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Tai Chi Chuan, health-related quality of life and self-esteem: A randomized trial with breast cancer survivors


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Health-related quality of life (HRQL) and self-esteem are often diminished among women diagnosed and treated for breast cancer. Tai Chi is a moderate form of exercise that may be an effective therapy for improving HRQL and self-esteem among these women. We sought to compare the efficacy of Tai Chi Chuan (TCC) and psychosocial support (PST) for improving HRQL and self-esteem among breast cancer survivors. A group of 21 women diagnosed with breast cancer, who had completed treatment within the last 30 months were randomized to receive 12 weeks of TCC or PST. Participants in both groups met three times a week for 60 minutes. HRQL and self-esteem were assessed at baseline, 6 weeks, and 12 weeks. The TCC group demonstrated significant improvements in HRQL, while the PST group reported declines in HRQL, with the differences between the two groups approaching significance at week 12. Additionally, the TCC group exhibited improvements in self-esteem, while the PST group reported declines in self-esteem, with the differences between groups reaching statistical significance at week 12. These findings, coupled with a visual inspection of the raw change scores, support the plausibility of a dose-response relationship concerning Tai Chi. In this pilot investigation, the TCC group exhibited improvements in HRQL and self-esteem from baseline to 6 and 12 weeks, while the support group exhibited declines. Randomized, controlled clinical trials with larger sample sizes are needed.
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Tai Chi Chuan, health-related quality of life and self-esteem: A randomized trial with breast cancer
By: Karen M. Mustian, Jeffrey A. Katula, Diane L. Gill, Joseph A. Roscoe, David Lang, and Karen Murphy
Mustian, K.M., Katula, J.A., Gill, D.L., Roscoe, J.A., Lang, D., & Murphy, K. (2004). Tai chi chuan, health-
related quality of life, and self-esteem: A randomized trial for breast cancer survivors. Supportive Care
in Cancer, 12, 871-876.
Made available courtesy of Springer Verlag:
Goals Health-related quality of life (HRQL) and self-esteem are often diminished among women diagnosed
and treated for breast cancer. Tai Chi is a moderate form of exercise that may be an effective therapy for
improving HRQL and self-esteem among these women. We sought to compare the efficacy of Tai Chi Chuan
(TCC) and psychosocial support (PST) for improving HRQL and self-esteem among breast cancer survivors.
Patients and methods A group of 21 women diagnosed with breast cancer, who had completed treatment within
the last 30 months were randomized to receive 12 weeks of TCC or PST. Participants in both groups met three
times a week for 60 minutes. HRQL and self-esteem were assessed at baseline, 6 weeks, and 12 weeks.
Results The TCC group demonstrated significant improvements in HRQL, while the PST group reported
declines in HRQL, with the differences between the two groups approaching significance at week 12.
Additionally, the TCC group exhibited improvements in self-esteem, while the PST group reported declines in
self-esteem, with the differences between groups reaching statistical significance at week 12. These findings,
coupled with a visual inspection of the raw change scores, support the plausibility of a dose-response
relationship concerning Tai Chi.
Conclusions In this pilot investigation, the TCC group exhibited improvements in HRQL and self-esteem from
baseline to 6 and 12 weeks, while the support group exhibited declines. Randomized, controlled clinical trials
with larger sample sizes are needed.
Keywords Breast cancer - Exercise - Quality of life - Self-esteem - Tai Chi
According to the American Cancer Society (ACS), approximately 217,440 new cases of invasive breast cancer
and 59,390 in situ (localized) cases will be diagnosed in 2004, resulting in nearly 40,580 deaths [1]. Despite the
increased survival rates experienced by women diagnosed with breast cancer, treatments for the disease result in
negative side effects, such as decreases in functional capacity, fatigue, nausea, vomiting, alopecia, depression,
poor body image and decreases in self-esteem that persist long after treatments have ended [11, 28, 29]. These
persistent side effects ultimately lead to impairments in HRQL [11, 28, 32].
HRQL is a biopsychosocial concept that is composed of psychological functioning, social adjustment,
functional ability, and disease- and treatment-related symptoms [3, 8]. Evidence suggests that self-esteem is a
primary indicant of health, illness coping and HRQL [7]. Self-esteem represents the evaluative and affective
components of self-concept (how an individual views the self) and can be described as the negative and positive
views individuals hold regarding themselves [5, 6, 13, 14, 16, 17, 26, 32]. Research has demonstrated that self-
esteem is positively correlated with, and is the psychological factor explaining most of the variance in HRQL
and well-being among breast cancer survivors [6]. This suggests that self-esteem plays a critical role in the
ability of breast cancer survivors to thrive and go on to live normal lives [14, 20, 32], and may be an
Supported by awards from the Susan Stout Exercise Science Research Fund and the Sally Schindel Cone Women s and Gender
Studies Research Fund at the University of North Carolina at Greensboro.
appropriate target for interventions designed to aid breast cancer survivors in maintaining and improving HRQL
[6, 7, 13, 14].
Currently, the most widely researched and accepted intervention to enhance self-esteem and HRQL in breast
cancer survivors is psychosocial support therapy (PST) [37, 38, 39], which is based on the premise that shared
experiences of emotional and social support are associated with enhanced self-esteem and coping. Although
PST groups are shown to be moderately effective at enhancing HRQL for some survivors [15, 37, 38, 39],
results have been inconsistent and many patients prefer not to attend support groups. Therefore, alternative
interventions are needed and should be examined for their efficacy.
