Article

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

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Abstract

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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... Meta-analyses were carried out according to the outcome of interest and the assessment point (immediately after intervention). Two corresponding authors were contacted several times for data requirements, but no answer was provided [28,29]; four RCTs did not report sufficiently homogenous data to be synthesised [23,[30][31][32], and another study did not report the corresponding author's contact [33]. Moreover, two studies shared the same sample, and they were grouped [34,35]. ...
... Most of the RCTs included participants in the survivorship phase, with only five of them investigating the effects of exercise interventions in self-perceived body image [44,45], self-esteem [29,34,35] and exercise self-efficacy [32] during primary adjuvant treatments. Seven of the 19 RCTs focused on endurance training [30,31,33,[46][47][48]54], three on muscle resistance [45,49,50], four combined both resistance and endurance exercises [29,51,52] and three studied different types of mind-body exercises [23,28,32]. Moreover, two studies included resistance, endurance and multimodal exercises in several groups [34,35,53]. ...
... Most of the exercise interventions were supervised; the intervention period ranged from 4 to 53 weeks, with a minimum of 4 weeks and 12 sessions. In most RCTs, exercise training was compared with no intervention [23, 29-31, 33-35, 46-48, 51, 52, 54], but also with flexibility or muscle relaxation exercises [45,53], sham flexibility [44] and educational/ counselling interventions [28,49,50] or with general recommendations to exercise [32]. ...
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Purpose To synthesise the effectiveness of exercise interventions on self-perceived body image, self-esteem and self-efficacy in women diagnosed with breast cancer who are undergoing or have completed primary adjuvant treatments. Methods A systematic review was conducted with meta-analysis and meta-regressions. Five electronic databases were searched from inception to June 2023, and hand searches were performed to explore the reference lists of similar systematic reviews. The established selection criteria were randomised clinical trials that evaluated any type of physical exercise intervention with self-perceived body image, self-esteem and self-efficacy as outcomes. No restrictions were imposed with respect to the control group. Main characteristics were extracted for each study. Meta-analyses, meta-regressions and sensitivity analyses were performed. The certainty of evidence for each outcome was graded using the GRADE approach. The risk of bias was evaluated using the RoB2 Cochrane tool. Results Twenty studies, comprising 19 different samples (n = 2030), were included. In general, meta-analysis indicated that physical exercise interventions were not superior to controls for improving self-esteem and body image in women diagnosed with breast cancer. However, subgroup meta-analysis showed a significant difference in self-esteem improvement for resistance exercise (SMD = 0.31; 95% CI = 0.07, 0.55; p = 0.01; I² = 0%) and supervised exercise (SMD = 0.25; 95% CI = 0.08, 0.42; p = 0.0004; I² = 0%) compared with controls. Self-efficacy results were scarce and controversial. In addition, serious concerns were mainly detected in terms of the risk of bias and indirectness of the evidence, which caused the certainty of evidence to be very low for all outcomes. Conclusion Supervised exercise and resistance training appear to be effective exercise modalities for improving self-esteem in women diagnosed with breast cancer. In contrast, exercise interventions are not significantly associated with improvements in body image, while results on self-efficacy are controversial. However, due to the study’s limitations, further research is needed.
... 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 ...
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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.
... As principais modalidade de exercício físico utilizadas como intervenção coadjuvante, aos convencionais, no câncer de mama são: treinamento resistido (TR), TA, além de atividades alternativas como yoga e tai chi-chuan (CAMPBELL et al., 2019b;MUSTIAN;PALESH;FLECKSTEINER, 2008;STAN et al., 2016). Visto pela distinção entre as modalidades de exercícios, assim como as diferentes intensidades, volume, frequência e demais variáveis, faz-se necessário compreendê-las separadamente, para posterior combinação. ...
... Atividades alternativas podem promover benefícios importantes para sobreviventes de câncer de mama, tais como melhora na qualidade de vida e fadiga desta população (KOCH et al., 2017;MUSTIAN;KATULA;ZHAO, 2006b;MUSTIAN;PALESH;FLECKSTEINER, 2008;STAN et al., 2016). O yoga consiste em uma atividade alternativa complexa envolvendo exercícios de respiração, práticas espirituais e meditação (WHITE, 2019), seu principal objetivo é promover bem estar físico e mental através, do que seus praticantes chamam de união entre mente, corpo e espírito (WHICHER; CARPENTER, 2003). ...
... Atividades alternativas podem promover benefícios importantes para sobreviventes de câncer de mama, tais como melhora na qualidade de vida e fadiga desta população (KOCH et al., 2017;MUSTIAN;KATULA;ZHAO, 2006b;MUSTIAN;PALESH;FLECKSTEINER, 2008;STAN et al., 2016). O yoga consiste em uma atividade alternativa complexa envolvendo exercícios de respiração, práticas espirituais e meditação (WHITE, 2019), seu principal objetivo é promover bem estar físico e mental através, do que seus praticantes chamam de união entre mente, corpo e espírito (WHICHER; CARPENTER, 2003). ...
... Finally, 20 articles were included in this review (Fig. 1). Of these 20 articles, 13 were in English [30,[35][36][37][38][39][40][41][42][43][44][45][46], and the other seven in Chinese [47][48][49][50][51][52][53]. All articles were published between 2003 and 2017. ...
... All articles were published between 2003 and 2017. The four articles published by Mustian et al. [30,[43][44][45] and the two articles published by Irwin et al. [35,39] were each regarded as a single trial in this review due to the same group of participants: only two articles, i.e. one for each group of papers [30,35], were included in data analysis. Thus, 16 RCTs were finally included in this review [30,[35][36][37][38][40][41][42][46][47][48][49][50][51][52][53]. ...
... Prior to this systematic review, five systematic reviews have been published with inconsistent conclusions [25][26][27][28][29]. Two reviews published by Pan et al. [26,27] counted the same trial (conducted by Mustian et al. [30,43,44]) as three independent studies in meta-analyses, thus compromising the review findings. Based upon the published reviews, evidence of effectiveness of tai chi on muscle strength, BMI, and psychosomatic wellbeing was conflicting. ...
Article
Background and purpose: Tai chi has been suggested as a potential effective intervention for improving function and wellbeing in breast cancer patients. This systematic review evaluated the current evidence for the effectiveness of tai chi in patients with breast cancer. Methods: Randomized Controlled Trials (RCTs) evaluating the effects of tai chi in breast cancer patients were identified through searches in OVID MEDLINE, AMED, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, CNKI, VIP, and Wanfang Data, up to June 2019. Meta-analyses were performed for results syntheses. Results: Sixteen RCTs involving 1268 participants were included in this review. It was demonstrated that tai chi is no different from conventional supportive care interventions in improving fatigue, sleeping quality, depression or body mass index at either 3 months or 6 months; however it significantly improves overall quality of life (QoL) at 3 months. Moreover, tai chi, when offered as an adjunct to conventional therapy, is more effective in improving fatigue at 3 months, and QoL at 3 months and 6 months compared to conventional therapy alone. Conclusion: Tai chi shows no improvement in fatigue compared with conventional supportive interventions, but it significantly relieves fatigue symptom for breast cancer patients when used with conventional supportive care interventions. Tai chi versus conventional supportive care interventions, and as an adjunct to conventional therapy is effective in improving QoL for breast cancer patients.
... Intervensi yang diberikan juga berupa kombinasi dengan meditasi. Hasil yang didapatkan adalah kualitas hidup pasien meningkat dan penerimaan diri diukur dengan menggunakan kuesioner harga diri didapatkan bahwa responden mengalami penerimaan diri yang baik (Mustian et al., 2004). ...
... Penelitian dari Mustian (2004) meneliti tentang relaksasi Tai Chi Cuan termasuk peregangan, pemanasan dan selama 10 menit terakhir responden menjalani latihan Tai Chi, citra diri dan meditasi. TCC berpotensi untuk pasca perawatan, modalitas rehabilitasi terapeutik untuk meningkatkan kualitas hidup pasien kanker payudara dan juga harga diri pasien. ...
... Instrumen yang digunakan untuk meneliti penerimaan diri berbeda untuk setiap penelitian dalam literatur review ini. Kuesioner-kuesioner tersebut mengukur penerimaan diri, (harga diri, memaafkan diri dan pesimisme diri) (Mustian et al., 2004;Saniatuzzulfa et al., 2015;Speca et al., 2014;Toussaint et al., 2014). ...
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p>Breast cancer patients experience low self-acceptance and some of the experiencing psychological problems but not a lot of research to increasing self-acceptance. Additional intervention is needed to improve the effectiveness to increase self-acceptance. Technique relaxation is especially related because easy and quick to learn, it involves no risk, does not need use or purchased equipment and can be used on its own and immediately to tiredness and ill patients. This paper offers a literature review assessing the implications of previous studies order to create evidence-based decisions about the possibility to use of relaxation techniques with adult breast cancer patient for low self-acceptance. The Science Direct, EBSCOhost, Pubmed, DOAJ, Google Scholar database were searched in 2017 in orders to replied two questions: are relaxation technique effective to increase self-acceptance in breast cancer patients, and implications the previous investigation to future research concerning increase self-acceptance in breast cancer patients? Four articles included in the literature review. The relaxation technique for breast cancer patients with low self-acceptance is statically significant, and good evidence-based to practice. Some use of relaxation techniques in this study needs clarification as to whether it can be used directly or need to learn. Procedures in the collection of data in the articles also need to be assessed. In this literature review explain 4 relaxation technique to use for increasing self-acceptance in breast cancer, there are self-forgiveness, meditation, tai-chi, reflection, prayer, mindfulness. This literature review can be used as the basis for the decision to use relaxation techniques for increasing self-acceptance in the breast cancer patient.</p
... [41] Light exercises comprising of TCC could be appropriately incorporated into a rehabilitation program for survivors. [42] TCC can be practiced easily without equipment, and is thus practical without external restrictions. It can easily learn in groups or in individuals, and may through regular practice facilitate a lifestyle which promotes wellness at both healthy and rehabilitation subjects in all age. ...
... People can benefit from the practice of TCC, which not only balances and smoothens the emotions, but can also strengthen human bodies to achieve homeostasis. [42] 2. TCC improves psychological well-being of breast cancer survivors TCC is believed to favor the psychological well-being of cancer survivors through its characteristics of relaxation, deep and regulated breath, and slow movements. Currently, the most widely accepted research intervention to enhance self-esteem and health related quality of life (HRQOL) in cancer survivors is psychosocial support therapy (PST). ...
... Mustian's research group compared the efficacy of TCC and psychosocial support (PST) for improving HRQOL. [42] and self-esteem. [43] among breast cancer survivors. ...
