Adapting an Evidence-Based Exercise and Education Program for Older Breast Cancer Survivors for the REJOIN Trial

in Journal of Aging and Physical Activity

Click name to view affiliation

Shirley M. BluethmannDepartment of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
Milton S. Hershey Medical Center, Cancer Institute, The Pennsylvania State University, Hershey, PA, USA

Search for other papers by Shirley M. Bluethmann in
Current site
Google Scholar
PubMedClose
https://orcid.org/0000-0003-1769-3600*
,
Eileen FloresDepartment of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
Milton S. Hershey Medical Center, Cancer Institute, The Pennsylvania State University, Hershey, PA, USA

Search for other papers by Eileen Flores in
Current site
Google Scholar
PubMedClose
,
Meghan GrotteDepartment of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA

Search for other papers by Meghan Grotte in
Current site
Google Scholar
PubMedClose
,
Jared HeitzenraterDepartment of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA

Search for other papers by Jared Heitzenrater in
Current site
Google Scholar
PubMedClose
,
Cristina I. TruicaMilton S. Hershey Medical Center, Cancer Institute, The Pennsylvania State University, Hershey, PA, USA
Department of Medicine, Milton S. Hershey Medical Center, The Pennsylvania State University College of Medicine, Hershey, PA, USA

Search for other papers by Cristina I. Truica in
Current site
Google Scholar
PubMedClose
,
Nancy J. OlsenMilton S. Hershey Medical Center, Cancer Institute, The Pennsylvania State University, Hershey, PA, USA
Department of Medicine, Milton S. Hershey Medical Center, The Pennsylvania State University College of Medicine, Hershey, PA, USA

Search for other papers by Nancy J. Olsen in
Current site
Google Scholar
PubMedClose
,
Christopher SciamannaDepartment of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
Department of Medicine, Milton S. Hershey Medical Center, The Pennsylvania State University College of Medicine, Hershey, PA, USA

Search for other papers by Christopher Sciamanna in
Current site
Google Scholar
PubMedClose
, and
Kathryn H. SchmitzDepartment of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
Milton S. Hershey Medical Center, Cancer Institute, The Pennsylvania State University, Hershey, PA, USA
Department of Kinesiology, College of Health and Human Development, The Pennsylvania State University, State College, Hershey, PA, USA

Search for other papers by Kathryn H. Schmitz in
Current site
Google Scholar
PubMedClose
DOI:
https://doi.org/10.1123/japa.2022-0013
Keywords:
survivorship; geriatric oncology; symptom management; aging
First Published Online:
14 Jun 2022
In Print:
Volume 31: Issue 1
Page Range:
59–67
Restricted access

Physical activity (PA) promotes survival and mitigates symptoms in older breast cancer survivors (BCS), especially to reduce joint pain associated with adjuvant hormonal treatment. The purpose is to describe the adaptation process for an evidence-based exercise and education curriculum (i.e., Fit & Strong!) to support older BCS participating in the Using Exercise to Relieve Joint Pain and Improve Aromatase Inhibitor Adherence in Older Breast Cancer Survivors trial. We reviewed all educational materials with scientific/clinical experts to identify necessary content changes. Next, we conducted semistructured phone interviews with BCS to review all educational materials and conducted a real-time pretest for the trial. Overall, BCS found the adapted materials and experience acceptable (mean score of 9.2/10 for satisfaction). Content changes included simplifying exercise instructions, prioritizing content related to the trial goals, and updating photographs. Because of COVID, the pretest was conducted via Zoom. Our multistep adaptation process provided an acceptable intervention to meet the needs of older BCS. Lessons learned will be applied to the forthcoming pilot trial.