Exercise has been found to be a safe method for enhancing HRQL among cancer patients [11] and increasing
self-esteem in healthy populations [12, 16, 17, 26, 33, 34, 36]. In breast cancer survivors, four studies have
demonstrated positive relationships between physical activity and self-esteem [4, 27, 30, 31]. These studies
investigated traditional modes of exercise, to which patients often have difficulty adhering/complying. A form
of exercise that may be particularly appropriate for breast cancer survivors is the practice of Tai Chi Chuan
(TCC), which is rapidly gaining popularity in the United States [10]. It is an easily modifiable, low-to-moderate
intensity form of physical exercise with psychological, physiological, and sociological benefits [18, 19]. For
example, TCC has been reported to have positive effects on HRQL, self-esteem, mood, anxiety, blood pressure,
osteoporosis, rheumatoid arthritis, natural killer cells, and components of health-related fitness, such as
cardiorespiratory function, flexibility, balance and strength [18, 19, 21, 24, 25, 42]. Despite research indicating
that TCC is an effective form of therapy for enhancing HRQL and self-esteem [19, 21, 22, 23], TCC has not
been tested as an intervention for improving HRQL and self-esteem among breast cancer survivors.
In summary, women diagnosed with breast cancer face a number of biopsychosocial challenges resulting from
treatment and diagnosis that may impair HRQL. Additionally, evidence suggests that self-esteem may play a
pivotal role in HRQL and in successful coping among these women. TCC may prove to be an effective
intervention to help survivors enhance HRQL and self-esteem, but intervention studies are lacking. Therefore, a
pilot study was conducted to compare the impact of a 12-week TCC program and a 12-week PST program on
HRQL and self-esteem in breast cancer survivors.
Breast cancer survivors were recruited collaboratively by the Behavioral Health and Fitness Laboratory at the
University of North Carolina Greensboro, Moses Cone Regional Cancer Center and the American Cancer
Society via mass mailings, posted flyers in the community and physician referrals. After expressing an interest
in participating in this investigation, each participant was contacted by the principal investigator, screened for
inclusion, and received an explanation of the details of the study. Inclusion criteria consisted of (1) being
female, (2) having a histological diagnosis of primary breast cancer stage 0IIIb, (3) being between 1 week and
30 months after treatment, (4) having no drainage tubes or catheters, (5) not engaging in moderate to vigorous
physical activity more than once a week, (6) obtaining a physician s clearance for fitness testing and exercise,
(7) having no physical limitations prohibiting exercise, and (8) having no clinical diagnosis of mental disorder,
as defined by the use of psychotropic drugs and self-report. The Institutional Review Board, prior to consenting
and enrolling any patients, approved the study.
Design and procedures
Participants reported to the Behavioral Health and Fitness Laboratory at the University of North Carolina
Greensboro and were randomly assigned to a 12-week TCC exercise group or PST group, both of which met
three times a week for 60 minutes in a classroom in the same building, and at the same time of day for
12 weeks. The PST sessions were lead by a graduate exercise psychology student, under the direct supervision
of a Master s-trained counselor. The PST sessions were theoretically guided following Spiegel s Supportive-
Expressive Group Therapy model [37] and conducted in an open-ended format that placed strong emphasis on
teaching behavioral coping strategies, peer support, and group cohesion. Participants in the PST group were
instructed not to begin any physical exercise programs or change their normal daily physical activity in any way
for the duration of the study. According to self-report data, 80% (n=8) of the women completing the PST
intervention adhered to this requirement, while 20% (n=2) did not, and actually began or increased a fitness
walking regimen.
The TCC group was led by an American College of Sports Medicine certified health and fitness instructor, who
was also an experienced TCC instructor. Participants performed 10 minutes of warm-up stretching and basic
Chi Kung (stationary TCC fundamentals). The participants then performed TCC for approximately 40 minutes,
and learned a 15-move short form of Yang style TCC. During the last 10 minutes of each session, participants
were instructed in regulatory breathing, imagery, and meditation in order to enhance their TCC skills and
provide an exercise cool-down. As in the PST group, participants in the TCC group were instructed not to begin
any other physical exercise programs and not to change their normal daily physical activity during the course of
the study. According to self-report data, 100% (n=11) of the women completing the TCC intervention adhered
to this requirement, with the only changes in physical activity occurring as a result of participation in the TCC
All participants completed a battery of self-report questionnaires (demographics, HRQL, and self-esteem) at
baseline, 6 weeks, and 12 weeks. In addition, participants were instructed to keep a daily log for each class they
attended in order to monitor attendance and compliance to TCC and PST sessions, as well as intensity and
duration of physical activity during the sessions. Participants were not given any formal assignments to do at
home outside of the structured sessions; however, they were encouraged to practice the TCC and behavioral
coping strategies they learned during the sessions.
Questionnaire packets were ordered the same for all participants and each packet contained evaluation
instruments for demographics and related medical information, HRQL, and self-esteem.
Demographics and related medical information Demographics assessed included age, height, weight, partnered
status, race, employment history, household income and educational background. Study participants provided
demographic information based on current status. Additionally, body mass index (BMI) was calculated [weight
(kg)/height (m
)] [2]. Medical information consisted of stage of disease, surgical treatment and adjuvant
Functional assessment of chronic illness therapyfatigue (FACITF) HRQL was assessed using the FACITF,
a 28-item HRQL scale developed specifically for use in cancer clinical trials [9]. Cella and colleagues, through
extensive interviews with patients experiencing symptoms of cancer and oncology professionals, developed the
questionnaire, and it has been validated in a series of studies of 542 cancer patients. The basic measure has
shown very good test/retest reliability, as well as validity [40, 41]. Along with a total score representing HRQL,
there are psychometrically validated subscales of physical, functional, social, cognitive-emotional, and fatigue
status. The FACITF has become one of the most commonly used measures in oncology. Reliability was
calculated in the current investigation for the total score and subscales, with Cronbach s alpha demonstrating
good internal consistency at or above r=0.75.
