@2024 Afarand., IRAN

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ISSN: 2383-2150    Journal of Education and Community Health 2015;2(1):50-57

Background
Breast cancer is one of the most common cancers and the most fatal malignancy among women worldwide. The highest rate of age-standardized outbreak of it has been reported 123.6 per 100.000 in North America as the lowest rate of 21.8 per 100.000 in South Asia [1].
Previous Studies
... [2-18].The use of non-pharmaceutical interventions such as exercising and consulting has an effective role in the quality of patients` lives along with pharmacological measures [19]. Many researchers believe that healthcare workers should include sports consulting and physical activities as part of common examinations of the patients [20].
Aim(s)
This study aimed to determine the effect of sports consulting on performance scales of life quality of women with breast cancer who had referred to cancer treatment centers in Hamadan in 2014.
Research type
This is a quasi-experimental study with two groups of intervention (sports consulting) and control which examines the patients` quality of life in two stages, before and after the intervention.
Research society, place and time
The population of the study consisted of 60 women aged from 20 to 60 years suffering from breast cancer who had referred to chemotherapy section of Shahid Beheshti medical educational center and Mahdieh MRI center of Hamadan.
Sampling method and number
The samples were divided into intervention (30 people) and control (30 people) groups using randomly sampling. The criteria for entering the study included residing in Hamadan, being at least two months passed from diagnosis according to the pathological result, being in the 1-2 stage of the disease, beginning the treatment interventions, the age range of 20 to 60 years, not doing regular exercises before, other complementary medicine techniques and not having physical problems. Exclusion criteria were worsening of the disease, metastasis and not participating in counseling sessions and exercises for more than two sessions. During the study 3 people from the intervention group and 4 people from the control group were excluded for several reasons and finally the research was carried out on 27 people from the control group and 26 people from the intervention group.
Used devices&materials
Data collection instrument comprised of three parts: the questionnaire of demographic information, the questionnaire of life quality of cancer patients and the specific questionnaire of life quality of breast cancer patients. The standard questionnaire of cancer patients' life quality (EORTC QLQ-C30): This questionnaire contains 30 questions and examines the life quality in cancer patients measuring five performance domains, 9 aspects of symptoms and the general domain oflife quality [12,21].Specific standard questionnaire of life quality of patients with breast cancer (EORTC QLQ- BR23): This questionnaire contains 23 questions, which measures 4 performance and 4 symptom domains.The reliability and validity of these two questionnaires have been assessed in several studies in Iran [12, 21]. The domains of these questionnaires were scored based on the European Organization Guide of EORT Research and Treatment of Cancer [22]. The score of all the domains is accordingly between zero and100. Both questionnaires have been designed from 1 to 4 based on 4-point Likert scale; except for the questions related to the general health status and life quality which have the 7-point scale. Higher points in the scope of performance indicate the better level of performance and in the symptom domain lower points illustrate a decrease in the symptoms [9]. Cronbach's alpha coefficient has been reported between 0.63 to 0.95 and 0.71 to 0.95 for multiple-choice scales and different dimensions, respectively[11]. The control group was asked to receive only conventional treatments during the study. Before the intervention, the certificate of no restrictions in the intervention was collected from the doctor and in the first session before the intervention all the patients of the intervention group were visited by the specialist in exercise physiology.Then the questionnaires were completed for both groups by the researcher. In order to hold the counseling sessions, the intervention group was divided into three groups of 8 to 10 people and the counseling sessions were conducted for each group separately. The intervention was done in two stages as follows: The first phase including two weeks of sports consulting: there were 2 sessions per week, each session including 1 hour of exercise consulting by the researcher for each of the groups. In this study, sports consulting took place based on5A consultation pattern, which includes Assess, Advise, Agree, Assist and Arrange [23] by the researcher with the intervention group for 1 hour.After the consultation for 45-60 minutes, the exercises designed by sports medicine physicianwere performed based on protocols of the Sports Medicine Association of America under the supervision of the coach. The stages of the exercises included warming up by walking slowly and gentle stretching for 5 to 10 minutes, aerobic exercises in the form of walking with moderate intensity, stretching and exercises specifically designed for arm and shoulder for 15-20 minutes which its duration increased for 2 minutes each session until it reached tothe maximum time of 40 minutes during the intervention and then it was stopped at the same level. The final step was cooling down stage in the form ofslow walking and relaxing gestures for 5 to 10 minutes. The consulting and sports exercises were free during thesetwo weeksin the gym of Qods Stadium in Hamedan. The second step including the performance of physical exercises (which weretrained and run by coaches) was conducted at home for 8 weeks and 2 sessions per week based on the same designed protocol. According to the agreement between the researcher and the intervention group in this period, the researcher made phone calls twice a week to make sure they do the exercises at home, to emphasis on filling the checklists and to answer the possible questions. Besides, during this period the control group waschecked by the researcher over phone. 