Narrowing the Gap for Minority Cancer Survivors: Exercise Oncology in the Past, Present, and Future

2020 ◽  
Vol 9 (4) ◽  
pp. 155-170
Author(s):  
Mary K. Norris ◽  
Frank S. Fox ◽  
Christi Lee ◽  
Ellice Wang ◽  
Katherine Green ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cancer Survivors ◽  
Cancer Survivor ◽  
Exercise Intervention ◽  
Cancer Prognosis ◽  
Minority Population ◽  
Exercise Participation ◽  
Exercise Timing ◽  
Barriers To Exercise ◽  
Exercise Oncology

ABSTRACT While the field of exercise oncology has substantially progressed in recent years, a significant void exists in the inclusion of and focus on minority patients diagnosed with cancer, particularly blacks and Hispanics. Blacks and Hispanics are less physically active, experience higher rates of comorbid conditions, and have poorer cancer prognosis when compared to white counterparts. Exercise prevents and reduces an array of health conditions, including cardiovascular disease, diabetes, obesity, and risk of certain cancers. However, black and Hispanic cancer survivors are underrepresented across exercise intervention trials. In this review, we discuss previous explorations among minority cancer survivors with a focus on exercise prescription, targeted outcomes, patient demographics, and barriers to exercise. We also discuss knowledge gaps and future directions necessary to progress the field of exercise oncology to include a more diverse cancer survivor cohort. In brief, we found few studies have evaluated the effect of exercise on physiologic health outcomes in black and Hispanic cancer survivors, with much research focused on psychosocial health. A majority of minority population-based research specifically targets the black breast cancer survivor population, with reported exercise-induced improvements observed in weekly physical activity, cardiorespira-tory fitness, muscle strength, quality of life, and fatigue. Minority cancer survivors also face unique challenges and barriers to exercise participation despite acknowledgement of the benefits with physical activity. Future investigations warrant explorations of exercise timing across the cancer continuum, inclusion of different types of cancer survivors, and novel exercise strategies with inclusion of culturally tailored educational and behavioral components.

scholarly journals Effects of exercise in breast cancer patients: implications of the trials within cohorts (TwiCs) design in the UMBRELLA Fit trial

2021 ◽  
Author(s):  
Roxanne Gal ◽  
Evelyn M. Monninkhof ◽  
Carla H. van Gils ◽  
Rolf H. H. Groenwold ◽  
Sjoerd G. Elias ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Physical Activity ◽  
Beneficial Effect ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Exercise Intervention ◽  
Intervention Group ◽  
Control Group ◽  
Physical Fatigue ◽  
Trials Within Cohorts

Abstract Purpose The Trials within Cohorts (TwiCs) design aims to overcome problems faced in conventional RCTs. We evaluated the TwiCs design when estimating the effect of exercise on quality of life (QoL) and fatigue in inactive breast cancer survivors. Methods UMBRELLA Fit was conducted within the prospective UMBRELLA breast cancer cohort. Patients provided consent for future randomization at cohort entry. We randomized inactive patients 12–18 months after cohort enrollment. The intervention group (n = 130) was offered a 12-week supervised exercise intervention. The control group (n = 130) was not informed and received usual care. Six-month exercise effects on QoL and fatigue as measured in the cohort were analyzed with intention-to-treat (ITT), instrumental variable (IV), and propensity scores (PS) analyses. Results Fifty-two percent (n = 68) of inactive patients accepted the intervention. Physical activity increased in patients in the intervention group, but not in the control group. We found no benefit of exercise for dimensions of QoL (ITT difference global QoL: 0.8, 95% CI = − 2.2; 3.8) and fatigue, except for a small beneficial effect on physical fatigue (ITT difference: − 1.1, 95% CI = − 1.8; − 0.3; IV: − 1.9, 95% CI = − 3.3; − 0.5, PS: − 1.2, 95% CI = − 2.3; − 0.2). Conclusion TwiCs gave insight into exercise intervention acceptance: about half of inactive breast cancer survivors accepted the offer and increased physical activity levels. The offer resulted in no improvement on QoL, and a small beneficial effect on physical fatigue. Trial registration Netherlands Trial Register (NTR5482/NL.52062.041.15), date of registration: December 07, 2015.