Bluethmann (szb332@psu.edu) is corresponding author, https://orcid.org/0000-0003-1769-3600

Supplementary Materials

    • Supplementary Material (PDF 357 KB)
  • Collapse
  • Expand

Journal of Aging and Physical Activity

Cover Journal of Aging and Physical Activity

  • Arimidex, Tamoxifen, Alone or in Combination Trialists’ Group, Buzdar, A., Howell, A., Cuzick, J., Wale, C., Distler, W., … Nabholtz, J.M. (2006). Comprehensive side-effect profile of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: Long-term safety analysis of the ATAC trial. The Lancet Oncology, 7(8), 633–643. https://doi.org/10.1016/S1470-2045(06)70767-7

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Ballard-Barbash, R., Friedenreich, C.M., Courneya, K.S., Siddiqi, S.M., McTiernan, A., & Alfano, C.M. (2012). Physical activity, biomarkers, and disease outcomes in cancer survivors: A systematic review. Journal of the National Cancer Institute, 104(11), 815–840. https://doi.org/10.1093/jnci/djs207

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Bellury, L.M., Ellington, L., Beck, S.L., Stein, K., Pett, M., & Clark, J. (2011). Elderly cancer survivorship: An integrative review and conceptual framework. European Journal of Oncology Nursing, 15(3), 233–242. https://doi.org/10.1016/j.ejon.2011.03.008

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Bluethmann, S.M., Mariotto, A.B., & Rowland, J.H. (2016). Anticipating the “Silver Tsunami”: Prevalence trajectories and comorbidity burden among older cancer survivors in the United States. Cancer Epidemiology Biomarkers & Prevention, 25(7), 1029–1036. https://doi.org/10.1158/1055-9965.EPI-16-0133

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Bluethmann, S.M., Murphy, C., Tiro, J., Mollica, M., Vernon, S., & Bartholomew, L. (2017). Deconstructing decisions to initiate, maintain, or discontinue adjuvant endocrine therapy in breast cancer survivors: A mixed-methods study. Oncology Nursing Forum, 44(3), E101–E110. https://doi.org/10.1188/17.ONF.E101-E110

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Bluethmann, S.M., Truica, C., Klepin, H.D., Olsen, N., Sciamanna, C., Chinchilli, V.M., & Schmitz, K.H. (2021). Study design and methods for the using exercise to relieve joint pain and improve AI adherence in older breast cancer survivors (REJOIN) trial. Journal of Geriatric Oncology, 12(7), 1146–1153. https://doi.org/10.1016/j.jgo.2021.05.011

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Borg, G.A. (1998). Borg’s perceived exertion and pain scales (p. 104). Human Kinetics.

  • Boyle, L., & Homer, M. (2006). Using what works: Adapting evidence-based programs to fit your needs. National Cancer Institute.

  • Burstein, H.J. (2007). Aromatase inhibitor-associated arthralgia syndrome. The Breast, 16(3), 223–234. https://doi.org/10.1016/j.breast.2007.01.011

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Burstein, H.J., Lacchetti, C., & Griggs, J.J. (2016). Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: American society of clinical oncology clinical practice guideline update on ovarian suppression summary. Journal of Oncology Practice, 12(4), 390–393. https://doi.org/10.1200/JOP.2016.011239

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Burstein, H.J., Prestrud, A.A., Seidenfeld, J., Anderson, H., Buchholz, T.A., Davidson, N.E., … American Society of Clinical Oncology. (2010). American society of clinical oncology clinical practice guideline: Update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. Journal of Clinical Oncology, 28(23), 3784–3796. https://doi.org/10.1200/JCO.2009.26.3756

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Burstein, H.J., Temin, S., Anderson, H., Buchholz, T.A., Davidson, N.E., Gelmon, K.E., … Griggs, J.J. (2014). Adjuvant endocrine therapy for women with hormone receptor–positive breast cancer: American society of clinical oncology clinical practice guideline focused update. Journal of Clinical Oncology, 32(21), 2255–2269. https://doi.org/10.1200/JCO.2013.54.2258

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Cahir, C., Guinan, E., Dombrowski, S.U., Sharp, L., & Bennett, K. (2015). Identifying the determinants of adjuvant hormonal therapy medication taking behaviour in women with stages I–III breast cancer: A systematic review and meta-analysis. Patient Education and Counseling, 98(12), 1524–1539. https://doi.org/10.1016/j.pec.2015.05.013