Article
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Tai Chi Chuan (TCC) is a traditional Chinese exercise, its movement is slow in order to achieve a state of relaxation and balance of both body and mind. TCC shows positive effects in relieving symptoms in patients with chronic diseases and malignant diseases after treatment. Research has proven that TCC helps improve the quality of life in breast cancer patients who had undergone surgery and chemotherapy. Studies have also demonstrated that TCC may exert its effects psychologically and physiologically. In order to document current researches of TCC in a scientific way, we tried to evaluate the changes of biological markers in breast cancer survivors who has been practicing TTC and its potential benefits in reducing treatment-related adverse effects, improving immunity and personal wellbeing. Cancer survivors suffer from a variety of psychological responses including depression, sadness, anxiety, fear and adverse effects from surgery and chemotherapy. Some studies confirmed that cancer survivors’ physical and psychological functions can be improved by regular exercises. Many studies have shown that regular physical exercises are particularly important in reducing the incidence and recurrence of breast cancer, prolonging the survival of patients and even improving the side effects during and after the treatment. It has also been linked to a better quality of life (QoL) for breast cancer survivors. After surgery, the shoulder function of breast cancer survivors would be impaired and their arms would show signs and symptoms including diminished tactile sensation in the arm or armpit, weakness, stiffness and lymphedema of the surgical sided arm. Conventional exercises such as running and/or swimming involves rigorous arm movements which require full mobility of the arms and legs. Such exercises are not recommended immediately following surgery. TCC exercises may help regain upper limb functional mobility for breast cancer survivors by slow and continuous movement of upper limb. Practicing TCC in a smooth and relaxed way will lessen tension and promote relaxation which may alleviate stress, depression and anxiety. TCC has been demonstrated in improving psychological well-being of breast cancer survivors by reducing anxiety or depression through stabilizing the level of cortisol and serotonin. Studies showed that TCC improves immunity in breast cancer survivors by means of hematological markers and cytokines. In this review, there were only four randomized controlled trials have made use of biological markers to monitor the effects of TCC in breast cancer survivors although most researchers tend to assess by means of aerobic capacity, muscular strength, and flexibility, as well as QOL. None of the studies investigated the relationship between TCC and treatment-related adverse effects or immunity through changes in biological markers. Therefore, researchers could develop the use of more cytokines, stressors (melatonin), activated natural killer cells, free radicals, biochemical markers or c-miRNAs to determine the effects of TCC.
... A total of 93 studies were identified using the abovementioned search strategy, 28 duplicate studies and 57 studies that did not meet the inclusion criteria were subsequently excluded. The baseline parameters of each trial were comparable; thus, six RCTs were included in the meta-analysis [6][7][8][9][10][11] (Figure 1). ...
... All six RCTs originated from the United States of America [6][7][8][9][10][11]. The participants' ages in all studies ranged from 49 to 65 years. ...
... The participants' ages in all studies ranged from 49 to 65 years. One RCT [11] included patients with stage I-II breast cancer, one RCT [6] included patients with stage 0-III, one RCT [7] included patients with stage I-IIIa, and two RCTs [8,9] included patients with stage I-IIIb disease. Participants in two RCTs [6,9] underwent surgery, adjuvant radiation, and/or chemotherapy during the TCC intervention. ...
... Walking was the most common aerobic training [8,14,17,20,21,25,27,28,34,37]. Other forms of aerobic training were yoga [22,26,31,32,35,36,42], treadmills or bicycle ergometers [8,16,18,24,33], qigong [23,29], tai chi [19], and dancing [36]. Among the 25 studies, three studies (sample sizes between 20 [18] and 175 [14]) reported no significant effects of aerobic training on QOL in patients with breast cancer compared with that of usual care [14,18,24]. ...
... Mustian et al. [19] compared the efficacy of Yang-style tai chi chuan with psychosocial support therapy for health-related QOL. Participants were instructed to keep a daily log; patients undertaking tai chi chuan demonstrated significant improvements in QOL and self-esteem. ...
... Among the included studies,12 discussed the intensity of exercise interventions [8,14,16,18,19,21,25,27,28,41,43,44]; of these, eight studies [8,14,16,18,25,41,43,44] reported that exercise prescriptions incorporating more than 150 min of high-intensity training per week was associated with a low incidence of adverse events in breast cancer patients and significantly improved upper and lower body strength and improved the QOL. Three studies [21,27,28] suggested that interventions should focus on achieving a weekly minimum of 150 min of moderate intensity activity, which would improve the QOL, and possibly derive associated benefits of reduced risk of mortality and recurrence [49]. ...
Article
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Purpose: The purpose of this study was to conduct a systematic review to assess the effect of exercise on the quality of life among people with breast cancer. Methods: We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Cochrane Library, PubMed, EMBASE, Web of Science, CINAHL, and four Chinese databases were searched for studies published until January 2018. The review included all randomized controlled trials that evaluated the effect of exercise on quality of life compared with that of usual care for people with breast cancer. Two reviewers independently assessed the quality of all the included studies using the Cochrane Handbook for Systematic Reviews of Interventions. Results: In total, 36 studies (3914 participants) met the inclusion criteria. We divided the exercise into three modes: aerobic, resistance, and a combination of aerobic and resistance. All three modes of exercise intervention showed a significant effect on quality of life between groups. Conclusions: Exercise is a safe and effective method of improving the quality of life in patients with breast cancer. In particular, combined training was associated with a significant improvement in quality of life. In future research, more high-quality, multicenter trials evaluating the effect of exercise in breast cancer patients are needed.
... 58 Tai Chi brings psychosocial benefits as well. Studies reported that Tai Chi has a positive effect in promoting healthrelated quality of life, 44,54,59,60 reduction of stress, 39,41 reduction of mood disturbance, 41,61 promotion of self-esteem, 35,59 management of depression 58 and anxiety, 55 and promotion of social outcome. 41 Particularly, Tai Chi has been found to bring improvement in self-esteem and health-related quality of life in the residents. ...
... 58 Tai Chi brings psychosocial benefits as well. Studies reported that Tai Chi has a positive effect in promoting healthrelated quality of life, 44,54,59,60 reduction of stress, 39,41 reduction of mood disturbance, 41,61 promotion of self-esteem, 35,59 management of depression 58 and anxiety, 55 and promotion of social outcome. 41 Particularly, Tai Chi has been found to bring improvement in self-esteem and health-related quality of life in the residents. ...
Article
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The lack of activity, opportunity for providing input and participation in activities, and interaction with other people are the features of institutional living which reinforces dependency among nursing home residents. Residents are usually frustrated with paternalistic-type care. Arranging health-oriented meaningful activities for residents contributes to health promotion and enhancement of healthy aging. Moreover, it contributes to the cultivation of a positive meaning of life which is particularly important as residents reach the late geriatric stages of their lives. With exercise being seen as generally beneficial for health, Tai Chi as a Chinese-based exercise with a body-mind emphasis and unique characteristics becomes a particularly suitable exercise in aiding the residents in this major shift of lifestyle. This paper analyzes the appropriateness, feasibility, and effectiveness of Tai Chi in promoting healthy aging for residents. Theoretical considerations and scientific evaluations lend it appropriate, feasible, and effective in providing physiological and psychosocial health benefits to the residents. This paper recommends the use of Tai Chi to promote healthy aging in nursing home residents. With a rapidly aging population and mounting demand for residential geriatric care worldwide, this paper's timely findings should provide important implications for adopting Tai Chi to advance the quality of care delivered by nursing homes worldwide.
... The Functional Assessment of Cancer Therapy-General (FACT-G) was generally used to measure the score of quality of life. Of all these 11 studies, most (n = 9) reported significantly positive effects after TCE interventions on quality of life, and the 60 or 90 min per time at 2-3 times per week for 10-12 weeks was the commonly used setting of TCE intervention [13,21,[24][25][26]30,[34][35][36]. Nevertheless, the remaining two studies conducted in 2013 proposed some different results. ...
... In terms of mood status and sleep quality, conflicting and equivocal results continued to emerge in recent years. Five of eight studies that examined the effects of TCE on mood status using corresponding self-administered questionnaire (e.g., Profile of Mood State (PMS)) reported significantly positive effects compared to control intervention [22,25,34,36,39], while the remaining three studies found no difference [35,38,40]. Similarly, only two of six studies that investigated the effects of TCE on sleep quality using corresponding self-rated questionnaire (e.g., Pittsburgh Sleep Quality Index (PSQI)) reported significantly positive effects compared to control intervention [13,23], while the remaining four studies found no difference [34,40,42,43]. ...
Article
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Traditional Chinese exercise (TCE) has gradually become one of the widespread complementary therapies for treatment and recovery of cancers. However, evidence based on the systematic evaluation of its efficacy is lacking, and there appears to be no conclusion regarding the setting of TCE interventions. The purpose of this systematic review is to summarize the current randomized controlled trials (RCTs) that outline the effects of TCE on cancer patients. Relevant studies were searched by GOOGLE SCHOLAR, SCIENCEDIRECT, and WEB OF SCIENCE using "traditional Chinese exercise" and "cancer." Only RCTs published in peer-reviewed English journals were included. A total of 27 studies covering 1616 cancer patients satisfied the eligibility criteria for this review. Despite the methodological limitation and relatively high risk of bias possessed by some included studies, positive evidence was still detected on the effects of TCE on these cancer-related health outcomes in physical, psychological, and physiological parameters. The 60-min or 90-min course of TCE intervention for two to three times per week for 10 to 12 weeks was found to be the most common setting in these studies and has effectively benefited cancer patients. These findings add scientific support to encourage cancer patients to practice TCE during or after conventional medical treatment. Nevertheless, future well-designed RCTs with improved methodology and larger sample size on this field are much warranted for further verification.
... The studies differed in geographical location, design, and type of clinical trial [ Table 1]. Sixteen articles was conducted in the United States, [27,28,31,33,[35][36][37]39,40,[42][43][44][45][46]48,51] three in Canada, [30,34,47] two in South Korea [32,53] and one in China, [41] Germany, [38] Iran, [26] Sweden, [29] England, [52] Turkey, [50] and India. [49] Eighteen studies from 28 included articles were randomized controlled trial (RCT). ...
... Moreover, 9 of the articles reported that they were pilot studies. [27,28,33,34,39,40,44,47,48] The total sample size of each study varied from 21 to 271 individuals. Fifteen studies had a sample size of 21-50, and 4 studies had a sample size of 51-100. ...
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Background: Breast cancer disease and its classic treatment lead to decrease in patients' quality of life (QOL). This systematic review aimed to compare the effectiveness of complementary and alternative medicines (CAMs) categories on the QOL of women with breast cancer. Methods: English clinical trials from PubMed, Emabase, Scupos, and Google Scholar databases were searched electronically by the end of 2018 with the Cochrane Collaboration protocol. Two researchers independently extracted data such as participants' characteristics, CAM methods, QOL assessment tools. CAMs were classified into three categories of dietary supplements, herbal medicine, and mind-body techniques. Results: During the initial search, 1186 articles were found. After reviewing titles, abstracts, and full texts based on inclusion and exclusion criteria, 28 clinical trials were included in the systematic review, 18 of which was randomized controlled trial (RCT). Participants included women with breast cancer who were undergoing the first three phases of breast cancer or postcancer rehabilitation. Among CAM interventions, one article used a dietary supplement, and the other 27 articles included a variety of mind-body techniques. Twenty-seven studies showed improved QOL (P > 0.05). Conclusion: The findings may indicate the potential benefits of CAMs, especially mind-body techniques on QOL in breast cancer patients. Further RCTs or long-term follow-up studies are recommended. Moreover, the use of similar QOL assessment tools allows for more meta-analysis and generalizability of results, especially for the development of clinical guidelines.