Self-esteem Self-esteem was assessed via the Rosenberg Self-Esteem Scale (RSE) [35]. The RSE is designed to
measure how individuals generally feel about themselves using a unidimensional approach. The RSE is a ten-
item survey on which participants respond using a Likert scale ranging from 1 to 5 (strongly agree, agree,
neutral, disagree, and strongly disagree, respectively), and scores are computed by summing responses.
Rosenberg reported an original reproducibility of 0.93 and a scalability of 0.73. Cronbach s alpha coefficients
for internal consistency range from 0.76 to 0.87, and test-retest reliabilities range from 0.63 and 0.85 for cancer
patients [13]. Reliability was calculated for the current investigation, with Cronbach s alpha demonstrating an
internal consistency of r=0.76.
Statistical analyses
Data analyses were conducted using SPSS version 12.0 software. Descriptive statistics were calculated to
determine the nature and variability of participants demographics, as well as reported HRQL and self-esteem.
The general analytic plan included calculating simple change scores, correlations and analyzing within- and
between-group differences on HRQL and self-esteem using analysis of variance (ANOVA) techniques with
appropriate post hoc analyses. Additionally, because this was a pilot study, post hoc analyses were conducted to
examine the effect of the intervention conditions on HRQL and self-esteem at 6 and 12 weeks despite the
absence of significant interaction effects, which would not have been statistically appropriate in a confirmatory
study, in order to provide knowledge to aid in the design of future randomized controlled clinical trials.
Of 31 breast cancer survivors who agreed to participate in the experiment, 68% (n=21) completed the study.
Among the TCC participants, 11 completed all study requirements, with a 72% exercise attendance/compliance
rate, while 10 PST group participants completed all study requirements, with a 67% PST attendance/compliance
rate. The reasons expressed by participants for discontinuing (TCC n=6, PST n=4) included not liking their
group assignment, work, family, joining a fitness center, and severe side effects from treatment (e.g., cognitive
deficits). Interestingly, all of the patients who dropped out because of not liking the group they were assigned to
were assigned to the PST group and desired the TCC group.
Participants ranged in age from 33 to 78 years old (mean 52 years, SD 9). The average body mass index was
26.3 (SD 4.9), and the average body fat percentage was 41.5% (SD 5.7) as assessed by bioelectrical impedance.
Almost half of the women were married (48%) and the majority were Caucasian (90%), had at least some
college (90%), were employed outside of the home (65%), and had household incomes above $40,000 (62%).
All of the participants were diagnosed with stage 0IIIb breast cancer and received surgical treatment (61%
lumpectomy, 33% mastectomy, 6% bilateral mastectomy), with the majority also receiving at least one form of
chemotherapy (84%), radiation therapy (61%), and hormonal therapy (56%). Participants in the two groups
were found to be significantly different in terms of baseline self-esteem, but not in terms of any other
characteristics. Additionally, HRQL and self-esteem were significantly correlated at all three assessment times
(Table 1).
Table 1 Correlations between HRQL and self-esteem
Pearson r
P value
6 weeks
12 weeks
A 2×3 (condition by time) repeated-measures ANCOVA, with HRQL as the dependent variable and baseline
self-esteem as the covariate (due to significant baseline differences between groups), revealed a significant time
main effect (F
=8.04; P=0.00). Follow-up repeated measures ANCOVAs, with the data split based on
intervention assignment, showed significant improvements in HRQL across the 12-week period among the TCC
participants (F
=4.34; P=0.03), but not among the PST participants (F
=2.66; P=0.14). Additionally, a one-
way ANOVA demonstrated a trend toward significant differences between participants in the TCC and PST
conditions on changes in HRQL at 12 weeks (F
=3.66; P=0.07), but not at 6 weeks (F
=2.07; P=0.17).
Furthermore, it is important to note that the TCC participants reported improvements in HRQL at 6 and
12 weeks, while the PST participants reported decreases in HRQL at both assessment times (Fig. 1).
Fig. 1 Comparison of changes in HRQL: Tai Chi Chuan vs psychosocial support
A 2×2 (condition by time) repeated-measures ANCOVA, with self-esteem as the dependent variable and
baseline self-esteem as the covariate, demonstrated a significant time main effect (F
=4.87; P=0.04). Follow-
up repeated measures ANCOVAs, with the data split based on condition, showed a trend toward significant
improvements in self-esteem among the TCC participants (F
=3.36; P=0.10), but not among the PST
participants (F
=1.40; P=0.27). Additionally, a one-way ANOVA revealed a significant difference between the
TCC and PST participants on changes in self-esteem at 12 weeks (F
=7.54; P=0.01), with the TCC group
exhibiting improvements in self-esteem and the PST group exhibiting decreases in self-esteem. Lastly, although
the changes in self-esteem at 6 weeks were not significantly different (F
=0.73; P=0.40), the TCC group
exhibited improvements in self-esteem, while the PST group showed reductions (see Fig. 2).
Fig. 2 Comparison of changes in self-esteem: Tai Chi Chuan vs psychosocial support
In summary, the TCC group exhibited improvements in HRQL and self-esteem from baseline to 6 and
12 weeks, while the support group exhibited declines in both. These differences reached statistical significance
at 12 weeks.
The purpose of this pilot study was to gather preliminary efficacy and feasibility data in preparation for a larger
study comparing the efficacy of TCC and psychosocial support therapy for improving HRQL and self-esteem in
women diagnosed with breast cancer after the completion of treatment (surgery, chemotherapy, radiation
therapy). The results from this preliminary investigation suggest that TCC has a significant positive influence
on HRQL and self-esteem in women diagnosed with breast cancer after treatment, but support therapy does not.