scholarly journals Effect of self-regulatory behaviour change techniques and predictors of physical activity maintenance in cancer survivors: a 12-month follow-up of the Phys-Can RCT

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anne-Sophie Mazzoni ◽  
Hannah L. Brooke ◽  
Sveinung Berntsen ◽  
Karin Nordin ◽  
Ingrid Demmelmaier
Keyword(s):  
Physical Activity ◽  
Cancer Survivors ◽  
Cancer Treatment ◽  
Tobacco Use ◽  
Exercise Intervention ◽  
Behaviour Change Techniques ◽  
Exercise Motivation ◽  
History Of

Abstract Background Current knowledge about the promotion of long-term physical activity (PA) maintenance in cancer survivors is limited. The aims of this study were to 1) determine the effect of self-regulatory BCTs on long-term PA maintenance, and 2) identify predictors of long-term PA maintenance in cancer survivors 12 months after participating in a six-month exercise intervention during cancer treatment. Methods In a multicentre study with a 2 × 2 factorial design, the Phys-Can RCT, 577 participants with curable breast, colorectal or prostate cancer and starting their cancer treatment, were randomized to high intensity exercise with or without self-regulatory behaviour change techniques (BCTs; e.g. goal-setting and self-monitoring) or low-to-moderate intensity exercise with or without self-regulatory BCTs. Participants’ level of PA was assessed at the end of the exercise intervention and 12 months later (i.e. 12-month follow-up), using a PA monitor and a PA diary. Participants were categorized as either maintainers (change in minutes/week of aerobic PA ≥ 0 and/or change in number of sessions/week of resistance training ≥0) or non-maintainers. Data on potential predictors were collected at baseline and at the end of the exercise intervention. Multiple logistic regression analyses were performed to answer both research questions. Results A total of 301 participants (52%) completed the data assessments. A main effect of BCTs on PA maintenance was found (OR = 1.80, 95%CI [1.05–3.08]) at 12-month follow-up. Participants reporting higher health-related quality-of-life (HRQoL) (OR = 1.03, 95%CI [1.00–1.06] and higher exercise motivation (OR = 1.02, 95%CI [1.00–1.04]) at baseline were more likely to maintain PA levels at 12-month follow-up. Participants with higher exercise expectations (OR = 0.88, 95%CI [0.78–0.99]) and a history of tobacco use at baseline (OR = 0.43, 95%CI [0.21–0.86]) were less likely to maintain PA levels at 12-month follow-up. Finally, participants with greater BMI increases over the course of the exercise intervention (OR = 0.63, 95%CI [0.44–0.90]) were less likely to maintain their PA levels at 12-month follow-up. Conclusions Self-regulatory BCTs improved PA maintenance at 12-month follow-up and can be recommended to cancer survivors for long-term PA maintenance. Such support should be considered especially for patients with low HRQoL, low exercise motivation, high exercise expectations or with a history of tobacco use at the start of their cancer treatment, as well as for those gaining weight during their treatment. However, more experimental studies are needed to investigate the efficacy of individual or combinations of BCTs in broader clinical populations. Trial registration NCT02473003 (10/10/2014).

A Group Dynamics-Based Exercise Intervention to Improve Physical Activity Maintenance in Breast Cancer Survivors

2019 ◽  
Vol 16 (9) ◽  
pp. 785-791
Author(s):  
Heather J. Leach ◽  
Katie B. Potter ◽  
Mary C. Hidde
Keyword(s):  
Breast Cancer ◽  
Physical Activity ◽  
Cancer Survivors ◽  
Group Dynamics ◽  
Breast Cancer Survivors ◽  
Exercise Intervention ◽  
Intervention Group ◽  
Group Cohesion ◽  
Self Report