... 9,75,77,[81][82][83] Exercise improves a wide array of physical and psychological symptoms, including muscle atrophy and weakness, fatigue, obesity, immune function, insomnia, anxiety, cognitive decline, and impaired quality of life, among others. [55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][84][85][86][87][88] Epidemiologic data also suggest that increased physical activity through regular exercise reduces the risk of cancer recurrence and cancer mortality. 39,[89][90] The ACSM published public health recommendations for exercise among survivors of cancer. ...
... Low to moderately intense mindfulnessbased exercise prescriptions, including yoga and tai chi chuan, scheduled one to three times a week for 60-90 minutes, are also highly effective in reducing symptom burden among older adults. 64,69,71,74,107,108 Additionally, those with advanced disease can safely perform, tolerate, and benefit from lowintensity exercise. 109-114 ...
Article
The number of survivors of cancer in the United States, already 14.5 million, is growing with improved cancer treatment and aging of the population. Two-thirds of cancer survivors will be older than age 65 and are likely to enter cancer treatment already deconditioned and with multiple comorbidities. Survivors of cancer face numerous adverse consequences of cancer treatment that add to or exacerbate the effects of existing comorbidities and increase risk of functional decline. Many of these problems are amenable to rehabilitation interventions, but referral to cancer rehabilitation professionals is not a standard part of care. We present an expanded prospective model of surveillance, cancer rehabilitation assessment, and referral efforts using a multidisciplinary team approach. In this model, cancer rehabilitation begins at the time of cancer diagnosis and continues through and beyond cancer treatment. Physical impairments and psychosocial symptoms are assessed and treated, and lifestyle and exercise interventions are provided to optimize functioning, health, and quality of life. We present a stepped-care framework to guide decisions on when, how, and where to refer survivors to cancer rehabilitation specialists depending on safety requirements and needs. This model has the potential to result in early identification of symptoms and impairments, appropriate referral and timely treatment, and, in turn, will better address and minimize both acute and long-term cancer morbidity.
... 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. ...
Article
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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. ...
Article
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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.
... We presented characteristics of some included studies in Table 2. All RCTs are in English, [17][18][19][20][21][22][23][24][25] publishing between 2006 and 2015. The details are shown in Table 2. ...
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Background: Taijiquan, as a supplementary and alternative method, has attracted more and more attention in the treatment of breast cancer. But up to now, no systematic review has been performed to evaluate the efficacy of Taijiquan in the treatment of breast cancer. In this study, Cochrane systematic review method will be used to evaluate the effect of Taijiquan in the rehabilitation process of breast cancer patients after treatment. Methods: PubMed, Embase. com, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and SinoMed will be searched to identify relevant studies up to May 31, 2021. We will include randomized controlled trials (RCTs) of the application of Taijiquan in post-treatment breast cancer patients. We will use the Cochrane bias risk assessment tool to assess the quality of included RCTs. We will use Stata 13.0 to perform pairwise meta-analyses using the inverse variance method. Subgroup analyses and sensitivity analyses will be conducted to investigate the sources of heterogeneity. Results: The results of this study will be published in a peer-reviewed journal. Conclusion: This study will comprehensively evaluate the efficacy of Taijiquan in the rehabilitation treatment of breast cancer. The results of this study will provide high-quality evidence to support clinical practice and guidelines development.
... Tai Chi is a physical and mental exercise that integrates martial arts with mental and breathing exercises. Practicing Ta Chi can effectively improve flexibility, balance, and coordination, while it has also proven effective against heart disease [9], coronary heart disease [10], hypertension [11], and cancer [12]. However, researchers hold different views regarding the effects of Tai Chi on diabetic patients' glucose and lipid metabolism. ...
Article
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This research review aimed to evaluate the effect of practicing Tai Chi on glucose and lipid metabolism in middle-aged and elderly diabetic patients. Furthermore, it aimed to provide a theoretical basis for the practice of Tai Chi as a way to improve glucose and lipid metabolism in middle-aged and elderly diabetic patients. Therefore, we searched for randomized controlled trials on the practice of Tai Chi in middle-aged and elderly diabetic patients in Chinese- and English-language electronic databases, such as Web of Science, PubMed, the Cochrane Library, EMBASE, Google Scholar, CNKI, Wanfang Database, and Weipu. We collected articles published no later than August 1, 2020. The methodological quality of the included studies was evaluated according to the standards of the Cochrane Collaboration System Evaluation Manual (version 5.1.0). Finally, 14 articles were included, showing an average Physiotherapy Evidence Database scale score of 6.57. The articles were meta-analyzed using Stata 14.0 software, showing that practicing Tai Chi improved middle-aged and elderly diabetic patients’ fasting blood glucose (WMD = -0.60, 95% CI [-1.08, -0.12], p = 0.015), glycosylated hemoglobin (WMD = -0.87, 95% CI [-1.60, -0.14], p = 0.019), total cholesterol (WMD = -0.48, 95% CI [-0.83, -0.14], p = 0.006), triglycerides (WMD = -0.21, 95% CI [-0.37, -0.04], p = 0.014), and low-density lipoprotein cholesterol level significantly (WMD = -0.32, 95% CI [-0.63,-0.00], p = 0.050). Conversely, patients’ high-density lipoprotein cholesterol levels (WMD = 0.09, 95% CI [-0.01, 0.17], p = 0.136) showed no obvious improvement. In conclusion, practicing Tai Chi in sessions lasting longer than 50 minutes (at least three times per week, for at least 12 weeks) can effectively improve glucose and lipid metabolism in middle-aged and elderly diabetic patients. However, several other factors affect glucose and lipid metabolism; therefore, further high-quality research is needed.
... First, it is recommended that people with chronic diseases, such as chronic obstructive pulmonary disease, Parkinson disease, and breast cancer, learn t'ai chi or qigong to improve their quality of life. [2][3][4][5][6][7][8][9][10][11] Qigong can also improve cognitive function in the early stages of dementia, 12 whereas TCM decoctions can be used as adjuvant treatment for patients with stroke and chronic obstructive pulmonary disease, chronic liver disease, chronic heart failure, and chronic or type 2 diabetic kidney disease. [13][14][15][16][17][18][19][20][21][22][23][24][25][26] Second, TCM can improve symptoms. ...
... In contrast, we observed that decreased self-esteem was a significant predictor of a poor physical component of quality of life. In a study with patients undergoing mastectomy, a procedure that similarly leads to the feeling of mutilation of the body, self-esteem was also reported to be decreased, which was a significant predictive factor for impaired health-associated quality of life (59). Cognitive Behavioral Therapy (CBT) was introduced as a method to increase individuals' adaptation to chronic health states. ...
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Objective: The purpose of this study was to identify clinical and psychosocial factors that predict an individual's subjective quality of life after having a lower limb amputation secondary to diabetic foot ulcer. Methods: Study sample comprised 65 patients who underwent amputation because of an infected diabetic foot ulcer. Short Form 36 (SF-36), The Trinity Amputation and Prosthesis Experience Scale (TAPES), Coping Attitudes Evaluation Scale (COPE), Multidimensional Scale of Perceived Social Support (MSPSS), Rosenberg Self-Esteem Scale (RSES) and Amputee Body Image Scale (ABIS) were evaluated through questionnaires. Stepwise linear regression analysis was conducted to assess the factors predicting quality of life. Results: Quality of life was negatively correlated with depression, anxiety, body image, activity limitation and dysfunctional coping strategies; positively correlated with perceived social support, satisfaction with prosthesis, self-esteem and problem focused coping style. Regression analysis showed that satisfaction with prosthesis and existing schemas that body perception, problem-focused coping strategies, dysfunctional coping strategies, self-esteem were factors with the highest predictive power for the physical component of quality of life, while body perception, problem-focused, and dysfunctional coping strategies were the strongest predictors for the mental component of quality of life. Conclusion: Impaired body image and self-esteem, less usage of problem-focused and high usage of dysfunctional coping strategies, in addition low satisfaction with the prosthesis were strongest predictors for poor quality of life. The factors associated with better quality of life after the amputation were investigated in this study and this may support future development of post-amputation rehabilitation strategies for lower limb amputees.
... Breast cancer has been the subject of three specific researches. In 2004, a pilot investigation was published [Mustian et al. 2004]: the TJQ group exhibited improvements in health-related quality of life and self-esteem from baseline to 6 and 12 weeks, while the support group exhibited decline. Anyway, randomized, controlled clinical trials with larger sample sizes were needed. ...
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Background. Since the first, pioneering works were published in 1974 [Ryan], interest in the effects of Taijiquan on health has increasingly involved biomedical research, producing many publications in English on scientific journals. Problem and aim. This study focuses specifically on oncological or neoplastic pathologies to evaluate the degree of integration between the biomedical organicistic approach, typical of western medicine and the holistic approach of traditional Chinese medicine , related to the effects of Taijiquan (TJQ) on this type of pathology. Methods. The study proposes an analysis of the methods and results of two meta-analyses and eight experimental case studies. Results. The fundamental difference in dealing with neoplasic pathology between Western Medicine and Traditional Chinese Medicine is that in the West the cancer is fought, while the cancer patient is treated in the Far East. Here we examine only the aspect of the practice of Taijiquan (TJQ) in dealing with the tumor and the benefits that derive from this practice. Checks related to TJQ show clearly how this discipline and also Qigong (QG) are able to allow for a rebalancing of physiological parameters. This process takes place through various mechanisms: the first of these is a reduction in cellular metabolism involving a reduction in oxygen consumption and therefore the capacity of the organism to reduce its energy intake, its energy consumption, to optimize its biological functions. In this case TJQ is a supplementary practice of the mind/body of Chinese Medicine with a component of physical activity that has positive effects on aerobic capacity, muscle strength and quality of life among cancer survivors. Conclusion. The combined use of chemotherapy and Chinese Medicine increases the effect of chemotherapy and reduces side effects. Often the use of the combination helps the patient to better tolerate the therapy and to complete the therapeutic plan.
... Moreover, Han et al. (28) found that Tai Chi significantly reduced the symptoms of anxiety and depression. Mustian et al. (29) found that Tai Chi increased the selfconfidence of the participants. Fransen et al. (30) found that Tai Chi did not have any positive effect on reducing stress, anxiety, and depression. ...
