Moving Forward Together 3: Breast Cancer Survivors Exercising Together

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After getting through her treatment for breast cancer, Ms. K* looked at the experience as an opportunity to get back into shape. She knew that she would have trouble motivating herself and needed a kick-start. It was an advertisement in her state newspaper that gave her just what she needed.

The ad was for Moving Forward Together 3, a study aiming to evaluate how to get breast cancer survivors to start and maintain an exercise routine.

There’s no question that exercise is good for patients and survivors of cancer. It’s an easy answer to the question of what survivors can do for themselves, once they’ve been declared “cancer-free.” However, getting started on exercising, and keeping up with it, can be difficult, and this is especially true for cancer survivors who have gone through physically taxing and exhausting treatment regimens.

Bernardine Pinto, PhD, associate dean for research and professor at the College of Nursing at the University of South Carolina, is the lead researcher on this study. “We know that exercise, becoming physically active, helps to improve patients’ recovery, in the sense that it improves their physical functioning, their mood, quality of life, and in some cases even fatigue,” Pinto said in an interview with Oncology Nursing News. “And then we have the issue of cancer patients being at increased risk for cardiovascular disease, diabetes, obesity and so on.”

The Moving Forward Together study will be open to women who are 21 years of age or older, have been diagnosed with stage 0-3 breast cancer in the past five years, are not participating in regular physical activity, can read and speak English, and have access to a telephone. Survivors must be able to walk without assistance and must live within the Eastern timezone.

Each of these survivors will receive a pedometer and then be paired with a fellow breast cancer survivor who has been trained through the American Cancer Society’s Reach to Recovery (RTR) program. “RTR is a peer-based program,” Pinto explained. “These are breast cancer survivors who have survived their treatment, and the ACS trained these individuals to help them to provide emotional and other kinds of support to patients at different times in diagnosis. They already know how to work with patients.”

Via weekly phone calls over 12 weeks, the RTR volunteers offer their survivor partners a home-based exercise program (mostly brisk walking) to help them gradually progress to exercise at least 150 minutes/week (this goal is consistent with the American College of Sports Medicine’s recommendation for cancer survivors).

Investigators plan to enroll 150 women in the study that launched in April 2015 and will be completed in March 2020.

In an interview with Oncology Nursing News, Ms. K said that having a survivor for an exercise coach “was a big help,” because it allowed her to “not only talk to the professionals, but to talk to someone who had been through it as well, someone who truly understands what the obstacles may be, but was still telling me, ‘I know you're going to do well.’”

For Ms. L, a coach with Moving Forward Together 3, physical fitness was always a part of her recovery. “Establishing a regular walking routine was a part of getting back to something like normal,” she said. “And that was on three levels — not just physical, but also part of the mental and spiritual recovery.”

All three of those components are important to Ms. L, and to her counseling. She explained that patients in this program “have to be prepared to understand that there are going to be setbacks.” She went on, “I counsel thoughtful goal-setting and a lot of forgiveness and patience with yourself.”

Ms. K also stressed the importance of starting slowly. “The key is just to do it incrementally,” she said, “a little bit at a time.” She went on to explain that her coach was sympathetic. “If I was only able to get in two sessions in a week, she would ask how I felt and tell me, ‘I had times when it was tough, but I did as much as I possibly could.’ It helped, since I knew she had gone through it herself.”

Before Moving Forward Together 3 in South Carolina, Pinto led two similar studies in 2015. These studies also evaluated the effects of survivors receiving exercise-related telephone mentorship from fellow survivors. Early results show that the intervention was successful in getting cancer survivors to engage in exercise routines. Pinto said, “We found that [the participants’] physical activity had improved significantly from their baseline. Their vigor had improved. Their quality of life had improved. Their fatigue had gone down.”

After the initial 12-week program in the study enrolling now, there will also be a follow-up at the 6 month, 9 month and 12 month marks to determine whether survivors were able to maintain their exercise routines.

The focus of Moving Forward Together 3 is on helping survivors adopt and maintain exercise. After the initial 12-week program has been completed, the study will examine three types of communication as maintenance strategies, including monthly phone calls, exercise logs and text messages/emails, to determine which is the most effective.

“The research shows how exercise can help cancer survivors with fitness, physical functioning and quality of life,” Pinto said. “In this partnership with the American Cancer Society, we hope to show how community-based organizations will be able to implement our home-based exercise program and help survivors become and stay physically active.”

If the study’s goals are met, researchers plan to conduct a larger trial of the program that will allow cancer care organizations that have been peer-based programs an opportunity to expand the scope of the services they offer to survivors of breast cancer.

Those interested in learning more about, or participating in, Moving Forward Together 3 may contact Kimberly Bowyer, University of South Carolina research assistant, at 803-777-3909, 888-829-1916 or chapmakp@mailbox.sc.edu. Participants do not have to live in South Carolina, but they must live in the Eastern time zone to participate.

*Aliases have been used