Interestingly, the TCC group reported improvements in HRQL and self-esteem at 6 and 12 weeks, while the
PST group reported declines in HRQL and self-esteem at both times. A possible explanation for this finding is
that the physical aspects of self-esteem may have been particularly salient for this group of women and the
physical nature of the TCC intervention may have been a better match for these patients needs than the
sedentary PST intervention. Prior research has shown that participating in physical activity has a positive
influence on self-esteem and is especially helpful for women who have been diagnosed with breast cancer [4,
27, 30, 31]. It is also possible that the patients feelings of being in control were enhanced more by the
relatively active TCC intervention than by the relatively inactive PST intervention, and this, in turn, contributed
to the greater benefits in HRQL and self-esteem observed in the former group.
Moreover, several of the women in both groups celebrated the 1-year anniversary of their diagnosis with breast
cancer while participating in the investigation, which is typically a time of significant emotional stress. Despite
this, the women in the TCC group reported feeling better about themselves and the quality of their life, while, as
previously noted, the women receiving support therapy did not experience improvements, but rather declines in
how they felt about themselves and the quality of their lives. As such, these data suggest that TCC may have
strong potential as a post-treatment and rehabilitative therapeutic modality for improving HRQL and self-
esteem among women diagnosed with breast cancer.
Further examination of the data demonstrated that there was a statistically significant difference between the
two treatment groups in terms of improvement in self-esteem, along with a trend toward significant differences
in terms of improvements in HRQL at the week-12 assessment. Although not statistically significant, the
improvement in HRQL (9%) and self-esteem (9%) observed during week 6 in women in the TCC group
compared to the women in the support group (HRQL=4%, CRF=7%) may be clinically meaningful to the
participants, as suggested by anecdotal evidence from participants in the current study. Furthermore, these
findings, coupled with a visual inspection of the raw change scores, support the plausibility of a dose-response
relationship concerning TCC, with significant improvements in HRQL and self-esteem occurring after 6 weeks
of participation in TCC, but prior to 12 weeks. Concomitantly, it is noteworthy that the TCC group, as a whole,
did not report declines in HRQL or self-esteem at either assessment point, whereas the women in the support
group, as a whole, reported declines in both outcomes at all time points.
Although these results are positive and hopeful, this study has several limitations. The small, homogeneous
sample of participants provided statistically analyzable data, but did not provide results generalizable to the
larger cancer patient population (e.g., men, children, individuals with disease at other sites, or individuals
undergoing treatment). Additionally, participants may have been particularly receptive to exercise, and the
results may not be generalizable to those less amenable to this mode of exercise. Furthermore, since this study
was not blinded or placebo controlled, it is possible that the benefits reported from the intervention were due to
experimenter bias, participant expectancy effects, or non-specific treatment effects (e.g., differences in patient
attention or social interaction).
Despite these limitations, the results of this pilot study are positive and provide preliminary evidence that TCC
may be effective in improving HRQL and self-esteem among women diagnosed with breast cancer. Future
large-scale and randomized clinical trials are needed to confirm and expand the findings of this pilot study.
Additionally, intent-to-treat, dose-response, and cost-benefit analyses might provide useful information. In
conclusion, TCC is a safe, well-accepted, and moderate form of exercise, with potential efficacy as a therapeutic
intervention for improving HRQL and self-esteem, and, thus, optimizing recovery from breast cancer diagnosis
and treatment.
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... Among the 26 studies, findings from 14 Tai Chi trials (13 RCTs and 1 NRCT) were reported (Figure 1), including six conducted in the United States, [30][31][32][33][34][35][36][37][38][39][40][41][42][43] six conducted in China [44][45][46][47][48][49][50] (one in Hong Kong special administrative region of China), [51][52][53] and one each conducted in Thailand 54 and Iran, 55 respectively. The sample sizes ranged from nine to 57 in each group. ...
... We summarized the study characteristics in Table S3. Seven trials were conducted in survivors of breast cancer, 30,[32][33][34][35][36][37][38][39][40][41][42][43]54,55 three in lung cancer, 47-50 two in head & neck cancer, 46,51-53 one in prostate cancer, 31 and one in mixed cancer. 45 The disease stage varied from stage 0 to IV with different treatments including chemotherapy, radiotherapy, chemoradiotherapy, and surgery. ...
... We summarized other outcomes assessed in Tai Chi trials in Table S7 including aerobic capacity, [32][33][34][35][36][37][51][52][53] and biological markers of hormone, [32][33][34][35][36][37][38][39][47][48][49]54 neuroendocrine, 30 inflammation, [32][33][34][35][36][37][38][39][40][41]50 and immunity. 30,[47][48][49] 3.6 | Summary of effects by phase of the cancer continuum ...
Full-text available
To manage acute, long‐term, and late effects of cancer, current guidelines recommend moderate‐to‐vigorous intensity aerobic and resistance exercise. Unfortunately, not all cancer survivors are able or willing to perform higher intensity exercise during difficult cancer treatments or because of other existing health conditions. Tai Chi is an equipment‐free, multicomponent mind–body exercise performed at light‐to‐moderate intensity that may provide a more feasible alternative to traditional exercise programs for some cancer survivors. This systematic review evaluated the therapeutic efficacy of Tai Chi across the cancer care continuum. We searched MEDLINE/PubMed, Embase, SCOPUS, and CINAHL databases for interventional studies from inception to 18 September 2020. Controlled trials of the effects of Tai Chi training on patient‐reported and objectively measured outcomes in cancer survivors were included. Study quality was determined by the RoB 2 tool, and effect estimates were evaluated using the Best Evidence Synthesis approach. Twenty‐six reports from 14 trials (one non‐randomized controlled trial) conducted during (n = 5) and after treatment (after surgery: n = 2; after other treatments: n = 7) were included. Low‐level evidence emerged to support the benefits of 40–60 min of thrice‐weekly supervised Tai Chi for 8–12 weeks to improve fatigue and sleep quality in cancer survivors. These findings need to be confirmed in larger trials and tested for scaling‐up potential. Insufficient evidence was available to evaluate the effects of Tai Chi on other cancer‐related outcomes. Future research should examine whether Tai Chi training can improve a broader range of cancer outcomes including during the pre‐treatment and end of life phases. Tai Chi training may improve fatigue and sleep quality in cancer survivors. Future research should examine a broader range of outcomes, particularly during difficult cancer treatments and for those with significant comorbidities.