... Tai chi can therefore play a role in both physical and mental rehabilitation. Some studies have suggested that tai chi has favourable effects on a variety of factors, including cardiovascular protection (10), fall prevention (11), balance (12), flexibility (13), depression (14) and quality of life (QoL) (15). Tai chi has potential benefits in treating different diseases, including chronic obstructive pulmonary disease (16), Parkinson's disease (17), osteoarthritis (18) and stroke (19). ...
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Objective: To systematically synthesize and critically evaluate evidence on the effects of tai chi for patients with type 2 diabetes mellitus. Data sources: Seven electronic databases (Wan Fang, SinoMed, China National Knowledge Infrastructure, VIP, PubMed, Embase, and Cochrane Library) were systematically searched from their inception to March 2018. Study selection: Randomized controlled trials investigating the effects of tai chi on individuals with type 2 diabetes mellitus were eligible. Data extraction: Biomedical outcomes (fasting plasma glucose, glycosylated haemoglobin (HbA1c), fasting insulin, insulin resistance, body mass index, total cholesterol, blood pressure) as well as balance and quality of life-related outcomes were extracted independently by 2 reviewers. Stata 12.0 software was used to synthesize data if there was no or moderate heterogeneity across studies. Otherwise, narrative summaries were performed. Data synthesis: A total of 23 studies (25 articles) involving 1,235 patients were included in this meta-analysis. Significant changes in tai chi-related effects were observed in lowering fasting plasma glucose (standardized mean difference; SMD –0.67; 95% confidence interval (95% CI) –0.87 to –0.47; p
... For example, exercise may prevent or improve side effects including functional and cognitive decline associated with cancer and cancer treatment, as well as ameliorate psychological and behavioral needs such as depression, anxiety, distress, and low self-esteem. These benefits could lead to improvement in treatment adherence, treatment outcomes, and quality of life (QoL) [17][18][19][20][21][22][23][24][25]. However, exercise is not routinely incorporated into cancer care due to multiple barriers, and studies have shown that b50% of physicians recommend exercise in routine clinical care and b20% of patients recalled being instructed to exercise by their oncologist [26][27][28][29]. ...
Article
The incidence of cancer in adults aged 60 years and older is expected to rise, and because cancer is associated with aging, the overall prevalence of cancer will rise as well. With advances in cancer treatment, more older adults will receive treatment but they will also suffer the biopsychosocial consequences of cancer and cancer treatment. In this review, we describe the importance of assessing biopsychosocial needs in this vulnerable population and highlight studies supporting the use of exercise in addressing these needs. We discuss challenges and research gaps in several areas including 1) Identifying the exercise doses and modes for specific outcomes, 2) Understanding risks and safety of exercise, and 3) Implementing exercise programs into clinical practice at the individual, health care team, and organizational levels, including strategies to increase adherence.
... Few studies have noted the role of self-confidence in the quality of life in patients with cancer. For instance, Mustian et al. (Mustian et al., 2004) conducted a study at Rochester School of Medicine in the US and examined the quality of life and self-confidence in 21 women with breast cancer whose treatment had ended over the past 30 months; they held 12 sessions of exercise training for one group and 12 sessions of psychological support therapy for the other group. The six-and 12-week follow-up showed that the group receiving exercise training had a better quality of life and self-confidence compared to the group receiving psychological support. ...
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Introduction Quality of life is an important topic in the study of chronic diseases, especially cancer which can have a major effect on patient self-confidence. This study was conducted to determine quality of life and its relationship with self-confidence in women undergoing treatment for breast cancer. Methods This cross-sectional, descriptive, analytical study was conducted in 2016 on 166 women with breast cancer undergoing treatment at Ghazi, Al-Zahra, International and/or Shams hospitals in Tabriz. The subjects were selected through convenience sampling. A personal-demographic questionnaire, the Cancer Quality of Life Questionnaire (QLQ-C30), and the Rosenberg Self-Esteem Scale (RSES) were completed for each patient. The data obtained were analyzed using independent t-tests, one-way ANOVA, multivariate linear regression and Pearson’s correlation coefficients. Findings The mean total score of quality of life was 59.1±17.4, ranging from 0 to 100. The highest mean score was obtained in the cognitive subscale (74.9±23.8) and the lowest in the emotional subscale (51.4±21.1). The mean score for self-confidence was 0.3 with a standard deviation of 0.1, ranging from -1 to +1. There was a significant positive relationship between self-confidence and quality of life, except in three symptom subscales for diarrhea, constipation and loss of appetite (P<0.05). Self-confidence, disease duration, lifestyle, marital satisfaction and caregiver status were among the predictors of quality of life. Discussion Given the significant relationship between quality of life and self-confidence, health care providers may need to pay special attention to women undergoing treatment for breast cancer and perform timely measures to maintain their belief in themselves.
... Further, it potentially has greater psychological advantages than Bstandard^physical exercise approaches. Thus, Tai Chi may be a better intervention for CRF management [21,27,43,44]. This background information leads us to conduct a meta-analysis focused on the effect of Tai Chi alone on CRF, rather than on other forms of exercise. ...
Article
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Purpose: This meta-analysis investigated the effectiveness of Tai Chi on cancer-related fatigue (CRF). Methods: Nine databases (PubMed, Web of Science, Ovid, the Cochrane Library, Embase, and four Chinese databases) were searched to identify randomized controlled trials (RCTs) that evaluated the effects of Tai Chi on CRF. The reference lists given in the identified RCTs were also reviewed to identify potentially relevant studies. Results: Six RCTs involving 373 patients were included. The change in short- and long-term CRF (SCRF and LCRF, respectively) was calculated as the change in the mean score for CRF from baseline to the end of intervention period and to the end of post-intervention follow-up, respectively. Pooled results suggested that Tai Chi had a significant positive effect on standard mean difference (i.e., SCRF; SMD = - 0.54; p < 0.0001), but the impact on LCRF remained unclear. Subgroup analyses of SCRF indicated positive effects of Tai Chi among patients with breast (SMD = - 0.81; p < 0.00001) and lung cancer (SMD = - 0.50; p = 0.002), but not prostate cancer (p = 0.98). Tai Chi also had effects on SCRF that were superior to physical exercise and psychological support (SMD = - 0.49 and - 0.84, respectively; both p < 0.05). A longer intervention time (8-12 weeks) benefited SCRF more than a shorter time (SMD = - 1.08 and - 0.36, respectively; both p < 0.05). Conclusion: Tai Chi for more than 8 weeks has short-term ameliorative effects on CRF, especially among patients with breast and lung cancer. Its beneficial effects are superior to physical exercise and psychological support. It remains unclear whether there are long-term benefits, and further study is needed.
... Studies have found that Tai chi can also lessen fatigue and improve quality of life. Hence, the improvement in fatigue and mood in this study might be attributed to the stretching exercises done by the control group (17). Therefore, more studies are needed to compare exercise and bed rest especially during the treatment period. ...
Article
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Objectives: Improvement in cancer care increases life expectancy of patients with cancer, most of whom have experienced prolonged episodes of fatigue during and after their treatment. This has been found to reduce the quality of life and increase morbidity and mortality of such patients. Therefore, additional interventions are beneficial to improve overall quality of life as well as longevity. There is growing evidence that exercise is beneficial for oncology patients though improvements in their physical, physiological abilities and functions. The purpose of the present article is to evaluate the current evidence to determine if exercise could be used as a safe and effective medicine to reduce fatigue and improve quality of life in these patients. Methods: Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and CINAHL search engines were electronically searched and 21 empirical studies, published between 1995 and 2009, were located. Results: There is accumulative data in the literature supporting the effectiveness of exercise interventions on the physical and psychological wellbeing of patients with cancer. Exercise can improve muscle mass and strength and whole body oxygen uptake which are reduced during bed rest, infection and cancer treatments. Discussion: Growing evidence is now supporting the effectiveness of exercise on specific populations such as women suffering from breast cancer. However, the effect of exercise on other populations such as children and patients suffering from other types of cancers is vague. Therefore, more research is needed to define scientific evidence based rehabilitation protocols for oncology patients with different types of cancer.
... Many studies have described the effects of exercise training on the levels of biomarkers, including various adipokines. Some studies have suggested that tai chi exercise induces changes in inflammatory cytokine levels [9]. However, there have been controversial results regarding the effects of exercise on leptin and adiponectin levels. ...
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Background Exercise has been identified as a beneficial intervention to enhance quality of life in breast cancer survivors. In addition, there has been a noteworthy increase in studies emphasizing the benefits of exercise in cancer. We sought to summarize the empirical literature concerning the effects of exercise on physical fitness and biomarker levels in breast cancer survivors according to the type of exercise. Methods We searched PubMed and PubMed Central for studies on the association of exercise with the levels of various biomarkers and physical fitness in breast cancer survivors. We investigated the effects of different types of exercise (aerobic, resistance, or combined) on breast cancer survivors, with changes in physical fitness and biomarker levels as the primary outcomes. Results In total, 118 research papers published from 2012 to July 2016 were retrieved from PubMed and PubMed Central. Of these, 24 papers met our inclusion criteria. All types of exercise were found to improve physical fitness in breast cancer survivors. However, the results with regard to biomarkers were controversial. Conclusion The findings of this review suggest that combined exercise is associated with better outcomes than aerobic or resistance exercise alone in breast cancer survivors.
... 14 As Tai Chi has become a popular physical activity, it attracts researchers worldwide and has been shown to have positive impact on physical, physiological, and psychological changes in healthy and clinical populations (e.g., Parkinson's disease, cardiovascular diseases, breast cancer survivor, and mental illness). [15][16][17][18][19][20] In recent years, some researchers also attempted to determine whether Tai Chi has a protective effect in attenuating BMD loss in postmenopausal women. 12, 21,22 Based on a number of randomized controlled studies on this topic, researchers conducted a systematic review and gave a hint that a long-term (at least 24 weeks) Tai Chi-based intervention program containing resistance training-based component is required to obtain protective effect in attenuating BMD loss in postmenopausal women. ...
