boat racing is a worldwide sport encom-
passing 93 teams in many countries, including the
United States, Australia, New Zealand, Poland, and
Italy, among others, research is needed within
countries and across countries. In other words,
research is needed on dragon boat racing teams for
breast cancer survivors within a country, but located in
different areas (provinces, states). Moreover, research
is needed to compare findings between different
countries. This type of cross-cultural research will
provide a broader understanding of the dimensions of
women’s health that might be positively affected
through dragon boat racing.
A second area for future research is connected to
knowledge translation. Information is needed to assess
how knowledge about dragon boat racing is currently
translated within Canada and other countries with
dragon boat racing teams. A greater understanding of
how such knowledge is translated will help determine
facilitators and barriers to participation. This research
will help identify the best way to share the knowledge
gained about the positive impact of dragon boat racing
on health and survivorship. In doing so, the goal is to
affect the survivorship of even greater numbers of
women.
A third area for future research is connected to
other leisure pursuits. Although dragon boat racing is
perhaps the largest organized pursuit of this nature for
breast cancer survivors, there are other similar activi-
ties such as fly fishing and snowmobiling. The focus
of these studies could be on the differences in bene-
fits for dragon boat racing as compared to participa-
tion in other activities.
Finally, the current study focused on short-term
benefits for health. Dragon boat racing for breast can-
cer survivors has been in existence for a decade now,
and it would be helpful to understand the long-term
health implications of involvement in such a leisure
pursuit. This could be accomplished by interviewing
women who have been involved in the pursuit for an
extended period of time. Another possible approach
would be longitudinal research that starts with
women who have just started dragon boat racing and
follows them for a number of years to shed light on
the long-term health benefits of dragon boat racing.
In conclusion, the current study demonstrates the
link between a leisure pursuit—dragon boat racing—
and women’s health. In doing so, the current research
highlights the importance of leisure to health and the
need to study health experiences as women describe
them. Given the areas for future research that the cur-
rent study has identified, we hope we will see further
study in this exciting area of women’s health and
well-being. Paddles up!
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Diana C. Parry, PhD, is an assistant professor in the Department
of Recreation and Leisure Studies and an affiliated scientist with
the Centre for Behavioral Research and Program Evaluation at
the University of Waterloo, Waterloo, Ontario, Canada.
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