Background: To maintain increases in physical activity (PA), interventions that implement group dynamics principles and strategies with the intent of enhancing group cohesion may be advantageous. This study examined group cohesion and PA following a group dynamics-based PA intervention among breast cancer survivors. Methods: The study was designed as a pilot randomized controlled trial comparing an 8-week group dynamics-based intervention with an individually supervised intervention. Group cohesion was measured by the Physical Activity Group Environment Questionnaire, and PA was measured at baseline, post-intervention, and 3-month follow-up using a self-report questionnaire and pedometer. Results: Group cohesion levels were high following the intervention and positively associated with PA at 3-month follow-up (ranger = .182–.555). At 3-month follow-up, 91.7% of participants in the group-dynamics-based intervention (n = 12) were classified as moderately active or greater, compared with 54.5% in the individually supervised intervention (n = 11). Conclusions: These results suggest that, for breast cancer survivors, peer support and fostering group cohesion as part of an exercise program may help to support PA following the completion of a structured intervention. A larger trial with longer follow-up is needed to establish comparative efficacy for a group-dynamics-based exercise intervention to enhance long-term PA adherence in breast cancer survivors.

A Physiological Profile of Ovarian Cancer Survivors to Inform Tailored Exercise Interventions and the Development of Exercise Oncology Guidelines

2017 ◽  
Vol 27 (7) ◽  
pp. 1560-1567 ◽  
Author(s):  
Christelle Schofield ◽  
Robert U. Newton ◽  
Daniel A. Galvão ◽  
Paul A. Cohen ◽  
Carolyn J. Peddle-McIntyre
Keyword(s):  
Physical Activity ◽  
Ovarian Cancer ◽  
Adverse Effects ◽  
Cancer Survivors ◽  
Current Knowledge ◽  
Physical Activity Behavior ◽  
Physiological Status ◽  
Physical Activity And Exercise ◽  
And Function ◽  
Exercise Oncology

ObjectivePhysical activity has become increasingly important in supportive cancer care. However, physical activity and exercise guidelines for ovarian cancer survivors remain generic. The aim of this narrative review is to summarize existing data regarding the physiological characteristics (treatment-related adverse effects, concurrent comorbidities, body weight and composition, physical fitness and function, and physical activity behavior) of ovarian cancer survivors to further understanding of their cancer-specific physical activity and exercise needs. We also highlight gaps in the current knowledge base.MethodsWe undertook a narrative review of current literature on the physiological status of ovarian cancer survivors. We defined physiological status as treatment-related adverse effects, concurrent comorbidities, body weight and composition, physical fitness and function, and physical activity behavior.ResultsIn addition to disease- and treatment-related symptoms and adverse effects, the majority of ovarian cancer survivors have comorbidities, which may adversely affect treatment effectiveness and safety, as well as survival. Despite high overweight and obesity rates, a large percentage of women are malnourished at diagnosis, with potentially compromised muscle mass and muscle density. Low muscle density at diagnosis and loss of muscle mass during treatment may be associated with worse survival outcomes. A small number of studies have observed impaired physical function and cardiorespiratory fitness in ovarian cancer survivors. The majority of ovarian cancer survivors are insufficiently active or sedentary.ConclusionsOur review suggests that ovarian cancer survivors could benefit from physical activity and exercise oncology interventions aimed at addressing detrimental changes to physiological status due to disease and treatment. However, current knowledge gaps regarding the physiological characteristics of ovarian cancer survivors throughout the entire survivorship spectrum challenge the development of tailored exercise intervention studies and exercise oncology guidelines.

scholarly journals Breast Cancer Survivors’ Preferences and Barriers Related to ICT-Based Diet and Physical Activity Interventions

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 967-967
Author(s):  
X Chen ◽  
C Chiu ◽  
HT Cheung ◽  
ME White ◽  
X Chen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Physical Activity ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Intervention Program ◽  
Exercise Intervention ◽  
Mobile Apps ◽  
Perceived Barriers ◽  
Cancer Center ◽  
Lifestyle Interventions

