Table 4 Integration of quantitative and qualitative results from the study My body, My Rhythm, My Voice

Engagement of breast cancer survivors

Recruitment

Recruitment rate

64/553

Thematic analysis of reported barriers to engage in physical activity

“A lot of the time you stop yourself from doing something because of the fears that others instill in you. (…) So many people do this, they tell you ‘oh you can’t do this with your pain, you can’t warm up’ no, no, no, you can’t do anything no, no, no. (…) I started researching and it turns out that when you get surgery you have to start exercising right away unlike what other people tell you. It’s important for Doctors to become aware of this, not just tell you no, no, no, they should motivate you instead”. (Intervention group, interview #3).

Recruitment of a diverse group of women was difficult due to misperceptions of physical activity and its potential benefits during and post cancer.

For future interventions, it is relevant to engage health care professionals and providers as physical activity promotion agents.

Participant characteristics

Middle socioeconomic level

62.17%

Thematic analysis of BCS narratives

“I’d say: it doesn’t matter, if I have to make sacrifices, I’m going to do it, I’m going to finish [the intervention] and that’s what I did and now I feel fulfilled to have been able to do it, even if I had to sacrifice a lot, because I’m always thinking about everyone else and not myself.” (Intervention group, interview #5)

Relevant background characteristics of the BCS who participated in My Body include their socioeconomic level, employment status, medical history, and time management practices regarding personal competing priorities (i.e., self-care, household caregiving duties, work, medical schedule).

Not working for payment

60.85%

Overweight/obese

80%

Time since diagnosis (years)

5.43

Participant retention

Attendance to ≥60% of My Body sessions

84.40%

Thematic analysis of facilitators to engage in physical activity.

“I felt fulfilled with everything we did and all the dancing (...) it was my exit from home. I used to spend all day lying down. This has been very exciting and beautiful for me. I tell everyone in my house that I'm sorry because it's over.” (Intervention group, interview #8).

“It motivates you to know that it’s led by people who know what they’re doing. They’re always looking out for you, asking if you got back safe or why you’re not there yet. The attention that they give us by asking how we’re doing, how things are going, how did we do, that’s something you sometimes don’t even get from family.” (Intervention group, interview #13).

The high retention rate among the Intervention group after starting My Body program might be related to facilitators reported at all levels: individual (enjoyment through dancing, positive beliefs regarding physical activity, the resilience process associated to the disease), interpersonal (group-based guided physical activity practice, peer care network), and community (motivated knowledgeable staff, interdisciplinary team, accessible place).

Effects of the intervention among breast cancer survivors in the physical activity group

Change in mean physical activity levels

Average time of MVPA per day

8.99 min

Thematic analysis of BCS perceived benefits

“I felt really good because honestly, my leg would give up on me a lot before. I was going to get surgery but with this I’ve felt much better, I can walk now, and I feel like I’ve been reborn. I’ve walked a lot and already feel so good.” (Intervention group, interview #5)

“Learning to know our bodies has been important too. Learning to know our own body and its rhythm. If I couldn’t do something, then it was ok and when I could do it, it was at my own pace.” (Intervention group, interview #1)

As a result of the intervention, BCS on average added 9 minutes to their average time of MVPA per day, when compared with the control group.

Change in motivation to engage in physical activity

Intrinsic regulation score

0.45

Thematic analysis of BCS’ perceptions of physical activity

“I learned that you’ve got to let go of the idea that you can’t do something. I used to think I couldn’t dance, and it turns out I can, and it makes me happy. You really need to free yourself from all those things that are holding you back.” (Intervention group, interview #6)

“Learning to have discipline and will power. For example, there were 3 classes left and I had all this leg pain, but I’d say no, I have to do this and finish it." (Intervention group, interview #4)

“I was a dancer as well (…). So, I’d think: the cancer, 20 rounds of chemo, 10 rounds of radiotherapies, how would I be able to even lift a finger? Then when I saw myself in this program I thought ‘no way, this is great’. Knowing that not everything is bad, that after all that cancer put me through, I was able to dance again. I love dancing” (Intervention group, interview #2)

The increases in the intrinsic motivation to engage in physical activity among BCS were possibly related to the experienced changes towards perceiving physical activity as a pleasant habit of personal enjoyment and self-care, positive attitudes (e.g. discipline, will, self-confidence), improving self-image and mood, and motivation to leave home among their perceptions of physical activity as an enjoyable behavior and perceived broad benefits (e.g., impacts in the self-belief system, improvements in flexibility, joint mobility, coordination, and vitality).

Change in quality of life

Quality of life score

Thematic analysis of BCS perceived benefits

“In an emotional level I really liked it because it helped me stay in a more optimistic state of mind (...) here I feel identified with everyone. I worked hard, I was very happy, and I felt that I forgot all my problems” (Intervention group, interview #3).

We did not find a significant change in QoL, but through the interviews women reported broad perceived benefits contributing to well-being enhancement. It is necessary to evaluate a larger sample size and longer intervention to capture changes in QoL. Additionally, relevant health outcomes for BCS that should be reported include sleep dysfunction, joint pain, specific self-efficacy measures for dancing (or corresponding type of physical activity), coordination, time management, self-care, and social networking.

Considerations for future implementation

Perceived acceptability of My Body program

Thematic analysis of aspects to maintain

“For me it was very gratifying [sharing with BCS] not because it happened to them but because I didn’t feel so alone. It’s not the same to talk to or be with someone who hasn’t been through what I’ve been through than to have a fellow fighting companion that knows what it’s like.” (Intervention group, interview #6)

Women underscored as successful aspects of the physical activity program: (1) the professionals implementing it, (2) the enjoyable physical activity sessions, (3) practicing physical activity with peers, family members, and friends, and (4) the communication channels.

Thematic analysis of aspects to strengthen or include

“These programs truly help and should be growing even more because if you tell us where to go, that’s where we’ll go to promote it further (…) tell them ‘look, there’s a program for this, to help us with our self-esteem because it goes so low’. I’d love to spread the word because I don’t want others to go through what I went through. On the contrary, I want to walk into those chemo rooms were people are pitying themselves and tell them, ‘no, we’re going to get through this and get pretty’.” (Intervention group, interview #10)

BCS suggested (1) increasing sites and hours for the physical activity sessions, (2) including nutrition workshops for preparation of recipes, and (3) installing capacity among BCS to become agents of physical activity promotion.