8 weeks after theintervention, the questionnaires were completed and collected by both the intervention and control groups. Statistical analysis All data was analyzed after the logging using SPSS software, version 20. The normality of the data was examined using KS test. To study the data, t-test, chi-square and Fisher tests were usedand in order to remove the effect of the baseline of the scores of life quality before the intervention inboth groups, ANCOVA test was employed. In all teststhe significance level was less than 0.05.
Findings by Text
Most of the patients(37.7%)were in the age range of 40 to 49 while the lowest number of them(13.2%)was 20 to 29 years. 74.1, 76.9 and 11.5%of them were married, unemployed and illiterate, respectively. There was no significant difference between the intervention and control groups in any of the demographic variables such as the records of hormone therapy, methods of contraception and breast feeding status (Table 1).The statistical T-test was used to compare the mean scores of performance domain of life quality between the two groups before and after the intervention and to remove the effect of the baseline of quality of life scores between the two groups before the intervention, ANCOVA test was deployed. The results showed that in the intervention group before intervening, the highest score was related to the sexual function domain with the mean of 88.88±28.11and the lowest score was for the emotional performance with the mean of 45.98±30.51. In the control group the highest and the lowest score was89.1±24.9and 59.29±21.25 and for these twodomains, respectively and there was no significant difference between the two groups (P>0.05). The total score of health status before intervening in the control and intervention groups was48.76± 24.96 and 47.75±15.7, respectively,without any significant difference between the two groups (P=0.28). In the control group before the intervention, some scores of performance domains were better than the intervention group and had significant statistical difference (P<0.05, Table 2). After the intervention in both groups, some scores of performance domain of life quality increased and the difference was significant between the two groups before and after the intervention (P<0.05). 8 weeks after intervening in the intervention group, there was a significant increase in some of the scores of performance domain and a significant difference was madecompared to before the intervention. These changes in performance domains were related to physical function, role playing, cognitive function, physical image and the total score ofperformance domain. The highest score was forthe cognitive function with 91.35±14.14. In other aspects such as sexual function, sexual pleasure and future outlooks there was no difference between the two groups (P>0.05). No significant difference was observed in the general health status in the two groups after the intervention (P>0.05) (Table 3).
Main comparison to the similar studies
... [24]. Most of the patients in the study (37.7 percent) were 40 to 49 years and it was consistent with the results of study by CharkaziPour Kiani and Ghourchaei[26]. In a study on 62 women with breast cancer in Kosovo,Murtezaniet al.demonstrated that 10 weeks of aerobic exercise for 25 to 40 minutes and three times a week at moderate intensity improved the quality of life and physical performance in patients. The greatest increase was in cognitive performance domain [27], which was in line with some results of this study. ... [28].
Suggestions
In health planning as well as studying the life quality of patients, it is recommended to place exercise counseling, physical activity and other non-pharmacological interventions as part of common measures along with medical interventions.In addition, extensive studies with larger participantsin a longer periodmust be done in this field.
Limitations
Lack of access of all patients to gyms, unawareness of healthcare workers about the sport protocols in certain patients, small sample size, lack of cooperation from some of the patients due to personal and cultural reasons were some of the limitations of the study.
Conclusions
Sportconsulting has a positive effect on performance domains of life quality of women with breast cancer andresults in significant improvements in them.
Acknowledgments
Many thanks are addressed to the Department of Research and Technology and International Branch of Hamedan University of Medical Sciences, manager of Physical Education inHamedan, personnel of ShahidBeheshtiHospital, Mahdieh MRI center and all patients and their families who havecooperated with the researcherin this study.
Conflict of interest
Non-declared
Ethical Permissions
The necessary permissions were takenfrom the manager of physical education for the exercises of the intervention group in Qods gym,Hamedan. The aim of this study was explained by the researcher for both intervention and control groups and letters of consent were taken from them for participating in the research.
Funding Sources
This article is the result of a part of the author’s thesis and was recorded in Iran’s clinical trial central under the number of IRCT201412066888N5.

TABLES and CHARTS

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