... Out of these, 38 records progressed for full-text screening, and 21 of them were excluded from the study. Finally, 17 RCTs were included for further analysis [41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57]. Figure 1 illustrates the study selection process. These studies included a total of 1103 cancer patients who were divided into control groups (n = 546) and treatment groups with martial arts (n = 557). ...
... Out of these, 38 records progresse screening, and 21 of them were excluded from the study. Finally, 17 RCTs for further analysis [41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57]. Figure 1 illustrates the study selection process included a total of 1103 cancer patients who were divided into control gr and treatment groups with martial arts (n = 557). The mean age of the in patients was 58 ± 3.1 years. ...
... Totally, three studies [48,49,51] reported the use of Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F). The results show martial arts significantly improved fatigue, compared to the control group (SMD = 0.68, 95% CI: 0.39-0.96; ...
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Background: To evaluate and synthesize the existing evidence of the effects of practicing martial arts by cancer patients and cancer survivors in relation to overall quality of life (QoL) and cancer-related fatigue (CRF). Methods: Randomized controlled trials (RCTs) from 1 January 2000 to 5 November 2020 investigating the impact of martial arts were compared with any control intervention for overall QoL and CRF among cancer patients and survivors. Publication quality and risk of bias were assessed using the Cochrane handbook of systematic reviews. Results: According to the electronic search, 17 RCTs were retrieved including 1103 cancer patients. Martial arts significantly improved social function, compared to that in the control group (SMD = -0.88, 95% CI: -1.36, -0.39; p = 0.0004). Moreover, martial arts significantly improved functioning, compared to the control group (SMD = 0.68, 95% CI: 0.39-0.96; p < 0.00001). Martial arts significantly reduced CRF, compared to that in the control group (SMD = -0.51, 95% CI: -0.80, -0.22; p = 0.0005, I2 > 95%). Conclusions: The results of our systematic review and meta-analysis reveal that the effects of practicing martial arts on CRF and QoL in cancer patients and survivors are inconclusive. Some potential effects were seen for social function and CRF, although the results were inconsistent across different measurement methods. There is a need for larger and more homogeneous clinical trials encompassing different cancer types and specific martial arts disciplines to make more extensive and definitive cancer- and symptom-specific recommendations.
... These include loss of physical function, muscle loss, bone loss, cachexia, cancer-related fatigue, cognitive impairment, and psychological distress [1][2][3]. Exercise appears to be a safe and effective therapeutic intervention for alleviating many of these adverse effects, including muscle atrophy and weakness, immune dysfunction, insomnia, anxiety, fatigue, obesity, cognitive decline, and impaired QoL [2,[4][5][6][7][8][9][10][11][12][13]. Additionally, evidence suggests exercise may have a favorable effect on cancer recurrence and mortality [14,15]. ...
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Introduction Technology-based exercise is gaining attention as a promising strategy for increasing physical activity (PA) in older adults with cancer (OACA). However, a comprehensive understanding of the interventions, their feasibility, outcomes, and safety is limited. This scoping review (1) assessed the prevalence and type of technology-based remotely delivered exercise interventions for OACA and (2) explored the feasibility, safety, acceptability, and outcomes in these interventions. Methods Studies with participant mean/median age ≥ 65 reporting at least one outcome measure were included. Databases searched included the following: PubMed, CINAHL, Embase, Cochrane Library Online, SPORTDiscus, and PsycINFO. Multiple independent reviewers completed screening and data abstractions of articles in English, French, and Spanish. Results The search yielded 2339 citations after removing duplicates. Following title and abstract screening, 96 full texts were review, and 15 were included. Study designs were heterogeneous, and sample sizes were diverse (range 14–478). The most common technologies used were website/web portal (n = 6), videos (n = 5), exergaming (n = 2), accelerometer/pedometer with video and/or website (n = 4), and live-videoconferencing (n = 2). Over half (9/15) of the studies examined feasibility using various definitions; feasibility outcomes were reached in all. Common outcomes examined include lower body function and quality of life. Adverse events were uncommon and minor were reported. Qualitative studies identified cost- and time-savings, healthcare professional support, and technology features that encourage engagement as facilitators. Conclusion Remote exercise interventions using technology appear to be feasible and acceptable in OACA. Implications for Cancer Survivors Some remote exercise interventions may be a viable way to increase PA for OACA.
... Several studies have 7 also reported that cancer patients experience a decreased level of selfesteem. 8,9,10,11 Hopelessness is also an important and crucial factor in these lifethreatening diseases which warrants more attention and researches. It has been dened as negative expectations about the future which may be visible particularly in complex stages of illness characterized by depressing cognitions and associated emotions concerning the future. ...