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Campbell, K.L., Winters-Stone, K.M., Wiskemann, J., May, A.M., Schwartz, A.L., Courneya, K.S., … Gerber, L.H. (2019). Exercise guidelines for cancer survivors: Consensus statement from international multidisciplinary roundtable. Medicine & Science in Sports & Exercise, 51(11), 2375–2390. https://doi.org/10.1249/MSS.0000000000002116

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Chakravarty, E.F., Hubert, H.B., Krishnan, E., Bruce, B.B., Lingala, V.B., & Fries, J.F. (2012). Lifestyle risk factors predict disability and death in healthy aging adults. The American Journal of Medicine, 125(2), 190–197. https://doi.org/10.1016/j.amjmed.2011.08.006

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Chlebowski, R.T., Kim, J., & Haque, R. (2014). Adherence to endocrine therapy in breast cancer adjuvant and prevention settings. Cancer Prevention Research, 7(4), 378–387. https://doi.org/10.1158/1940-6207.CAPR-13-0389

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Davies, C., Pan, H., Godwin, J., Gray, R., Arriagada, R., Raina, V., … Bonfill, X. (2013). Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. The Lancet, 381(9869), 805–816. https://doi.org/10.1016/S0140-6736(12)61963-1

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Demark-Wahnefried, W., Rogers, L.Q., Alfano, C.M., Thomson, C.A., Courneya, K.S., Meyerhardt, J.A., … Ligibel, J.A. (2015). Practical clinical interventions for diet, physical activity, and weight control in cancer survivors. CA: A Cancer Journal for Clinicians, 65(3), 167–189. https://doi.org/10.3322/caac.21265

    • Search Google Scholar
    • Export Citation

  • Denlinger, C.S., Ligibel, J.A., Are, M., Baker, K.S., Demark-Wahnefried, W., Dizon, D., … Freedman-Cass, D.A. (2014). Survivorship: Healthy lifestyles, version 2.2014. Journal of the National Comprehensive Cancer Network, 12(9), 1222–1237. https://doi.org/10.6004/jnccn.2014.0121

    • Crossref
    • Search Google Scholar
    • Export Citation

  • DeNysschen, C., Burton, H., Ademuyiwa, F., Levine, E., Tetewsky, S., & O’Connor, T. (2014). Exercise intervention in breast cancer patients with aromatase inhibitor‐associated arthralgia: A pilot study. European Journal of Cancer Care, 23(4), 493–501. https://doi.org/10.1111/ecc.12155

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Duarte, N., Hughes, S.L., & Paúl, C. (2019). Cultural adaptation and specifics of the fit & strong! Program in Portugal. Translational Behavioral Medicine, 9(1), 67–75. https://doi.org/10.1093/tbm/iby003

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Edwards, B.K., Noone, A., Mariotto, A.B., Simard, E.P., Boscoe, F.P., Henley, S.J., … Kohler, B.A. (2014). Annual report to the nation on the status of cancer, 1975–2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer. Cancer, 120(9), 1290–1314. https://doi.org/10.1002/cncr.28509

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Fontein, D.B.Y., Seynaeve, C., Hadji, P., Hille, E.T.M., van de Water, W., Putter, H., … van de Velde, C.J.H. (2013). Specific adverse events predict survival benefit in patients treated with tamoxifen or aromatase inhibitors: An international tamoxifen exemestane adjuvant multinational trial analysis. Journal of Clinical Oncology, 31(18), 2257–2264. https://doi.org/10.1200/JCO.2012.45.3068

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Gaillard, S., & Stearns, V. (2011). Aromatase inhibitor-associated bone and musculoskeletal effects: New evidence defining etiology and strategies for management. Breast Cancer Research, 13(2), 1. https://doi.org/10.1186/bcr2818

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Graves, K.D. (2003). Social cognitive theory and cancer patients’ quality of life: A meta-analysis of psychosocial intervention components. Health Psychology, 22(2), Article 210. https://doi.org/10.1037/0278-6133.22.2.210

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Hadji, P., Blettner, M., Harbeck, N., Jackisch, C., Luck, H.J., Windemuth-Kieselbach, C., … Kreienberg, R. (2013). The patient’s anastrozole compliance to therapy (PACT) program: A randomized, in-practice study on the impact of a standardized information program on persistence and compliance to adjuvant endocrine therapy in postmenopausal women with early breast cancer. Annals of Oncology, 24(6), 1505–1512. https://doi.org/10.1093/annonc/mds653