Abstract Objectives To establish the preferences and perceived barriers related to physical activity and diet programming of breast cancer survivors (BCS) to inform the development of Information and Communication Technology (ICT)-based lifestyle interventions. Methods This was a cross-sectional study of 197 BSC aged 18 years or older and diagnosed with ductal carcinoma in situ (DCIS) or Stage I-IV breast cancer. The BCS were recruited during routine oncology appointments at a Midwestern cancer center. A survey was conducted to query survivors’ level of interest in, preferences for, and perceived barriers to participating in an exercise and dietary intervention program, with a specific emphasis on ICT-based programming. Results Overall, 85% of BCS reported they would consider participating in exercise and diet intervention research. Approximately 45% of participants reported that they had received diet and/or exercise information as part of their cancer care. However, only 15% of the participants received such information from healthcare professionals with the appropriate expertise (e.g., Dietitian, Exercise Specialist). Over two-thirds of the participants reported frequent use of mobile devices and the internet, and 80% indicated comfort using these devices (e.g., tablet, smart phone). The top three preferred formats for an ICT-based diet and exercise intervention program were “website”, “mobile apps” and “e-mails”. Older participants (>60 years) were more likely to report a preference for e-mails while younger participants (<60 years) were more likely to report a preference for websites or mobile apps. The most common perceived barriers to participation in a lifestyle intervention included fatigue, family responsibility and work. Conclusions Most BCS in this study were interested in exercise and diet interventions and would be comfortable with an ICT-based format with a preference for delivery via websites, mobile apps or e-mails. Future ICT-based lifestyle interventions should be designed with consideration of BCS’ age, barriers, facilitators and other characteristics. Funding Sources USDA-NIFA Hatch Project 1,011,487

scholarly journals Osteoporosis-Related Health Behaviors in Men With Prostate Cancer and Survivors

2016 ◽  
Vol 11 (1) ◽  
pp. 13-23 ◽  
Author(s):  
Annie-Claude M. Lassemillante ◽  
Tina L. Skinner ◽  
John D. Hooper ◽  
John B. Prins ◽  
Olivia R. L. Wright
Keyword(s):  
Prostate Cancer ◽  
Cancer Survivors ◽  
Health Beliefs ◽  
Bone Health ◽  
Self Efficacy ◽  
Prostate Cancer Survivors ◽  
Healthy Behaviors ◽  
Exercise Participation ◽  
Osteoporosis Knowledge ◽  
Barriers To Exercise

This descriptive study aimed to (a) determine the extent of osteoporosis knowledge, perceived health beliefs, and self-efficacy with bone healthy behaviors in men with prostate cancer and survivors and (b) identify how dietary bone healthy behaviors are associated with these psychobehavioral and psychosocial factors. Three different questionnaires were used to measure osteoporosis knowledge, health beliefs, and self-efficacy in a group of men with prostate cancer and survivors. Bone health was assessed via dual-energy X-ray absorptiometry and calcium intake using a diet history. The prevalence of osteoporosis and low bone mass was high at over 70%. Participants had inadequate osteoporosis knowledge with a mean score of 43.3% ( SD = 18%) on the Facts on Osteoporosis Quiz. Participants scored low on the subscale measuring barriers to exercise (median = 11; interquartile range [IQR] = 6.5), indicating minimal barriers to exercise participation, and the subscale measuring the benefits of exercise scored the highest (median = 24; IQR = 3.5) compared with the other subscales. Men with prostate cancer and survivors were highly confident in their exercise and calcium self-efficacy (83.0%, IQR = 24.0% and 85.7%, IQR = 27.0%, respectively). Participants did not meet their calcium requirements or consume enough dairy products for optimum bone health. Men with prostate cancer and survivors have poor osteoporosis knowledge, but are confident in their self-efficacy of undertaking bone healthy behaviors. This confidence did not translate to specific dietary behaviors as they did not meet their calcium or dairy intake requirements. Implications for cancer survivors is that there is a need for bone health education programs among prostate cancer survivors. These programs should go beyond education and empowerment to provide practical guidance to maximize uptake of bone healthy behaviors.

scholarly journals Healthy Moves to Improve Lifestyle Behaviors of Cancer Survivors and Their Spouses: Feasibility and Preliminary Results of Intervention Efficacy

Nutrients ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 4460
Author(s):  
Cindy L. Carmack ◽  
Nathan H. Parker ◽  
Wendy Demark-Wahnefried ◽  
Laura Shely ◽  
George Baum ◽  
...  
Keyword(s):  
Physical Activity ◽  
Weight Loss ◽  
Cancer Survivors ◽  
Exercise Intervention ◽  
Primary Source ◽  
Lifestyle Behaviors ◽  
Chair Stand ◽  
Intervention Efficacy ◽  
Strenuous Physical Activity