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Background: Self-esteem and hopelessness are interrelated cognitive constructs which play a crucial role in coping strategies of cancer and AIDS patients. Main aim of this cross-sectional study was to compare the differences in these cognitive constructs i.e. self-esteem and hopelessness among cancer and AIDS patients. Methods: A total of 30cancer and 30 AIDS consecutive patients were selected through purposive sampling technique. Rosenberg Self-esteem scale (RSE) and Beck Hopelessness Scale (BHS) were administered. Data was analyzed using Mean, S.D and unpaired t-test. The level of statistical signicance was kept at p value < 0.05. Results: The mean age of cancer patients ranged from 26 to 75(M = 54.23 & SD= 14.30) whereas the mean age of AIDS patients ranged from 25 to 50 (M = 38.83 & SD= 6.95).Among 30 cancer patients, 56.66 % were men and 43.33 % were women. Among another group of 30 AIDS patients, 53.33 % were men and 46.66 % were women. AIDS patients expressed higher level of hopelessness as compared to the cancer group (t= -5.259, p= .000).On the contrary, cancer patients expressed higher level of self-esteem when compared to the AIDS patients (t= 3.451, p= .001). Conclusion: The results revealed that AIDS patients have signicantly lower level of self-esteem accompanied by higher level of hopelessness when compared to their cancer counterparts. Clinicians and mental health professionals treating these patients should also focus on early identification of patients with low self-esteem and high degree of hopelessness for better prognosis.
... It also refers to the belief that one "is capable of coping with the challenges in life and is worthy of happiness" [5]. One study showed that self-esteem is a key factor in the growth and return to normal life in patients with breast cancer [6]. Low self-esteem has been found to be strongly correlated with depression [7] and other psychological distress [8]. ...
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This study aimed to explore the relationship between self-esteem and mental adjustment and examine the directional effects in patients with breast cancer using path modeling. This was a cross-sectional, descriptive, and correlational study. A total of 128 patients with breast cancer were selected through convenience sampling at a medical center in northern Taiwan. They completed a basic characteristics questionnaire, the Memorial Symptom Assessment Scale short form, the Rosenberg Self-Esteem Scale, and the mini-Mental Adjustment to Cancer Scale. Descriptive statistics, regression analysis, and path analysis were used to analyze the data. The results showed that higher self-esteem was associated with better mental adjustment (β = 0.9, 95% confidence interval 0.6~1.3, p < 0.001). Age, religious beliefs, employment, cancer stage, and symptom distress were correlated with mental adjustment. Path modeling demonstrated that self-esteem, cancer stage, performance status, and symptom distress directly affected mental adjustment in patients with breast cancer. These findings suggest that health professionals should evaluate self-esteem, performance status, and symptom distress in patients with breast cancer immediately upon admission. This can facilitate early implementation of relevant nursing interventions and, consequently, improve self-esteem and symptom distress and increase mental adjustment in these patients.
... Interestingly enough, Tai Chi (a form of Chinese martial arts/mediative practice) has been shown to have a beneficial effect on self-efficacy in a variety of patient groups, 9,10 including breast cancer survivors. 11 However, more than one third of all breast cancer survivors experience distress even after completing medical therapy. 12 This distress leads to a higher risk of psychological illness in breast cancer survivors. ...
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Introduction Breast cancer survivors are faced with several psychological issues. We report the influence on self-efficacy by a holistic orientated training schedule based on the “Kyusho Jitsu” martial art and explore the effects on self-efficacy, distress, fear, and depression. Methods Breast cancer survivors (N = 51) were randomly assigned to an intervention (n = 30) or control group (n = 21). The intervention group participated in a Kyusho Jitsu intervention twice a week over a period of 6 months, the control group received no intervention. Patients from both groups were measured at baseline, 3 and 6 months on level of self-efficacy (German General-Self-Efficacy Scale, SWE), stress (Perceived Stress Questionnaire, PSQ20), and fear and depression (Hospital Anxiety and Depression Scale, HADS). Results Analysis of the original data showed a significant difference between both groups regarding the subscale “joy” ( P = .018). Several significant results within the intervention group were seen in self-efficacy ( P = .014), fear ( P = .009) and the overall score for fear and depression ( P = .043). Both groups improved significantly within “worries” (intervention P = .006, control P = .019) and the PSQ20 overall score (both P = .005). The control group also significantly improved in the subscale for “demands” ( P = .019). Conclusion To summarize, our pilot study showed that Kyusho Jitsu training is safe and feasible. Though, the intervention alone cannot be considered as being effective enough to help breast cancer survivors regarding relevant psychological issues, but might be an important supplement offer within follow-up care.
... 15 Self-esteem represents an evaluative and affective component of an individual's self-view or a positive and negative attitude that a person forms about themself, their opinion, and behavior. 16 Women who have changed their view of their own body due to different treatment methods show lower self-esteem. 2 In a sample of women under the age of 50 who were married or in a stable relationship, Fobair and colleagues 2 found a statistically significant association between self-esteem and body image, while the impact of self-esteem on partnerships and sexual functioning was not confirmed. ...
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For women with breast cancer, sexual quality of life is one of the most disrupted aspects of life often associated with long-term physical and emotional difficulties. The main goal of this paper is to systematically review the literature to determine the level of sexual quality of life in women with breast cancer considering the individual and combined impact of grade, progression of the disease, type of treatment, body image, degree of depression, and anxiety, self-esteem, and social partner support and to determine whether the perception of the body, level of self-esteem and the presence of depressive and anxiety symptoms differ regarding different types of treatment or the level of partners’ social support. Using the PRISMA method, all found literature published in electronic databases PubMed, EBSCO, and Hrcak were reviewed and resulted in 10 relevant scientific and review papers. The results showed that women with breast cancer reported disruption in their sexual quality of life. Among the types of treatment, mastectomy and chemotherapy proved to be the most important, while it is not possible to draw clear conclusions about degree and progression of the disease. Disturbed body image, depressive and anxiety symptoms, lower self-esteem, and inadequate social support of the partner are associated with a lower sexual quality of life. The discussion provides detailed explanations of these results and highlights implications for future research.
