1 The European Cancer Rehabilitation Symposium 2014 September 8, 2014 Parallel session: Obesity, physical activity and dietary challenges
2 PROGRAM, September 8, 13:15 14:15 13:15 Meaningfulness of physical activity and exercise in cancer rehabilitation - a meta-synthesis of qualitative research Speaker: Julie Midtgaard [Chair] 13:30 Safety and efficacy of resistance training in Germ Celle cancer patients undergoing chemotherapy a Randomized Controlled Trial Speaker: Jesper Frank Christensen 13:45 Predictors of physical activity among colorectal cancer survivors: results from the longitudinal populatiom-based PROFILES registry Speaker: Nicole Ezendam High levels of physical activity are associated with lower levels of fatigue among lymphoma patients: results from the longitudinal PROFILES registry Speaker: Olga Husson
3 European Cancer Rehabilitation Symposium 2014 Parallel Session: Obesity, physical activity and dietary challenges September 8, 2014 MEANINGFULNESS OF PHYSICAL ACTIVITY AND EXERCISE IN CANCER REHABILITATION: A Meta-Synthesis of Qualitative Research Julie Midtgaard Associate Professor, Psychologist, PhD
4 Qualitative research Any kind of research that produces findings not arrived at by means of statistical procedures or other means of quantification. (Strauss & Corbin, 1990)
5 European Cancer Rehabilitation Symposium 2014 Parallel Session: Obesity, physical activity and dietary challenges September 8, 2014 MEANINGFULNESS OF PHYSICAL ACTIVITY AND EXERCISE IN CANCER REHABILITATION: Evidence Beyond Measures and Numbers Julie Midtgaard Associate Professor, Psychologist, PhD
6 Background Evidence for the health benefits of physical activity and exercise for cancer survivors is accumulating, including potential effect on survival (e.g. Fong et al. 2012, Brown et al. 2012; Mishra et al. 2012). However, the meaningfulness of physical activity from the perspective of the patient has not yet been established.
7 Meta-synthesis Method for integrating findings from multiple qualitative studies to produce a new interpretation of findings that is more substantive than those resulting from individual investigations (e.g. Sandelowski & Barroso 2007, Estabrooks et al. 1994, Jensen & Allen 1996).
8 Aim To aggregate, interpret and synthesize findings from qualitative studies that included cancer survivors experiences of participation in exercise-based cancer rehabilitation.
9 Search Method Five electronic databases were searched systematically for articles published up to May 2014, using keywords and mesh headings.
10 Study selection Inclusion Primary data pertaining to cancer survivors experience from partcipation in structured, supervised moderate-tovigorous intensity exercise Exclusion Home-based, unsupervised or selfinitiated physical activity Mind-body interventions and other types of non-vigorous exercise Children
11 PubMed 998 papers (998 unique) PsychINFO 160 papers (60 unique) EMBASE papers (896 unique) CINAHL 409 papers (187 unique) Scopus papers (307 unique) Papers excluded after detailed evaluation of abstract (n=52): Exercise not structured/supervised and institutional/center based, e.g. dragon boat and home based exercise (n=27) Exercise not resistance and/or cardiovascular training, e.g. yoga, mind-body and life style interventions (n=15) Not focus on patient experiences with exercise-based rehabilitation (n=3) Not a qualitative investigation (n=4) Including other diagnostic groups than cancer (n=1) Conference abstract (n=1) Doublet (n=1) Patient perspectives on exercise-based rehabilitation secondary to a related topic (n=11): Feasibility (n=3) Quality of life (n=1) Group Cohesion (n=1) Coping abilities (n=1) Fatigue (n=1) Pain (n=1) Return to work (n=1) Erythropoietin (n=1) Appearance and identity (n=1) Potentially relevant papers identified by literature search (n=2448) Detailed examination of abstracts (n=89) Papers retrieved for full text examination (n=37) Papers assessed for methodological quality and included in the systematic review (n=19) Papers included in the meta-synthesis (n=8) Papers excluded after evaluation of title (n=2359) Papers excluded after evaluation of full text (n=18): Unsupervised, unstructured or home-based exercise (e.g. dragon boat ) (n=8) Non-vigorous or mind-body exercise interventions (e.g. yoga, stretching, patient education) (n=8) Not focus on patient experiences (n=1) Conference abstract (n=1)
12 Characteristics of included papers (n=390) Treatment status Undergoing active treatment (10/19) Post-treatment (5/19) Both (4/19) Data collection method In-depth (semi-structured) interviews (n=10/19) Focus Group interviews (n=6/19) Observation (n=3/19) Included participants (n=390) Women (67.8%) Mixed diagnoses (11/19) Type of intervention Group-based (16/19) Individual (3/19)
13 Analytical Process (Meta-synthesis) 1. Thorough reading of each paper several times 2. Extraction of findings relating to experiences of exercise across the papers 3. Visual mapping of selected key findings 4. Clustering and translating the findings into themes 5. Re-reading of each individual paper 6. Final description of themes and assigning of theme titles (categories) Sandelowski, M., & Barroso, J. (2007). Handbook for synthesizing qualitative research. Springer, New York.
14 Categories and Themes (n=174) 1) Emergence of continuity Building structure Goal-setting Positive distraction 2) Preservation of normality Social support Autonomy Affirmation of own health 3) Reclaiming the body Enhanced performance Safety trough professional supervision Overcoming barriers
15 Synthesis Meaningfulness of exercise-based rehabilitation according to cancer survivors is related to the development of personal strategies including: Buildings structure including upholding a positive outlook Feeling normal and in control Restoring confidence and feeling safe
16 Methodological considerations Only electronic searchers were performed Synthesis was performed several researchers (researcher triangulation) Synthesis validated by the original researchers (member-checking)
17 Conclusion Cancer survivors experience structured exercise as a means to fulfill their mental, social and physical well-being independent of treatment and disease status. Cancer survivors may benefit from exercisebased rehabilitation in the process of restoring and creating meaning in life after diagnosis. More research is needed in order to clarify the meaningfulness of unsupervised, home-based exercise and the role of exercise-based rehabilitation in juvenile cancer-survivors.
18 Clinical Implications Clinicians and policy-makers must acknowledge and promote the meaningfulness of physical activity and exercise. This knowledge may be used to provide new solutions to current problems related to: Recruitment Long-term adherence Implementation
19 Collaborators UCSF, Rigshospitalet Nanna Maria Hammer, Research Assistant Anders Larsen, Librarian Christina Andersen, PhD, Post Doc Ditte Marie Bruun, Research Assistant Mary Jarden, PhD, Associate Professor
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