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A recent survey study concluded that to encourage metastatic breast cancer patients to exercise, individualized, accessible programs with clear instructional materials should be created. To improve patient engagement and program evaluation, there is a need for country-specific strategies, reimbursement clarification, and interdisciplinary collaboration.

Despite notable progress in the early detection and therapeutic interventions for breast cancer, it has been observed that approximately 30% of individuals initially diagnosed with early-stage breast cancer ultimately develop metastatic illness. Despite the advancements in survival rates associated with contemporary treatments for metastatic breast cancer (MBC), individuals affected by this condition still endure longterm symptoms and treatment-induced adverse effects. These include fatigue, diminished physical capabilities, heightened anxiety, and depression, all of which significantly compromise their overall quality of life. 

Research has demonstrated that exercise yields favorable therapeutic outcomes, specifically by mitigating fatigue and enhancing psychological well-being among individuals diagnosed with breast cancer. This study, published in the journal Supportive Care in Cancer, sought to understand patients’ viewpoints on physical activity following a diagnosis of metastatic breast cancer.

Study Population

This study involved a total of 420 participants, with 111 individuals (26.4%) from the Netherlands, 99 (23.6%) from Spain, 98 (23.3%) from Germany, 64 (15.2%) from Poland, and 48 (11.4%) from Sweden. The mean age of the participants was 56.5 ± 10.8 years. Among the respondents, 70% reported having bone metastases, with 39.8% indicating liver metastases and 27.9% indicating lung metastases.

Disparities in Exercise Understanding Among Participants

Participants showed a positive disposition towards engaging in physical activity after being diagnosed with MBC. Nearly half understood the suggested amount of exercise. However, only 8% correctly recognized the ideal aerobic activity duration (140–160 min/week), with 54% choosing <140 min/week and 38% >160 min/week. Resistance exercise frequency was appropriately reported by 69% (2–3 times per week). Moreover, 68% reported having adequate aerobic exercise skills, and only 35% felt similarly about their resistance exercise skills, indicating substantial inter-country disparities (p-values ≤0.01).

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Barriers, Incentives, and Goals in Exercise Engagement Post-MBC Diagnosis

Fatigue (23%), limited access to specialized programs for cancer patients (27%), and perceived weakness (23%) were the primary obstacles to exercise. Positive prior physical (72%) or emotional (68%) experiences, as well as individualized guidance from a physical therapist (62%), served as incentives for exercising. Common objectives encompassed the preservation or enhancement of endurance (69%), muscular strength (60%), and fatigue reduction (43%).

Preferred Exercise Modalities and Frequencies Across Countries Post-MBC Diagnosis

Flexibility exercises (44%), walking (65%), and mind–body exercises (47%) were the most preferred forms of exercise. Walking was preferred in every country except for Germany, where flexibility exercises were favored. Most respondents (59%) favored moderate intensity, and 40% consistently preferred exercising twice per week. Regarding location preference, community sports facilities and public gyms were favored by 26% of respondents.

Supervision Preferences, Insurance Uncertainty, and Spending Limits

Thirty-eight percent of participants preferred physiotherapist supervision during exercise. German and Swedish respondents often preferred fitness instructors or exercise professionals. Approximately 21% of participants had no preference. 

Most participants (57%) were unsure about insurance coverage for fitness programs. Thirty-six percent of people were willing to spend up to 25 euros each month, while 9% were willing to spend more than 50 euros.

Sweegers, M. G., Depenbusch, J., Kampshoff, C. S., Aaronson, N. K., Hiensch, A. E., Wengström, Y., Backman, M., Gunasekara, N., Clauss, D., Peláez, M., Lachowicz, M., May, A. M., Steindorf, K., Stuiver, M. M., Arrieta, H., Toribio, M. G., Santillán, M. L., Tol, J., Malter, W., & Puppe, J. (2023). Perspectives of patients with metastatic breast cancer on physical exercise programs: results from a survey in five European countries. Supportive Care in Cancer, 31(12). https://doi.org/10.1007/s00520-023-08124-4 

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