Background: Radiation therapy (RT) is given to about half of all people with cancer. RT alone is used to treat various cancers at different stages. Although it is a local treatment, systemic symptoms may occur. Cancer- or treatment-related side effects can lead to a reduction in physical activity, physical performance, and quality of life (QoL). The literature suggests that physical exercise can reduce the risk of various side effects of cancer and cancer treatments, cancer-specific mortality, recurrence of cancer, and all-cause mortality. Objectives: To evaluate the benefits and harms of exercise plus standard care compared with standard care alone in adults with cancer receiving RT alone. Search methods: We searched CENTRAL, MEDLINE (Ovid), Embase (Ovid), CINAHL, conference proceedings and trial registries up to 26 October 2022. Selection criteria: We included randomised controlled trials (RCTs) that enrolled people who were receiving RT without adjuvant systemic treatment for any type or stage of cancer. We considered any type of exercise intervention, defined as a planned, structured, repetitive, objective-oriented physical activity programme in addition to standard care. We excluded exercise interventions that involved physiotherapy alone, relaxation programmes, and multimodal approaches that combined exercise with other non-standard interventions such as nutritional restriction. Data collection and analysis: We used standard Cochrane methodology and the GRADE approach for assessing the certainty of the evidence. Our primary outcome was fatigue and the secondary outcomes were QoL, physical performance, psychosocial effects, overall survival, return to work, anthropometric measurements, and adverse events. Main results: Database searching identified 5875 records, of which 430 were duplicates. We excluded 5324 records and the remaining 121 references were assessed for eligibility. We included three two-arm RCTs with 130 participants. Cancer types were breast and prostate cancer. Both treatment groups received the same standard care, but the exercise groups also participated in supervised exercise programmes several times per week while undergoing RT. Exercise interventions included warm-up, treadmill walking (in addition to cycling and stretching and strengthening exercises in one study), and cool-down. In some analysed endpoints (fatigue, physical performance, QoL), there were baseline differences between exercise and control groups. We were unable to pool the results of the different studies owing to substantial clinical heterogeneity. All three studies measured fatigue. Our analyses, presented below, showed that exercise may reduce fatigue (positive SMD values signify less fatigue; low certainty). • Standardised mean difference (SMD) 0.96, 95% confidence interval (CI) 0.27 to 1.64; 37 participants (fatigue measured with Brief Fatigue Inventory (BFI)) • SMD 2.42, 95% CI 1.71 to 3.13; 54 participants (fatigue measured with BFI) • SMD 1.44, 95% CI 0.46 to 2.42; 21 participants (fatigue measured with revised Piper Fatigue Scale) All three studies measured QoL, although one provided insufficient data for analysis. Our analyses, presented below, showed that exercise may have little or no effect on QoL (positive SMD values signify better QoL; low certainty). • SMD 0.40, 95% CI -0.26 to 1.05; 37 participants (QoL measured with Functional Assessment of Cancer Therapy-Prostate) • SMD 0.47, 95% CI -0.40 to 1.34; 21 participants (QoL measured with World Health Organization QoL questionnaire (WHOQOL-BREF)) All three studies measured physical performance. Our analyses of two studies, presented below, showed that exercise may improve physical performance, but we are very unsure about the results (positive SMD values signify better physical performance; very low certainty) • SMD 1.25, 95% CI 0.54 to 1.97; 37 participants (shoulder mobility and pain measured on a visual analogue scale) • SMD⁠⁠⁠⁠⁠⁠ 3.13 (95% CI 2.32 to 3.95; 54 participants (physical performance measured with the six-minute walk test) Our analyses of data from the third study showed that exercise may have little or no effect on physical performance measured with the stand-and-sit test, but we are very unsure about the results (SMD 0.00, 95% CI -0.86 to 0.86, positive SMD values signify better physical performance; 21 participants; very low certainty). Two studies measured psychosocial effects. Our analyses (presented below) showed that exercise may have little or no effect on psychosocial effects, but we are very unsure about the results (positive SMD values signify better psychosocial well-being; very low certainty). • SMD 0.48, 95% CI -0.18 to 1.13; 37 participants (psychosocial effects measured on the WHOQOL-BREF social subscale) • SMD 0.29, 95% CI -0.57 to 1.15; 21 participants (psychosocial effects measured with the Beck Depression Inventory) Two studies recorded adverse events related to the exercise programmes and reported no events. We estimated the certainty of the evidence as very low. No studies reported adverse events unrelated to exercise. No studies reported the other outcomes we intended to analyse (overall survival, anthropometric measurements, return to work). Authors' conclusions: There is little evidence on the effects of exercise interventions in people with cancer who are receiving RT alone. While all included studies reported benefits for the exercise intervention groups in all assessed outcomes, our analyses did not consistently support this evidence. There was low-certainty evidence that exercise improved fatigue in all three studies. Regarding physical performance, our analysis showed very low-certainty evidence of a difference favouring exercise in two studies, and very low-certainty evidence of no difference in one study. We found very low-certainty evidence of little or no difference between the effects of exercise and no exercise on quality of life or psychosocial effects. We downgraded the certainty of the evidence for possible outcome reporting bias, imprecision due to small sample sizes in a small number of studies, and indirectness of outcomes. In summary, exercise may have some beneficial outcomes in people with cancer who are receiving RT alone, but the evidence supporting this statement is of low certainty. There is a need for high-quality research on this topic.