Article
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Background and objectives: According to Chinese White Paper on Osteoporosis Prevention (2009), an estimated number of 69 million Chinese people are experiencing osteoporosis caused by loss and deterioration of bone mineral density (BMD). Middle-aged women have a greater possibility in developing osteoporosis in comparison with men because of a decreased estrogen level and degeneration in physical fitness level. A Tai Chi-based intervention in the present study will be created based on four components consisting of fall-prevention/balance training, stretching/flexibility training, resistance training (Tai Chi push hand), and strength training. >Design: A prospective three-arm parallel randomized controlled trial. Methods: This study will take place in ten community centers in southeast China, and postmenopausal women aged 50–65 years and without menses for 6–12 months will be recruited and randomly assigned into three groups with the allocation ratio of 1:1:1 (n = 50 for each group), including two experimental groups (a traditional Tai Chi group and a modified Tai Chi-based intervention group) and a control group. Participants in the control group will be asked to maintain their original lifestyle during the 12-month intervention period. Participants in the traditional Tai Chi and modified Tai Chi-based intervention groups will experience the traditional Yang-style Tai Chi and receive the modified Tai Chi-based intervention, respectively. The modified Tai Chi-based intervention contains four components: 1) eight Tai Chi based fall-prevention movements; 2) ten Qigong-based stretching/flexibility movements; 3) eight resistance training-based Tai Chi push hand movements; 4) eight Chen style-based Tai Chi movements. For both the experimental groups, study participants will experience four 60-minute Tai Chi training sessions weekly for 12 months. >Outcome measures: BMD at multiple musculoskeletal regions is primary outcome measure. Secondary outcome measures include low limb muscle strength, physical function, and reaction time at both upper and low limbs, which will be measured at baseline and 12 months (at the end of the intervention). Discussion: Results of this study will provide preliminary evidence regarding the value of Tai Chi movement as an intervention for attenuating BMD loss in postmenopausal women. >Ethics and dissemination: This study protocol was approved by the Institution Review Board of Shanghai Sports University (approval No. 11290502800) and will be performed in accordance with the principles of the Declaration of Helsinki. Patient recruitment started in August 2017. The analysis of primary outcome measures will be completed in October 2018. The estimated study completion date is June 2019. Dissemination plans include presentations at scientific conferences and scientific publications. Trial registration: This trial was registered with the Chinese Clinical Trial Registry (registration No. ChiCTR-IOR-15005887) on 27 January 2015.
... [51][52][53] Polarity therapy, 53,54 (which is energy or light touch intervention), tai chi, 55-59 and yoga 60,62-67 may be effective for treating insomnia, anxiety, depression, impaired cardiovascular function, impaired muscular function, cancer-related fatigue, and quality of life. Tai chi [55][56][57][58][59] and yoga 60,[62][63][64][65][66][67] also meet the criteria for being defined as exercise, and the interventions that have been shown to be most effective require similar metabolic energy expenditure to that of low-to moderate-intensity exercise. 55-60,62-68 A recent review of 12 studies has shown acupunture's positive signal for treating anxiety, insomnia, depression, and improving quality of life in cancer patients and survivors. ...
Article
Cancer-related fatigue, insomnia, and cancer-related cognitive impairment are commonly experienced symptoms that share psychological and physical manifestations. One or more of these symptoms will affect nearly all patients at some point during their course of treatment or survivorship. These side effects are burdensome and reduce patients' quality of life well beyond their cancer diagnosis and associated care treatments. Cancer-related fatigue, insomnia, and cancer-related cognitive impairment are likely to have multiple etiologies that make it difficult to identify the most effective method to manage them. In this review, we summarized the information on cancer-related fatigue, insomnia, and cancer-related cognitive impairment incidence and prevalence among breast cancer patients and survivors as well as recent research findings on pharmaceutical, psychological, and exercise interventions that have shown effectiveness in the treatment of these side effects. Our review revealed that most current pharmaceutical interventions tend to ameliorate symptoms only temporarily without addressing the underlying causes. Exercise and behavioral interventions are consistently more effective at managing chronic symptoms and possibly address an underlying etiology. Future research is needed to investigate effective interventions that can be delivered directly in clinic to a large portion of patients and survivors.
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Introduction: Although numerous related articles have been published to date, there is still a lack of bibliometric analysis to summarize the highly cited papers on Tai Chi-related research. This study aimed to identify and characterize the 50 top-cited clinical studies published in Tai Chi. Methods: Using the terms "Tai Chi" or "Taiji," we searched for publications from the Web of Science Core Collection (SCI-EXPANDED). The 50 top-cited clinical studies were included for further analysis. The first author, country, publication year, journal, total citations, average citations per year (from 2010 to 2023), participants, and study design were extracted from each eligible article. In addition, VOSviewer software was used to analyze keywords co-occurring in 50 articles to illustrate the research hotspots related to Tai Chi. Results: The 50 top-cited articles were published between 1996 and 2017, with a mean of 176.02 (range 101 to 711) citations per article. The 50 top-cited articles were published in 28 journals, predominantly in the Journal of the American Geriatrics Society (n = 9) and Archives of Physical Medicine and Rehabilitation (n = 7). These articles originated from 11 countries, with the United States (n = 30) and China (n = 14) being the most prolific. Clinical research hotspots around Tai Chi include populations: Parkinson's, stroke, mild cognitive impairment, osteoarthritis, postmenopausal women, and older adults; and outcomes: physical activity, sleep quality, geriatric depression, fall risk, and balance control. Conclusion: The 50 most influential articles in Tai Chi clinical research were mainly published by American and Chinese scholars in geriatric and rehabilitation medicine journals, reflecting the future research hotspots of Tai Chi and healthy aging and disease prognosis.
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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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Esta obra reúne um conjunto de treze trabalhos que, embora possua capítulos com temáticas um pouco distintas, se aproximam pela relação direta ou indireta que expressam com o universo da Educação Física. Trata-se de uma coletânea que conta com a colaboração de pesquisadores do Brasil e de Portugal, que possuem compreensões muito pertinentes e que merecem ser compartilhadas sobre a Educação Física, a Infância e a Saúde, bem como aos temas que a eles se articulam. A coletânea foi organizada e publicada de maneira a dar continuidade às discussões compartilhadas em sua primeira edição, publicada em versões eletrônica e digital no início do ano de 2020, também pela Editora Navegando. Esta nova obra pretende, por um lado, apresentar conceitos e discutir aspectos sobre “Educação Física, Infância e Saúde”, e, por outro lado, almeja contribuir com reflexões e problematizações sobre assuntos que permeiam o mundo, sobremaneira, da ciência, do conhecimento, da educação, da cultura midiática, das subjetividades, do exercício físico, do pilates, da saúde pública, do jogo, do brincar, do currículo, da dança, da nutrição, da infância, e outros, como terão a oportunidade de verificar nas entrelinhas dos capítulos. Espero que este livro contribua em várias dimensões com o processo de construção e circulação do conhecimento e, por fim, desejo que ocorra uma estreita relação entre o leitor e as palavras escritas cuidadosamente pelos autores, de maneira a provocar boas reflexões e debates necessários para o avanço da nossa área. Boa leitura
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Aim of the study: The goal of our study was to assess the sexual functioning of patients undergoing mastectomy, five years after surgery, compared to a control group. Material and methods: A cross-sectional study included 170 patients five years post mastectomy (group A1) and 149 healthy women (group A2) who had never been diagnosed with breast cancer. The study was conducted at the Oncology Centre in Bydgoszcz, at the Amazon Clubs, and at the University of the Third Age by the University of Economy in Bydgoszcz. Standardised questionnaires: the Female Sexual Function Index (FSFI) and Rosenberg's SES (self-esteem scale) were used. Results: Our study results show significantly worse sexual functioning in the domains pertaining to desire (p = 0.0015), arousal (p = 0.0052), lubrication (p = 0.0026), ability to reach orgasm (p = 0.0417), sexual satisfaction (p = 0.0142), and the presence of clinically significant sexual dysfunction (p = 0.0028) among patients after amputation of the mammary gland. On the scale of pain relating to sexuality, there were no significant differences between the two groups (p> 0.05). The overall score in the FSFI questionnaire was also lower (p = 0.0066) among women after mastectomy. Highly statistically significant (p < 0.0001) differences in self-esteem were also noted between the two groups, with worse results observed in patients after mastectomy. Conclusions: Diagnosis of sexual dysfunction in patients treated for breast cancer allows timely implementation of counselling and interventional therapy depending on the causal factors and individual preferences of patients.
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For most patients, receiving a cancer diagnosis is an anxiety provoking experience. During this overwhelming time, many of our patients who are interested or curious find it difficult to make informed decisions about the use of integrative therapies. An integrative health professional, knowledgeable about cancer and integrative therapies, can be an invaluable resource. The main objective of the integrative oncology encounter is to enhance the exchange of ideas between patients and clinicians regarding complementary and alternative medicine decisions, and to direct the patient to beneficial therapies. Use of mind body therapies in supportive cancer care has become commonplace throughout cancer centers in the United States and abroad. Imagery has gained significant popularity as a mind–body technique used by cancer patients throughout the course of treatment and into survivorship. Hypnosis is a state of calm focused attention that utilizes enhanced mental imagery and directed suggestions for therapeutic purposes in patients.
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Purposes To assess the effects of Tai Chi on quality of life (QOL) of cancer survivors. Methods The following databases were searched: PubMed, Cochrane CENTRAL, EBSCO (including MEDLINE, CINAHL, and other databases), ScienceDirect, CNKI, Wangfang Data, and CQVIP until April 25, 2018. Randomized controlled trials (RCTs) published in English or Chinese examining the effects of Tai Chi intervention for cancer survivors were included. The primary outcome was QOL; the secondary outcomes were limb function/muscular strength, immune function indicators, cancer-related fatigue (CRF), and sleep disturbance. Methodological quality was assessed using the Cochrane Risk of Bias tool. Results of RCTs were pooled with mean difference (MD) or standardized mean difference (SMD) with 95% confidence intervals (CI). Quality of evidence for each outcome was assessed with the GRADE system. Results Twenty-two RCTs were included in this review. Tai Chi improved the physical (SMD 0.34, 95%CI 0.09, 0.59) and mental health (SMD 0.60, 95%CI 0.12, 1.08) domains of quality of life. The intervention improved the limb/muscular function of breast cancer survivors (SMD 1.19, 95%CI 0.63, 1.75) and in mixed samples of cancer survivors reduced the levels of cortisol (MD − 0.09, 95%CI − 0.16, − 0.02), alleviated CRF (SMD − 0.37, 95%CI − 0.70, − 0.04), and promoted sleep (SMD − 0.37, 95%CI − 0.72, − 0.02). Conclusion There is low-level evidence suggesting that Tai Chi improves physical and mental dimensions of QOL and sleep. There is moderate-level evidence suggesting Tai Chi reduces levels of cortisol and CRF and improves limb function. Additional studies with larger sample sizes and with higher-quality RCT designs comparing different regimens of Tai Chi are warranted.
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Objective Recent research has documented the harmful effects of ambivalence over emotional expression (AEE) on psychological well‐being, but few studies to date have examined AEE among Mainland Chinese breast cancer patients, an ethnic group that prioritizes emotion restraint to preserve social harmony. The present study examined the relationship between AEE and well‐being (viz., anxious and depressive symptoms, and quality of life), and evaluated perceived social support as a potential mediator of this relationship in a sample of Mainland Chinese breast cancer patients. Method 327 Chinese breast cancer patients recruited from Weifang, China completed a self‐reported questionnaire containing the Ambivalence over Emotional Expression Questionnaire (AEQ), the Medical Outcomes Study Social Support Scale (MOS‐SSS), the Self‐rating Anxiety Scale (SAS), the Self‐rating Depression Scale (SDS), and the Functional Assessment of Cancer Therapy‐Breast (FACT‐B). Results Overall, Mainland Chinese breast cancer patients endorsed high levels of AEE. A series of mediation analyses revealed perceived social support served as a partial mediator of the relationship between AEE and well‐being. Specifically, AEE was associated with lower perceived social support (βs = ‐.13, p < .001), which in turn, was associated with greater anxious symptoms (β = .23, p < .001), depressive symptoms (β = .20, p < .001) and lower quality of life (β = ‐.30, p < .001). Conclusions The harmful relationship between AEE and well‐being is partially explained by reduced social support. Psychosocial interventions that facilitate emotional disclosure without harming social harmony may be culturally‐effective for mainland Chinese breast cancer patients.