    • Search Google Scholar
    • Export Citation

  • Heisig, S.R., Shedden-Mora, M.C., von Blanckenburg, P., Schuricht, F., Rief, W., Albert, U., & Nestoriuc, Y. (2015). Informing women with breast cancer about endocrine therapy: Effects on knowledge and adherence. Psycho-Oncology, 24(2), 130–137. https://doi.org/10.1002/pon.3611

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Howlader, N., Noone, A.M., Krapcho, M., Neyman, N., Aminou, R., Waldron, W., Altekruse, S.F., Kosary, C.L., Ruhl, J., Tatalovich, Z., Cho, H., Mariotto, A., Eisner, M.P., Lewis, D.R., Chen, H.S., Feuer, E.J., Cronin, K.A., Edwards, B.K. (Eds.). (2011). SEER cancer statistics review, 1975–2008. National Cancer Institute. (Based on November 2010 SEER data submission, posted to the SEER website). http://seer.cancer.gov/csr/1975_2008/

    • Search Google Scholar
    • Export Citation

  • Hsieh, H., & Shannon, S.E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288. https://doi.org/10.1177/1049732305276687

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Hughes, S.L., Seymour, R.B., Campbell, R., Pollak, N., Huber, G., & Sharma, L. (2004). Impact of the fit and strong intervention on older adults with osteoarthritis. Gerontologist, 44(2), 217–228. https://doi.org/10.1093/geront/44.2.217

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Hughes, S.L., Seymour, R.B., Campbell, R.T., Desai, P., Huber, G., & Chang, H.J. (2010). Fit and strong: Bolstering maintenance of physical activity among older adults with lower-extremity osteoarthritis. American Journal of Health Behavior, 34(6), 750–763. https://doi.org/10.5993/AJHB.34.6.10

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Hughes, S.L., Seymour, R.B., Campbell, R.T., Huber, G., Pollak, N., Sharma, L., & Desai, P. (2006). Long-term impact of fit and strong! On older adults with osteoarthritis. Gerontologist, 46(6), 801–814. https://doi.org/10.1093/geront/46.6.801

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Hurria, A., Levit, L.A., Dale, W., Mohile, S.G., Muss, H.B., Fehrenbacher, L., … Cohen, H.J. (2015). Improving the evidence base for treating older adults with cancer: American society of clinical oncology statement. Journal of Clinical Oncology, 33(32), 3826–3833. https://doi.org/10.1200/jco.2015.63.0319

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Hurtado-de-Mendoza, A., Cabling, M.L., Lobo, T., Dash, C., & Sheppard, V.B. (2016). Behavioral interventions to enhance adherence to hormone therapy in breast cancer survivors: A systematic literature review. Clinical Breast Cancer, 16(4), 247–255. https://doi.org/10.1016/j.clbc.2016.03.006

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Jennings, S.C., Manning, K.M., Bettger, J.P., Hall, K.M., Pearson, M., Mateas, C., … Morey, M.C. (2020). Rapid transition to telehealth group exercise and functional assessments in response to COVID-19. Gerontology and Geriatric Medicine, 6, Article 2333721420980313. https://doi.org/10.1177/2333721420980313

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Jim, H.S., Richardson, S.A., Golden-Kreutz, D.M., & Andersen, B.L. (2006). Strategies used in coping with a cancer diagnosis predict meaning in life for survivors. Health Psychology, 25(6), 753–761. https://doi.org/10.1037/0278-6133.25.6.753

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Krivitsky, L.N., Parker, S.J., Pal, A., Meckler, L., Shengelia, R., & Reid, M.C. (2012). A systematic review of health promotion and disease prevention program adaptations: How are programs adapted? In E. Wethington & R.E. Dunifon (Eds.), Research for the public good: Applying the methods of translational research to improve human health and well-being (pp. 73–99). American Psychological Association.