Spouses offer a primary source of support and may provide critical assistance for behavior change. A diet-exercise intervention previously found efficacious in improving cancer survivors’ lifestyle behaviors was adapted to utilize a couples-based approach. The aims were to test the feasibility of this couples-based (CB) intervention and compare its efficacy to the same program delivered to the survivor-only (SO). Twenty-two survivor-spouse couples completed baseline assessments and were randomized to the CB or SO interventions. The study surpassed feasibility benchmarks; 91% of survivors and 86% of spouses completed a 6-month follow-up. Survivors and spouses attended 94% and 91% of sessions, respectively. The SO survivors showed significant improvements on the 30-s chair stand and arm curl tests, weight, and fruit and vegetable (F and V) consumption. The CB survivors showed significant improvements on the 6-min walk and 2-min step tests, body weight, and fat and F and V consumption. Improvement in the 30-s chair stand and arm curl tests was significantly better for SO survivors. The SO spouses showed no significant changes in outcome measures, but the CB spouses showed significant improvements in moderate-to-strenuous physical activity, weight, and fat and F and V consumption. Weight loss was significantly greater in CB spouses compared to SO spouses. Findings demonstrate feasibility, warranting further investigation of CB approaches to promote lifestyle change among cancer survivors and spouses.

Building a healthy body after cancer: Results of a focus group with young adult survivors to inform an intervention for exercise after treatment.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 164-164
Author(s):  
Brittany Kimball ◽  
Gladys Asiedu ◽  
Carrie A. Thompson
Keyword(s):  
Physical Activity ◽  
Weight Gain ◽  
Young Adult ◽  
Focus Group ◽  
Cancer Survivors ◽  
Adult Survivors ◽  
Adolescent And Young Adult ◽  
Barriers To Exercise ◽  
After Cancer ◽  
Lymphoma Survivors

164 Background: Adolescent and young adult (AYA) cancer survivors have distinctive and often unmet needs, may lead long lives after treatment, and are a population for whom targeted health supports are limited. Exercise in particular has become increasingly recognized as a vital part of cancer survivors’ health needs, yet, little is known about what interventions would be most appropriate for this population. This ongoing study reports early data on barriers and facilitators to exercise in AYA lymphoma survivors. Methods: We conducted a focus group with five young adult lymphoma survivors. Participants completed questionnaires to assess quality of life, exercise habits, and knowledge about evidence for exercise after cancer treatment. Charts were abstracted for demographic and treatment-related details. The focus group was audio recorded and transcribed. Data is being analyzed thematically to generate applied findings and identify areas for action. Results: Participants were 24-35 years old, 60% male, and an average of 2.97 years from the time of diagnosis. All reported some form of physical activity, with 80% active and 20% moderately active. Preliminary analysis identified fatigue, weight gain, and lack of time as barriers to exercise. Participants identified fatigue particularly in the early survivorship period, and discussed the issue of non-cancer survivor peers not relating with or recognizing fatigue after treatment. 100% of participants reported that someone from their doctor’s office had talked with them about exercise, but indicated during the focus group that this recommendation did not motivate them to exercise. Other themes revolve around the relationship between healthy diet and physical activity. In terms of an intervention, survivors were interested in activity trackers and fitness apps, exercise variety, and fitness groups targeted specifically for AYA survivors. Conclusions: Fatigue, weight gain, and time are barriers to exercise for AYA survivors. Interventions that incorporate fitness tracking technology, provide variety, and/or include other AYA survivors may be successful in this unique population.

Effects of a personal trainer led exercise intervention on physical activity and physical function of breast cancer survivors.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e23053-e23053
Author(s):  
Linda F. Wang ◽  
Yvonne L. Eaglehouse ◽  
Janette T. Poppenberg ◽  
Jill Brufsky ◽  
Emily Geramita ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Physical Activity ◽  
Cancer Survivors ◽  
Physical Function ◽  
Breast Cancer Survivors ◽  
Exercise Intervention ◽  
Exercise Group ◽  
Step Test ◽  
Control Group ◽  
Personal Trainer