Article
This work intends to develop an intelligent, four-dimensional (namely X-Y-Z plus somatosensory), partial control, and virtual-reality-enabled Tai-Chi System (VTCS). Tai-Chi is a traditional mind-body wellness and healing art, and its clinical benefits have been well documented. VTCS integrates Tai-Chi with a series of cutting-edge computer technologies including 4D sensor technology, big-data, signal processing and analysis, human body kinematics, deep learning, virtual reality, and 4D-reconstruction, etc. The aforementioned system will generate a controllable and consistent 4D experience to help, push and coach (HPC) people to get involved in sports activities. In particular, VTCS makes Tai-Chi movements suitable to individuals who suffer from mobility disabilities due to diseases or injuries as an accessible rehabilitation and fitness modality. VTCS consists of the following modules: acquisition, transmission and reconstruction of user׳s 4D data, data preprocessing, identification of user׳s kinetic movement, and individualized movement choreography. Under the support of collaborative hospitals, the physiological and psychological benefits brought about by VTCS will be critically assessed.
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Although the treatment of cancer is more effective now than ever, patients with cancer still face acute and chronic toxicities such as fatigue, cardiotoxicity, pain, cognitive impairment, and neurotoxicity. In this narrative review, we briefly discuss the use of exercise for toxicity management in patients with cancer, biological mechanisms underlying the toxicities and the effects of exercise, barriers that patients- especially underserved patients-face in adopting and adhering to exercise programs, and new technologies to overcome barriers to exercise. Our conclusions and clinical suggestions are: (1) exercise is safe and effective for treating many toxicities; (2) patients can benefit from a variety of exercise modalities (e.g., walking, cycling, resistance bands, yoga); (3) exercise should be started as soon as possible, even before treatments begin; (4) exercise should be continued as long as possible, as a lifestyle; and (5) barriers to exercise should be identified and addressed, (e.g., continually encouraging patients to exercise, using mobile technology, advocating for safe communities that encourage active lifestyles). Future research should inform definitive clinical guidelines for the use of exercise to ameliorate toxicities from cancer and its treatment.
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Background: Women with a diagnosis of breast cancer may experience short- and long-term disease and treatment-related adverse physiological and psychosocial outcomes. These outcomes can negatively impact prognosis, health-related quality of life (HRQoL), and psychosocial and physical function. Physical activity may help to improve prognosis and may alleviate the adverse effects of adjuvant therapy. Objectives: To assess effects of physical activity interventions after adjuvant therapy for women with breast cancer. Search methods: We searched the Cochrane Breast Cancer Group (CBCG) Specialised Registry, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Physiotherapy Evidence Database (PEDro), SPORTDiscus, PsycINFO, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform, on 18 September 2015. We also searched OpenGrey and Healthcare Management Information Consortium databases. Selection criteria: We searched for randomised and quasi-randomised trials comparing physical activity interventions versus control (e.g. usual or standard care, no physical activity, no exercise, attention control, placebo) after adjuvant therapy (i.e. after completion of chemotherapy and/or radiation therapy, but not hormone therapy) in women with breast cancer. Data collection and analysis: Two review authors independently selected studies, assessed risk of bias, and extracted data. We contacted trial authors to ask for additional information when needed. We calculated an overall effect size with 95% confidence intervals (CIs) for each outcome and used GRADE to assess the quality of evidence for the most important outcomes. Main results: We included 63 trials that randomised 5761 women to a physical activity intervention (n = 3239) or to a control (n = 2524). The duration of interventions ranged from 4 to 24 months, with most lasting 8 or 12 weeks (37 studies). Twenty-eight studies included aerobic exercise only, 21 involved aerobic exercise and resistance training, and seven used resistance training only. Thirty studies described the comparison group as usual or standard care, no intervention, or control. One-fifth of studies reported at least 20% intervention attrition and the average physical activity adherence was approximately 77%.No data were available on effects of physical activity on breast cancer-related and all-cause mortality, or on breast cancer recurrence. Analysis of immediately postintervention follow-up values and change from baseline to end of intervention scores revealed that physical activity interventions resulted in significant small-to-moderate improvements in HRQoL (standardised mean difference (SMD) 0.39, 95% CI 0.21 to 0.57, 22 studies, 1996 women; SMD 0.78, 95% CI 0.39 to 1.17, 14 studies, 1459 women, respectively; low-quality evidence), emotional function (SMD 0.21, 95% CI 0.10 to 0.32, 26 studies, 2102 women, moderate-quality evidence; SMD 0.31, 95% CI 0.09 to 0.53, 15 studies, 1579 women, respectively; low-quality evidence), perceived physical function (SMD 0.33, 95% CI 0.18 to 0.49, 25 studies, 2129 women; SMD 0.60, 95% CI 0.23 to 0.97, 13 studies, 1433 women, respectively; moderate-quality evidence), anxiety (SMD -0.57, 95% CI -0.95 to -0.19, 7 studies, 326 women; SMD -0.37, 95% CI -0.63 to -0.12, 4 studies, 235 women, respectively; low-quality evidence), and cardiorespiratory fitness (SMD 0.44, 95% CI 0.30 to 0.58, 23 studies, 1265 women, moderate-quality evidence; SMD 0.83, 95% CI 0.40 to 1.27, 9 studies, 863 women, respectively; very low-quality evidence).Investigators reported few minor adverse events.Small improvements in physical activity interventions were sustained for three months or longer postintervention in fatigue (SMD -0.43, 95% CI -0.60 to -0.26; SMD -0.47, 95% CI -0.84 to -0.11, respectively), cardiorespiratory fitness (SMD 0.36, 95% CI 0.03 to 0.69; SMD 0.42, 95% CI 0.05 to 0.79, respectively), and self-reported physical activity (SMD 0.44, 95% CI 0.17 to 0.72; SMD 0.51, 95% CI 0.08 to 0.93, respectively) for both follow-up values and change from baseline scores.However, evidence of heterogeneity across trials was due to variation in intervention components (i.e. mode, frequency, intensity, duration of intervention and sessions) and measures used to assess outcomes. All trials reviewed were at high risk of performance bias, and most were also at high risk of detection, attrition, and selection bias. In light of the aforementioned issues, we determined that the evidence was of very low, low, or moderate quality. Authors' conclusions: No conclusions regarding breast cancer-related and all-cause mortality or breast cancer recurrence were possible. However, physical activity interventions may have small-to-moderate beneficial effects on HRQoL, and on emotional or perceived physical and social function, anxiety, cardiorespiratory fitness, and self-reported and objectively measured physical activity. The positive results reported in the current review must be interpreted cautiously owing to very low-to-moderate quality of evidence, heterogeneity of interventions and outcome measures, imprecision of some estimates, and risk of bias in many trials. Future studies with low risk of bias are required to determine the optimal combination of physical activity modes, frequencies, intensities, and durations needed to improve specific outcomes among women who have undergone adjuvant therapy.
Article
Purpose: The present study examined perceived social support as a mediator of the longitudinal link between ambivalence over emotional expression (AEE) and quality of life among a sample of Chinese breast cancer survivors. Methods: Ninety-six Chinese breast cancer survivors recruited from Southern California completed four surveys in total: (1) a baseline survey (T1), 1-month follow-up (T2), 3-month follow-up (T3), and 6-month follow-up (T4). Participants filled out a paper-pen questionnaire containing the Ambivalence over Emotional Expression Questionnaire (AEQ), the Functional Assessment of Cancer Therapy-General (FACT-G), and the Medical Outcomes Study Social Support Scale (MOS-SSS). Results: Higher T1 AEE was associated with lower T1 social support (B = -0.01, SE = 0.004, p < 0.01) which in turn was associated with lower quality of life at T2 (B = 2.98, SE = 0.64, p < 0.01), T3 (B = 2.14, SE = 0.54, p < 0.01), and T4 (B = 2.08, SE = 0.68, p < 0.01). Conclusions: These results suggest that the harmful effect of AEE on quality of life is explained by reduced social support. Given the detrimental effects of AEE on social support and quality of life, future research on interventions that facilitate emotional disclosure is needed. Implications for the effects of Chinese culture on AEE are discussed.