    • Search Google Scholar
    • Export Citation

  • Kushi, L.H., Doyle, C., McCullough, M., Rock, C.L., Demark‐Wahnefried, W., Bandera, E. V., … Gansler, T. (2012). American cancer society guidelines on nutrition and physical activity for cancer prevention. CA: A Cancer Journal for Clinicians, 62(1), 30–67. https://doi.org/10.3322/caac.20140

    • Search Google Scholar
    • Export Citation

  • Lorig, K.R., & Holman, H.R. (2003). Self-management education: History, definition, outcomes, and mechanisms. Annals of Behavioral Medicine, 26(1), 1–7. https://doi.org/10.1207/S15324796ABM2601_01

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Lorig, K.R., Ritter, P.L., Laurent, D.D., & Plant, K. (2006). Internet-based chronic disease self-management: A randomized trial. Medical Care, 44(11), 964–971. https://doi.org/10.1097/01.mlr.0000233678.80203.c1

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Lorig, K.R., Sobel, D.S., Stewart, A.L., Brown, B.W., Jr., Bandura, A., Ritter, P., … Holman, H.R. (1999). Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: A randomized trial. Medical Care, 37(1), 5–14. https://doi.org/10.1097/00005650-199901000-00003

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Mayer, E.L., & Burstein, H.J. (2015). Adjuvant endocrine therapy for postmenopausal women: Type and duration. The Breast, 24(Suppl. 2), S126–S128. https://doi.org/10.1016/j.breast.2015.07.028

    • Crossref
    • Search Google Scholar
    • Export Citation

  • McCorkle, R., Ercolano, E., Lazenby, M., Schulman-Green, D., Schilling, L.S., Lorig, K., & Wagner, E.H. (2011). Self-management: Enabling and empowering patients living with cancer as a chronic illness. CA: A Cancer Journal for Clinicians, 61(1), 50–62. https://doi.org/10.3322/caac.20093

    • Search Google Scholar
    • Export Citation

  • Murphy, C.C., Bartholomew, L.K., Carpentier, M.Y., Bluethmann, S.M., & Vernon, S.W. (2012). Adherence to adjuvant hormonal therapy among breast cancer survivors in clinical practice: A systematic review. Breast Cancer Research and Treatment, 134(2), 459–478. https://doi.org/10.1007/s10549-012-2114-5

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Mustian, K.M., Sprod, L.K., Janelsins, M., Peppone, L.J., & Mohile, S. (2012). Exercise recommendations for cancer-related fatigue, cognitive impairment, sleep problems, depression, pain, anxiety, and physical dysfunction: A review. Oncology & Hematology Review, 8(2), 81–88. https://doi.org/10.17925/OHR.2012.08.2.81

    • Search Google Scholar
    • Export Citation

  • Naeim, A., Aapro, M., Subbarao, R., & Balducci, L. (2014). Supportive care considerations for older adults with cancer. Journal of Clinical Oncology, 32(24), 2627–2634. https://doi.org/10.1200/JCO.2014.55.3065

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Newton, R.U., Hart, N.H., & Clay, T. (2020). Keeping patients with cancer exercising in the age of COVID-19. JCO Oncology Practice, 16(10), 656–664. https://doi.org/10.1200/op.20.00210

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Niravath, P. (2013). Aromatase inhibitor-induced arthralgia: A review. Annals of Oncology, 24(6), 1443–1449. https://doi.org/10.1093/annonc/mdt037

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Nyrop, K.A., Callahan, L.F., Cleveland, R.J., Arbeeva, L.L., Hackney, B.S., & Muss, H.B. (2017). Randomized controlled trial of a home-based walking program to reduce moderate to severe aromatase inhibitor-associated arthralgia in breast cancer survivors. The Oncologist, 22(10), 1238–1249. https://doi.org/10.1634/theoncologist.2017-0174

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Nyrop, K.A., Muss, H.B., Hackney, B., Cleveland, R., Altpeter, M., & Callahan, L.F. (2014). Feasibility and promise of a 6-week program to encourage physical activity and reduce joint symptoms among elderly breast cancer survivors on aromatase inhibitor therapy. Journal of Geriatric Oncology, 5(2), 148–155. https://doi.org/10.1016/j.jgo.2013.12.002