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Introduction: Body practices can bring physical, psychological benefits and social rehabilitation and may be an alternative treatment for breast cancer. Objective: To analyze the evidence of the results of body practices over the psychological aspects of survivors women undergoing treatment for breast cancer. Method: Systematic blind and independent review from September to December 2021 following the PRISMA guidelines, carried out in the databases: Embase Elsevier; PubMed Central; ScienceDirect; Scopus Elsevier and Web of Science – Core Collection. Results: Of 1,372 studies identified, 22 were included in this systematic review. Among the practices that stood out are meditation and Yoga, with anxiety being the most investigated variable by the studies. It is clear that body practices are options for non-pharmacological clinical treatments utilized in clinical practice by different health professionals in women who have survived breast cancer. Conclusion: Body practices proved to be beneficial in the treatment and psychological health of women who survived breast cancer. This evidence may help to implement body practices as a therapeutic resource to be used in the clinical practice of health professionals. However, more randomized clinical trials that follow study protocols more rigorously are suggested, so that the effectiveness of this approach can be evaluated in different clinical outcomes.
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There is increasing interest in the contribution of exercise in both the promotion of mental well-being and the treatment and prevention of mental illness and disorders. Within this context, self-esteem has been regarded as an important element of well-being and a construct that might be open to change through exercise. This paper discusses recent advances in the theory and measurement of self-esteem including the concepts of multidimensionality, hierarchical structuring and the specific role of the physical self with a view to a) informing critique of the existing literature and b) suggesting future research challenges. The results of a recent comprehensive review of 37 randomised and 42 non-randomised controlled studies investigating the effects of exercise on self-esteem and physical self-perceptions are summarised. This is followed by suggestions for advancing research in the field and practical pointers for those already involved in the promotion of exercise for mental health.
With the increase in the number of women who have survived breast cancer, there is a growing need to attend to the physical and emotional effects of cancer and its treatment as experienced by these survivors. Psychological distress, fatigue, weight gain, premature menopause and changes in body image are some of the long‐term sequelae of breast cancer. Exercise as an adjunctive treatment may help to attenuate these effects and thereby contribute to rehabilitation of women with breast cancer. We present data from the exercise literature and from studies on breast cancer patients that support this role of exercise. Following a critique of the research efforts, we present a brief outline of questions that should be addressed in evaluating the role of exercise in cancer rehabilitation. Copyright © 1999 John Wiley & Sons, Ltd.
The purpose of this study was to examine the relationship between physical exercise and self-esteem in breast cancer survivors using Sonstroem and Morgan's (1989) exercise and self-esteem model (EXSEM). Participants were 64 women from four breast cancer support groups. Each participant completed a battery of self-administered questionnaires that assessed exercise participation, physical competence, physical acceptance, and global self-esteem. Pearson correlation analyses demonstrated that physical acceptance, physical competence, and exercise participation each had significant zero-order relationships with global self-esteem. Multiple regression analysis determined that these three constructs together explained 46% of the variance in global self-esteem. Consistent with hypotheses, path analysis showed that the significant relationship between exercise participation and global self-esteem was mediated entirely by physical competence. It was concluded that the EXSEM may be a viable framework for examining the mechanisms by which physical exercise may influence self-esteem in breast cancer survivors.
The article describes a randomized, controlled trial conducted to examine the effects of a Tai Chi intervention program on perceptions of personal efficacy and exercise behavior in older adults. The sample comprised 94 low-active, healthy participants (mean age = 72.8 years, SD = 5.1) randomly assigned to either an experimental (Tai Chi) group or a wait-list control group. The study length was 6 months, with self-efficacy responses (barrier, performance efficacies) assessed at baseline, at Week 12, and at termination (Week 24) of the study. Exercise attendance was recorded as an outcome measure of exercise behavior. Random-effects models revealed that participants in the experimental group experienced significant improvements in self-efficacy over the course of the intervention. Subsequent repeated-measures ANOVA revealed that participants' changes in efficacy were associated with higher levels of program attendance. The findings suggest that self-efficacy can be enhanced through Tai Chi and that the changes in self-efficacy are likely to improve exercise adherence.
We have been closet Cartesians in modern medicine, treating the mind as though it were reactive to but otherwise disconnected from disease in the body. Although medical science has productively focused on the pathophysiology of disease, such as tumor biology, coronary artery disease, and immunology, it has done so at the expense of studying the body's psychophysiological reactions to these disease processes. These reactions are mediated by brain and body mechanisms, including the endocrine, neuroimmune, and autonomic nervous systems. While a large portion of the variance in any disease outcome is accounted for by the specific local pathophysiology of that disease, some variability must also be explained by host resistance factors, which include the manner of response to the stress of the illness. For example, in a series of classic experiments in animals, Riley¹,2 showed that crowding accelerated the rate of tumor growth and mortality. In a recent authoritative review of human stress literature, McEwen³ documented the adverse health effects of cumulative stressors and the body's failure to adapt the stress response to them. Activation of the hypothalamic-pituitary-adrenal axis (HPA) is an adaptive response to acute stress, but over time, in response to cumulative stress, the system's signal-to-noise ratio can be degraded, so that it is partially "on" all the time, leading to adverse physiological consequences, including abnormalities of glucose metabolism,⁴ hippocampal damage,⁵ and depression.⁶,7
Psychosocial treatments, including group, individual and family psychotherapies, are of proven efficacy, and deserve inclusion as standard components of biomedical treatment for cancer patients. Anxiety and depression are very common (and treatable) problems among cancer patients, most of whom can benefit from intervention. Psychotherapy, both group and individual, employs three fundamental approaches: emotional expression, social support, and cognitive symptom-management skills. Psychotherapy has been shown to be effective in improving quality of life. Results of studies of various psychotherapies include reduction in depression, anxiety, and pain, and improved coping skills, and, in some cases, there is evidence of extended survival times.