Article
Background: The prognosis and survival rate of women with breast cancer have significantly improved worldwide. Effective home-based multidimensional programmes for breast cancer survivors have gained an ever greater emphasis in survivorship care to maximise women's quality of life for their successful transition to rehabilitation and normal life. It is important to summarise the best available evidence to evaluate the effects of home-based multidimensional survivorship programmes on quality of life in women within 10 years of the completion of surgery or adjuvant cancer therapy for breast cancer, or both. Objectives: To assess the effects of home-based, multidimensional survivorship (HBMS) programmes on maintaining or improving the quality of life in breast cancer survivors. Search methods: In April 2016 we searched the Cochrane Breast Cancer Specialised Register, CENTRAL, PubMed, Embase, CINAHL Plus, PsycINFO, Web of Science, and the World Health Organization's International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov. We also screened reference lists of all identified studies and contacted study authors. Selection criteria: Randomised controlled trials (RCTs) and quasi-RCTs assessing the effects of HBMS programmes in maintaining or improving quality of life in women with stages 0 to 3 breast cancer who completed primary cancer treatment (surgery or adjuvant cancer therapy, or both) up to 10 years earlier. We considered studies where the interventions included more than one of the following listed components: educational (such as information provision and self-management advice), physical (such as exercise training and resistance training) and psychological (such as counselling and cognitive therapies), to constitute a multidimensional programme. Interventions had to be allowed to be carried out at home. Data collection and analysis: Two authors independently assessed eligible studies for inclusion, and performed quality assessment and extracted relevant data of the included studies. Quality of life was the primary outcome of the review. Main results: We included 22 RCTs and four quasi-RCTs on 2272 participants. We categorised the intervention components into four groups: educational and psychological; educational and physical; physical and psychological; and educational, physical and psychological. Most of the studies used usual care (routine medical follow-up services) as the comparator. A few studies used a lower level or different type of intervention (e.g. stress management or exercise) or attention control as the comparator.We used the Functional Assessment of Cancer Therapy-Breast (FACT B), European Organisation for Research and Treatment of Cancer Quality of Life C30 (EORTC C30), Quality of Life (QoL) Breast Cancer, and SF36 questionnaires to assess quality of life. HBMS programmes may increase breast cancer-specific quality of life and global quality of life immediately after the intervention, as measured by FACT-B and EORTC C30 (FACT-B: mean difference (MD) 4.55, 95% confidence interval (CI) 2.33 to 6.78, 7 studies, 764 participants; EORTC: MD 4.38, 95% CI 0.11 to 8.64, 6 studies; 299 participants; moderate-quality evidence). There was no evidence of a difference in quality of life as measured by QoL-Breast Cancer or SF-36 (QoL-Breast Cancer: MD 0.42, 95% CI -0.02 to 0.85, 2 studies, 111 participants, very low-quality evidence; physical composite score SF36: MD 0.55, 95% CI -3.52 to 4.63, 2 studies, 308 participants, low-quality evidence).We observed a similar pattern at one to three months after the intervention: FACT-B (MD 6.10, 95% CI 2.48 to 9.72, 2 studies, 426 participants), EORTC-C30 (MD 6.32, 95% CI 0.61 to 12.04, 2 studies; 172 participants) and QoL-Breast Cancer (MD 0.45, 95% CI -0.19 to 1.09, 1 study, 61 participants). At four to six months and 12 months, there was no evidence of a difference in quality of life between groups (four to six months: EORTC - MD 0.08, 95% CI -7.28 to 7.44, 2 studies; 117 participants; SF-36 - MD -1.05, 95% CI -5.60 to 3.51, 2 studies, 308 participants; 12 months: EORTC - MD 2.04, 95% CI -9.91 to 13.99, 1 study; 57 participants).Functional status was incorporated into the quality of life subscale findings. HBMS programmes may decrease anxiety (MD of Hospital Anxiety and Depression Scale (HADS) -1.01, 95% CI -1.94 to -0.08, 5 studies, 253 participants, low-quality evidence) compared to control immediately after the intervention but the effect did not persist at four to six months. There was no evidence of improvements in depression immediately after HBMS (MD of HADS -1.36, 95% CI -2.94 to 0.22, 4 studies, 213 participants, low-quality evidence) or at follow-up. HBMS programmes may also decrease fatigue (MD -1.11, 95% CI -1.78 to -0.45, 3 studies, 127 participants; low-quality evidence) and insomnia (MD -1.81, 95% CI -3.34 to -0.27, 3 studies, 185 participants, low-quality evidence).None of the included studies reported service needs and utilisation and cost of care, and therefore the effect of HBMS programmes on healthcare utilisation and cost is unknown. Due to the variations in assessment methods of adherence among the eight studies, we could not combine the results for meta-analysis. We synthesised the results narratively, with the reported adherence rates of 58% to 100%. Authors' conclusions: The results of this systematic review and meta-analysis revealed that HBMS programmes in breast cancer survivors appear to have a short-term beneficial effect of improving breast cancer-specific quality of life and global quality of life as measured by FACT-B and EORTC-C30, respectively. In addition, HBMS programmes are associated with a reduction in anxiety, fatigue and insomnia immediately after the intervention. We assessed the quality of evidence across studies as moderate for some outcomes, meaning that we are fairly confident about the results, while we assessed other outcomes as being low-quality, meaning that we are uncertain about the result.
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Answer questions and earn CME/CNE Patients with breast cancer commonly use complementary and integrative therapies as supportive care during cancer treatment and to manage treatment‐related side effects. However, evidence supporting the use of such therapies in the oncology setting is limited. This report provides updated clinical practice guidelines from the Society for Integrative Oncology on the use of integrative therapies for specific clinical indications during and after breast cancer treatment, including anxiety/stress, depression/mood disorders, fatigue, quality of life/physical functioning, chemotherapy‐induced nausea and vomiting, lymphedema, chemotherapy‐induced peripheral neuropathy, pain, and sleep disturbance. Clinical practice guidelines are based on a systematic literature review from 1990 through 2015. Music therapy, meditation, stress management, and yoga are recommended for anxiety/stress reduction. Meditation, relaxation, yoga, massage, and music therapy are recommended for depression/mood disorders. Meditation and yoga are recommended to improve quality of life. Acupressure and acupuncture are recommended for reducing chemotherapy‐induced nausea and vomiting. Acetyl‐L‐carnitine is not recommended to prevent chemotherapy‐induced peripheral neuropathy due to a possibility of harm. No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment‐related side effects. In summary, there is a growing body of evidence supporting the use of integrative therapies, especially mind‐body therapies, as effective supportive care strategies during breast cancer treatment. Many integrative practices, however, remain understudied, with insufficient evidence to be definitively recommended or avoided. CA Cancer J Clin 2017;67:194–232 . © 2017 American Cancer Society .
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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.
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This book attempts to pull together the diverse range of research on self-concept from the medical sciences, psychology, sociology, physical education, and exercise and sport science. In doing so, this book attempts to trace how the concept of the physical self has evolved over the last decade and how it has contributed to our understanding of the total self. The contributors examine how the physical self motivates and determines behavior and contributes to mental health and well-being. The following specific issues as they relate to the physical self are covered: physical self-perception measurement; research considerations; body image; social construction; role of sport and physical education in children's self-esteem; identity development; weight management; disability issues and the therapeutic effects of exercise. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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We have highlighted some of the considerations necessary to measure quality of life in cancer patients of various ages and at different stages of disease and treatment. Although quality of life is a multidimensional and complex construct, its measurement is both feasible and practical. Quality of life can be measured as a routine part of active treatment and long-term follow-up. The measurement of quality of life in cancer patients is best accomplished with an integral approach that combines a general measure of quality of life with specific items written to apply only to a subset of patients with special needs and concerns.
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Approximately 1 million Americans are diagnosed with cancer each year and must cope with the disease and treatments. Many studies have documented the deteriorations in quality of life that occur. These data suggest that the adjustment process is burdensome and lengthy. There is ample evidence showing that adults experiencing other long-term stressors experience not only high rates of adjustment difficulties (e.g., syndromal depression) but important biologic effects, such as persistent downregulation of elements of the immune system, and adverse health outcomes, such as higher rates of respiratory tract infections. Thus, deteriorations in quality of life with cancer are underscored if they have implications for biological processes, such as the immune system, relating to disease progression and spread. Considering these and other data, a biobehavioral model of adjustment to the stresses of cancer is offered, and mechanisms by which psychological and behavioral responses may influence biological processes and, perhaps, health outcomes are proposed. Finally, strategies for testing the model via experiments testing psychological interventions are offered.
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The study's purpose was to describe the relations among self-esteem, learned resourcefulness, and social support, and to show how they predict health-related quality of life (HRQL) for long-term survivors of cancer. With advances in oncology and increased survival, variables influencing the HRQL of long-term survivors of cancer must be explored. The design was descriptive and correlational. Five instruments were sent to 456 long-term survivors in southern California. Data were analyzed for 62 of 111 consenting individuals, most of whom were married, retired, white, college-educated, female survivors of breast cancer older than 60 years of age treated by radiation and surgery. Subjects with higher self-esteem reported higher HRQL (r = 0.69; p = 0.00). Learned resourcefulness had a significant negative relation with HRQL (r = -0.32; p = 0.01). Social support was operationalized as functional components, network properties, and recent loss. Only the loss component of social support had a significant negative relation with HRQL (r = -0.38; p = 0.00). Together, the three variables explained more than half of the variance (R2 = 0.53) of HRQL, with self-esteem being the strongest predictor. The HRQL of long-term survivors of cancer may increase with interventions such as both survivor- and nurse-led support groups aimed at supporting and improving self-esteem. In addition, education to anticipate social support losses may further enhance HRQL.
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We focus on quality of life (QOL) measurement as applied to chronic illness. There are 2 major types of health-related quality of life (HRQOL) instruments-generic health status and targeted. Generic instruments offer the opportunity to compare results across patient and population cohorts, and some can provide normative or benchmark data from which to interpret results. Targeted instruments ask questions that focus more on the specific condition or treatment under study and, as a result, tend to be more responsive to clinically important changes than generic instruments. Each type of instrument has a place in the assessment of HRQOL in chronic illness, and consideration of the relative advantages and disadvantages of the 2 options best drives choice of instrument. The Functional Assessment of Chronic Illness Therapy (FACIT) system of HRQOL measurement is a hybrid of the 2 approaches. The FACIT system combines a core general measure with supplemental measures targeted toward specific diseases, conditions, or treatments. Thus, it capitalizes on the strengths of each type of measure. Recently, FACIT questionnaires were administered to a representative sample of the general population with results used to derive FACIT norms. These normative data can be used for benchmarking and to better understand changes in HRQOL that are often seen in clinical trials. Future directions in HRQOL assessment include test equating, item banking, and computerized adaptive testing.
Article
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.
Article
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.
Article
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.
Article
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
Article
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.
Article
Using a randomized controlled trial, this study examined whether a 6-month Tai Chi exercise program enhanced elderly individuals' multidimensional, hierarchical physical self-esteem. Participants either continued their daily routine activities or participated in a Tai Chi exercise class performing slow rhythmic movements. Both global and domain-specific physical esteem measures were assessed at baseline, at 3 months, and at the 6-month termination of the intervention. Growth curve models were used to analyze the repeated-measures data. Results indicated that individuals who participated in the 6-month Tai Chi exercise program showed increased levels of global self-esteem, domain-specific physical self-worth, and subdomain-specific esteem of attractive body, physical strength, and physical condition. Thus, Tai Chi, a simple, low-cost form of physical activity, has the potential to alter favorably specific facets of physical self-worth/ esteem in older adults, which may in turn enhance important aspects of their quality of life.
Article
The psychological effects of two group therapy intervention models with newly diagnosed primary breast cancer patients were evaluated. Sixty women were randomized to attend either 12 sessions of group Cognitive Behavior Therapy (CBT) or a supportive therapy group. Self-report psychological assessments were completed before and after therapy, and at 4 months follow-up. In the period following therapy, patients in both groups showed significant reductions in depression, quality of life and self-esteem relative to their baseline scores. Patients in the CBT group also showed significant improvements in quality of life and self-esteem relative to those in the supportive therapy group. These differences were no longer apparent at the 4-month follow-up. The findings suggest that a group CBT intervention generates greater short-term benefits than a supportive therapy group among primary breast cancer patients. Some limitations of the design are discussed.
Article
This index is intended to facilitate finding information on instruments discussed in Robinson, Shaver, and Wrightsman (1991). The book has a detailed table of contents, but no index. When required to find information quickly on a particular instrucment, librarians and researchers would rather consult an index than peruse a lengthy table of contents.