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Risendal, B.C., Dwyer, A., Seidel, R.W., Lorig, K., Coombs, L., & Ory, M.G. (2015). Meeting the challenge of cancer survivorship in public health: Results from the evaluation of the chronic disease self-management program for cancer survivors. Frontiers in Public Health, 2, Article 214. https://doi.org/10.3389/fpubh.2014.00214

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Rock, C.L., Doyle, C., Demark‐Wahnefried, W., Meyerhardt, J., Courneya, K.S., Schwartz, A.L., … McCullough, M. (2012). Nutrition and physical activity guidelines for cancer survivors. CA: A Cancer Journal for Clinicians, 62(4), 242–274. https://doi.org/10.3322/caac.21142

    • Search Google Scholar
    • Export Citation

  • Runowicz, C.D., Leach, C.R., Henry, N.L., Henry, K.S., Mackey, H.T., Cowens‐Alvarado, R.L., … Jacobs, L.A. (2016). American Cancer Society/American Society of Clinical Oncology breast cancer survivorship care guideline. CA: A Cancer Journal for Clinicians, 66(1), 43–73. https://doi.org/10.3322/caac.21319

    • Search Google Scholar
    • Export Citation

  • Schmitz, K.H., Courneya, K.S., Matthews, C., Demark-Wahnefried, W., Galvao, D.A., Pinto, B.M., … American College of Sports Medicine. (2010). American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Medicine & Science in Sports & Exercise, 42(7), 1409–1426. https://doi.org/10.1249/MSS.0b013e3181e0c112

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Seymour, R.B., Hughes, S.L., Campbell, R.T., Huber, G.M., & Desai, P. (2009). Comparison of two methods of conducting the fit and strong! Program. Arthritis Care and Research, 61(7), 876–884. https://doi.org/10.1002/art.24517

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Siegel, R.L., Miller, K.D., & Jemal, A. (2016). Cancer statistics, 2016. CA: A Cancer Journal for Clinicians, 66(1), 7–30. https://doi.org/10.3322/caac.21332

    • Search Google Scholar
    • Export Citation

  • Smith, S.G., & Chagpar, A.B. (2010). Adherence to physical activity guidelines in breast cancer survivors. American Surgeon, 76(9), 962. https://doi.org/10.1177/000313481007600929

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Strauss, A., & Corbin, J.M. (1990). Basics of qualitative research: Grounded theory procedures and techniques. Sage Publications, Inc.

  • Stubblefield, M.D., & Keole, N. (2014). Upper body pain and functional disorders in patients with breast cancer. PM&R, 6(2), 170–183. https://doi.org/10.1016/j.pmrj.2013.08.605

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Stull, V.B., Snyder, D.C., & Demark-Wahnefried, W. (2007). Lifestyle interventions in cancer survivors: Designing programs that meet the needs of this vulnerable and growing population. The Journal of Nutrition, 137(Suppl. 1), 243S–248S. https://doi.org/10.1093/jn/137.1.243S

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Underwood, J.M., Townsend, J.S., Stewart, S.L., Buchannan, N., Ekwueme, D.U., Hawkins, N.A., … Fairley, T.L. (2012). Surveillance of demographic characteristics and health behaviors among adult cancer survivors—Behavioral risk factor surveillance system, United States, 2009. MMWR Surveillance Summaries, 61(1), 1–23.

    • Search Google Scholar
    • Export Citation

  • Williams, N. (2017). The Borg rating of perceived exertion (RPE) scale. Occupational Medicine, 67(5), 404–405. https://doi.org/10.1093/occmed/kqx063

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Willis, G.B. (2004). Cognitive interviewing: A tool for improving questionnaire design. Sage Publications.

  • Wolin, K.Y., Schwartz, A.L., Matthews, C.E., Courneya, K.S., & Schmitz, K.H. (2012). Implementing the exercise guidelines for cancer survivors. The Journal of Supportive Oncology, 10(5), 171–177. https://doi.org/10.1016/j.suponc.2012.02.001

    • Crossref
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 1685 1468 57
Full Text Views 58 50 1
PDF Downloads 77 66 2