e23053 Background: Regular exercise is an important tool to address physical and emotional effects of breast cancer treatment. However, many breast cancer survivors do not meet minimum recommended levels of physical activity. This study examines effects of a personal trainer led exercise intervention on physical activity levels and physical function in breast cancer survivors. Methods: Women who completed active treatment for breast cancer were recruited from oncology clinics and survivorship programs from September 2015-to September 2017. Subjects were randomized to an immediate exercise or a wait-list control group. The intervention included 3 personal training sessions over a period of up to 30 weeks. Physical activity and function were assessed before and after intervention by pedometer (7-day record) and endurance step test (steps in 2 minutes). Results: 60 women were randomized to immediate intervention (n = 31) or wait-list control (n = 29). Subjects were an average of (mean ± SD) 56 ± 10 years old and 2 ± 1 years since breast cancer diagnosis. At baseline, the exercise group averaged (mean ± SD) 5236 ± 2214 steps/day and 101 ± 23 steps on 2-minute step test while the control group averaged 5856 ± 2916 steps/day and 106 ± 23 steps on 2-minute step test. After intervention, change (mean ∆ ± SD) was 143 ± 1842 steps/day in the exercise group and 79 ± 1862 steps/day in the control group ( p= 0.9). On the 2-minute step test, the exercise group increased 18 ± 20 steps and the control group increased 9 ± 12 steps ( p= 0.07). Conclusions: While there was some improvement in physical function after the personal-trainer led intervention, the short duration and intensity of the intervention may have diminished the effects. Our results suggest a multi-faceted approach may be needed to support significant changes in breast cancer survivors’ physical activity. Future efforts employing a multidisciplinary team, which includes a certified personal trainer, and with larger patient samples may help address this possibility. Clinical trial information: NCT02770781.

scholarly journals The influence of a supervised group exercise intervention combined with active lifestyle recommendations on breast cancer survivors’ health, physical functioning, and quality of life indices: study protocol for a randomized and controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Luiz Augusto Riani Costa ◽  
Raphael F. Barreto ◽  
Sarah Milani Moraes de Leandrini ◽  
Aline Rachel Bezerra Gurgel ◽  
Gabriel Toledo de Sales ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Physical Activity ◽  
Cancer Survivors ◽  
Physical Functioning ◽  
Breast Cancer Survivors ◽  
Exercise Intervention ◽  
Group Exercise ◽  
Active Lifestyle

Abstract Background Most cancer patients, under active treatment or not, are sedentary, despite increasing scientific and clinical understanding of the benefits of exercise and physical activity, such as improving quality of life, limiting disease symptoms, decreasing cancer recurrence, and increasing overall survival. Studies have shown that both supervised exercise and unsupervised physical activity programs have low adherence and limited long-term benefits among cancer survivors. Therefore, interventions focused on increasing physical activity levels have clinical and psychological relevance. The present study will examine the feasibility and efficacy of an intervention that combines supervised group exercise with active lifestyle recommendations, analyzing its clinical, psychological, physiological, functional, and immunological effects in breast cancer survivors. Methods Women aged 35–75 years who have completed chemotherapy, radiotherapy, and surgery for breast cancer will be recruited from the Cancer Institute of the State of Sao Paulo (ICESP) and take part in a 16-week, parallel-group, randomized, and controlled trial. They will receive a booklet with recommendations for achieving a physically active lifestyle by increasing overall daily movement and undertaking at least 150 min/week of structured exercise. Then, they will be randomized into two groups: the supervised group will take part in two canoeing group exercise sessions every week, and the unsupervised group will increase their overall physical activity level by any means, such as active commuting, daily activities, or home-based exercise. Primary outcome includes aerobic capacity. Secondary outcomes are physical activity, physical functioning, self-reported quality of life, fatigue, presence of lymphedema, body composition, immune function, adherence to physical activity guidelines, and perceptions of self-image. Discussion Results should contribute to advance knowledge on the impact of a supervised group exercise intervention to improve aspects related to health, physical functioning, and quality of life in female breast cancer survivors. Trial registration Brazilian Registry of Clinical Trials Number: RBR-3fw9xf. Retrospectively Registered on 27 December 2018. Items from the World Health Organization Trial Registration Data Set can be accessed on http://www.ensaiosclinicos.gov.br/rg/RBR-3fw9xf/.

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