Article
Self-esteem in cancer patients has received considerable attention during the last decade. This article describes one measure of self-esteem, the Rosenberg Self-Esteem Scale (RSE), and reviews the results of 16 studies that have used this measure. The following observations concerning this body of literature are discussed: (1) no definitive picture of self-esteem in cancer patients has emerged because of differences in scoring the RSE, (2) global self-esteem, as measured by the RSE, may not be the only aspect of self-concept that is relevant to cancer patients, and (3) self-esteem, although routinely considered to be an outcome variable in cancer research, also can be conceptualized as a causal agent. The relationship between hypothetical mechanisms of how self-esteem is involved in adapting to cancer and possible interventions also is addressed.
Article
Knowledge of the impact that breast cancer has on self-esteem and well-being has been limited, conceptually, by the failure to consider potentially positive outcomes after diagnosis and treatment and, methodologically, by an overall lack of focus on well-being. Sixty-four women with breast cancer and 64 age-matched women without cancer completed three measures of self-esteem and five measures of well-being. The results supported the theoretical notion that the potential impact of breast cancer on a woman's self-esteem and well-being can be positive as well as negative. The results also highlighted the importance of considering the full impact of cancer.
Article
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 summarized. 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. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
[considers] the positive psychosocial benefits of physical activity / psychosocial outcomes as discussed herein are restricted to perceptions of self-esteem, psychological well-being, and self-efficacy (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Self‐transformation as a factor in the self‐esteem and well‐being of breast cancer survivors Diagnosis with a life‐threatening illness can lead to many changes in one’s self. These changes, called self‐transformation, are not well understood. The present study used triangulation of methods and measures to (i) describe individual differences in self‐transformation among breast cancer survivors, (ii) examine factors associated with self‐transformation in breast cancer survivors, and (iii) examine the relationships between self‐transformation and self‐esteem and well‐being in breast cancer survivors and age‐matched comparison women without cancer. Cancer survivors ( n = 60) participated in structured interviews and both survivors and comparison women ( n = 60) completed a set of questionnaires. Narrative analysis revealed three categories of transformation among breast cancer survivors: positive transformation, minimal transformation and feeling stuck. These groups differed by age, marital status and income, but not by disease or treatment variables. Breast cancer survivors in the positive transformation group had significantly higher self‐esteem and well‐being in comparison with (i) survivors grouped as feeling stuck and (ii) age‐matched counterparts without cancer. Cancer survivors who reported feeling stuck had significantly lower self‐esteem and well‐being than the other groups of survivors and lower well‐being in comparison with healthy women of the same age. Findings provide support for the concept of self‐transformation and a new understanding of disease, demographic and treatment factors associated with the concept. Findings also suggest that self‐transformation may be a factor in the self‐esteem and well‐being of breast cancer survivors.
Article
Predicting well-being among breast cancer survivors The purpose of this descriptive study was to test a conceptual model that predicts well-being among women who have survived breast cancer. The model was derived from empirical research findings that identified health care orientation, uncertainty, social support, resourcefulness and self-esteem as significant predictors of well-being in persons diagnosed with cancer. The convenience sample was of 84 women who had completed primary treatment for breast cancer and were currently disease-free. After informed consent was obtained each woman completed six questionnaires which measured the study variables. Multiple regression techniques were used to empirically test the predicted conceptual relationships and to estimate predictive validity for the model. Findings indicated that uncertainty and social support were significant predictors of resourcefulness and explained 12% of the variance in resourcefulness. Resourcefulness and social support were significant predictors of self-esteem and explained 33% of the variance in self-esteem. In combination, social support, resourcefulness, and self-esteem were significant predictors of well-being and explained 42% of the variance in well-being. Health care orientation was not a significant variable. This study confirmed hypotheses and provided insight into the variables that significantly influence well-being in women who have survived breast cancer. Recommendations for practice are given with suggestions made for further research.
Book
There are few topics so fascinating both to the research investigator and the research subject as the self-image. It is distinctively characteristic of the human animal that he is able to stand outside himself and to describe, judge, and evaluate the person he is. He is at once the observer and the observed, the judge and the judged, the evaluator and the evaluated. Since the self is probably the most important thing in the world to him, the question of what he is like and how he feels about himself engrosses him deeply. This is especially true during the adolescent stage of development.
Article
Thirty-six men and women age fifty or older participated in a study to examine the health effects of Tai Chi Chuan on older adults in a community setting. Participants in the experimental group (n = 23) received thirty-two one-hour sessions of Tai Chi Chuan instruction in sixteen weeks. Health effects were determined by measuring heart rate, blood pressure, muscle tension, anxiety, and flexibility. Results of data analysis indicated participants received training in Tai Chi Chuan had a greater improvement in flexibility and muscle relaxation than participants who did not receive training. In addition to retaining improved flexibility and muscle relaxation, participants in the experimental group also showed significant improvements in blood pressure, anxiety scores at the follow-up session. These results appear to support the beneficial effects of practicing Tai Chi Chuan for health promotion and disease prevention for older adults in the community.
Article
Tai Chi, a moving meditation, is examined for its efficacy in post-stressor recovery. Forty-eight male and 48 female Tai Chi practitioners were randomly assigned to four treatment groups: Tai Chi, brisk walking, mediation and neutral reading. Mental arithmetic and other difficult tests were chosen as mental challenges, and a stressful film was used to produce emotional disturbance. Tai Chi and the other treatments were applied after these stressors. After all treatments, the salivary cortisol level dropped significantly, and the mood states were also improved. In general the stress-reduction effect of Tai Chi characterized moderate physical exercise. Heart rate, blood pressure, and urinary catecholamine changes for Tai Chi were found to be similar to those for walking at a speed of 6 km/hr. Although Tai Chi appeared to be superior to neutral reading in the reduction of state anxiety and the enhancement of vigour, this effect could be partially accounted for by the subjects' high expectations about gains from Tai Chi. Approaches controlling for expectancy level are recommended for further assessment.
Article
Changes in psychological and physiological functioning following participation in Tai Chi were assessed for 33 beginners and 33 practitioners. The variables in the three-way factorial design were experience (beginners vs practitioners), time (morning vs afternoon vs evening), and phase (before Tai Chi vs during Tai Chi vs after Tai Chi). Phase was a repeated measures variable. Relative to measures taken beforehand, practice of Tai Chi raised heart rate, increased noradrenaline excretion in urine, and decreased salivary cortisol concentration. Relative to baseline levels, subjects reported less tension, depression, anger, fatigue, confusion and state-anxiety, they felt more vigorous, and in general they had less total mood disturbance. The data suggest that Tai Chi results in gains that are comparable to those found with moderate exercise. There is need for research concerned with whether participation in Tai Chi has effects over and above those associated with physical exercise.
Article
Social stress, psychological distress, and psychosocial support effect the adjustment of breast cancer patients, influence their experience of and adherence to medical treatment, and may effect the course of the disease. The literature indicates that levels of distress, depression, and anxiety are substantially elevated among patients with breast cancer. These problems persist in a sizable minority of patients even years after diagnosis. Coping styles are related to adjustment and, in some studies, survival time. The nature of the relationship with physicians affects adjustment to the illness, satisfaction with treatment outcome, and adherence to medical treatment protocols, which can influence relapse and survival. In many but not all studies, serious life stress adversely affects medical outcome. Social support in general and structured psychotherapy in particular have been shown to positively affect both adjustment and survival time. Clear and open communication, expression of appropriate emotion, and collaborative planning and problem-solving enhance adjustment and improve outcome. Conversely, influences that isolate breast cancer patients from others or undermine support can have adverse medical and psychological consequences.
Article
Quality of life for persons with cancer has been studied extensively in urban populations. The Functional Assessment of Cancer Therapy-General (FACT-G) scale was developed for use in clinical trials. The authors tested the psychometric properties of the FACT-G scale in a sample of rural cancer patients. A systematic replication of the 1993 study by Cella et al., in which FACT-G was developed, was employed to assess the reliability, validity, and factor structure of the scale. The reliability and validity of the FACT-G scale for evaluating rural cancer patients was determined to be sufficient for research purposes. The factor structure was the same as that reported by Cella et al. The FACT-G scale is appropriate for use in studies of the quality of life of rural cancer patients.
Article
To compare the effects on blood pressure of a 12-week moderate-intensity aerobic exercise program and a T'ai Chi program of light activity. A randomized clinical trial. A suburban clinic in the Baltimore, MD, area. Sixty-two sedentary older adults (45% black, 79% women, aged > or = 60 years) with systolic blood pressure 130-159 mm Hg and diastolic blood pressure < 95 mm Hg (not on antihypertensive medication). Participants were randomized to a 12-week aerobic exercise program or a light intensity T'ai Chi program. The goal of each condition was to exercise 4 days per week, 30 minutes per day. Blood pressure was measured during three screening visits and every 2 weeks during the intervention. Estimated maximal oxygen uptake and measures of physical activity level were determined at baseline and at the end of the intervention period. Mean (SD) baseline systolic and diastolic blood pressures were 139.9 (9.3) mm Hg and 76.0 (7.3) mm Hg, respectively. For systolic blood pressure, adjusted mean (SE) changes during the 12-week intervention period were -8.4 (1.6) mm Hg and -7.0 (1.6) mm Hg in the aerobic exercise and T'ai Chi groups, respectively (each within-group P < .001; between-group P = .56). For diastolic blood pressure, corresponding changes were -3.2 (1.0) mm Hg in the aerobic exercise group and -2.4 (1.0) mm Hg in the T'ai Chi group (each within-group P < .001; between-group P = .54). Body weight did not change in either group. Estimated maximal aerobic capacity tended to increase in aerobic exercise (P = .06) but not in T'ai Chi (P = .24). Programs of moderate intensity aerobic exercise and light exercise may have similar effects on blood pressure in previously sedentary older individuals. If additional trials confirm these results, promoting light intensity activity could have substantial public health benefits as a means to reduce blood pressure in older aged persons.
Article
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
Article
Diagnosis with a life-threatening illness can lead to many changes in one's self. These changes, called self-transformation, are not well understood. The present study used triangulation of methods and measures to (i) describe individual differences in self-transformation among breast cancer survivors, (ii) examine factors associated with self-transformation in breast cancer survivors, and (iii) examine the relationships between self-transformation and self-esteem and well-being in breast cancer survivors and age-matched comparison women without cancer. Cancer survivors (n = 60) participated in structured interviews and both survivors and comparison women (n = 60) completed a set of questionnaires. Narrative analysis revealed three categories of transformation among breast cancer survivors: positive transformation, minimal transformation and feeling stuck. These groups differed by age, marital status and income, but not by disease or treatment variables. Breast cancer survivors in the positive transformation group had significantly higher self-esteem and well-being in comparison with (i) survivors grouped as feeling stuck and (ii) age-matched counterparts without cancer. Cancer survivors who reported feeling stuck had significantly lower self-esteem and well-being than the other groups of survivors and lower well-being in comparison with healthy women of the same age. Findings provide support for the concept of self-transformation and a new understanding of disease, demographic and treatment factors associated with the concept. Findings also suggest that self-transformation may be a factor in the self-esteem and well-being of breast cancer survivors.
Article
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.