الفهرس 
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Abstract
The aim of this study was to determine the effect of an exercise training program on breast cancer outcomes. These outcomes included the following:
• Levels of anxiety.
• QOL. Namely, health and functioning subscale, social and economic subscale, psychological/spiritual subscale, and family subscale.
• Functional capacity.
• Shoulder ROM-abduction of the affected breast.
To fulfill the aim of the study, the following research hypotheses were formulated:
• The mean scores of anxiety level among patients who will apply the exercise training program will be lower than the mean scores of a control group.
• The mean scores of QOL among patients who will apply the exercise training program will be higher than the mean scores of a control group.
• The mean scores of functional capacity among patients who will apply the exercise training program will be higher than the mean scores of a control group.
• The mean scores of ROM among patients who will apply the exercise training program will be higher than the mean scores of a control group.
The study was conducted at General Surgery, Out Patient Clinics of Oncology, and Rheumatology and Rehabilitation at Assiut University Hospitals and South Egypt Cancer Institute in Assiut, in a period of 15 months (June 2005 to September 2006).
To accomplish the purpose of this study, data were collected from 60 pre-operative female adult patients aged from 18 years to less than 60 years with stage II and stage III breast cancer. Patients suffered from debilitating illness as severe pulmonary diseases, heart disease, uncontrolled hypertension, diabetes mellitus, renal diseases, severe fatigue, cognitive disorders, and patients with physical limitations, which would have prevented them from taking part in our training program, were excluded from this study. Those 60 subjects were equally divided on random basis into study and control group (30 each).
The following tools were utilized for data collection; a) Demographic data sheet to cover the demographic variables b) Speilberger’s State Anxiety Inventory c) Ferrans and Powers QOL index (QLI)–cancer III version.
d) Functional capacity evaluation e) ROM test for the involved joint.
The training program was a group exercise program, as group sessions helped the women to provide support and experiences for each other. The exercise program consisted of deep breathing and coughing exercises, ROM exercises for upper limb, and aerobic exercises.
Collected data were analyzed using appropriate descriptive and inferential statistics through using SPSS version 11. Results were interpreted to suit the research problem under investigation and were summarized in appropriate tables and charts. The following tests for significance were used, Mean, Standard Deviation and Percentage. T-test for comparison of means. A probability level of 0.05 was adopted as a level of significance for testing the research hypothesis.
Main findings of the present study were as the follows:
As regard socio-demographic characteristics, the mean age ± SD of the study group patients was (40.6±0.5) years, ranged between (25-57) years, living in rural areas (76.7%), were married (63.3%), had children (90%), and were illiterate (66.7%). While the mean age ± SD of the control group patients was
(40.7±0.5), ranged between (27-58) years, living in rural areas (90%), were married (66.7%), had children (85.7%), and were illiterate (76.7%). No significant difference was found between study and control groups patients as regard socio-demographic characteristics.
Regarding pre-program levels of anxiety, 100% of study group patients, and 70% of control group patients suffered from severe level of anxiety. No significant difference was found between study and control group as regard pre-program levels of anxiety.
Regarding pre-program mean ± SD scores of QOL, scores of social and economic dimension of QOL were higher among study group (20.9±2.5) than control group (19.6±2.4). While, mean ± SD scores of psychological/spiritual dimension of QOL were higher among control group (21.0±1.4) than study group (18.8±1.6). Significant difference (P >0.05) was found between study and control groups patients as regard scores of social and economic dimension and psychological/spiritual dimension of QOL. No significant difference was found between study and control groups patients as regard pre-program scores of health and functioning dimension, family dimension of QOL, and total QOL.
Concerning pre-program pulmonary function tests, no significant difference was found between study and control groups patients as regard mean ± SD of pulmonary function tests: FVC/L, FVC (% predicted), FEV1/L, FEV1
(% predicted), PEF (L/sec), and PEF (% predicted).
Regarding pre-program mean ± SD of VO2max, workload, and test time as an indirect method for evaluating the functional capacity and ROM, shoulder ROM-abduction of the affected breast was higher among study group (62.3±11.4) than control group (54.3±9.4). High significant difference (P=0.004) was found between study and control groups as regard shoulder ROM-abduction of the affected breast. No significant difference was found between study and control groups as regard pre-program VO2max, workload, and test time.
As regard to post-program mean ± SD levels of anxiety, levels of anxiety were higher among control group (52.7±3.6) than study group (29.8±3.1). High significant difference (P>0.001) was found between study and control groups patients as regard post-program levels of anxiety.
Dealing with post-program mean ± SD scores of QOL, scores of health and functioning dimension, social and economic dimension psychological/spiritual dimension, family dimension of QOL, and total QOL were higher among study group patients (24.9±1.1, 22.3±2.5, 24.8±1.1, 26.5±1.8, and 24.3±0.9, respectively) than control group patients (18.3 ± 1.8, 19.5±2.4, 20.7±1.5, 22.6±2.7, and 19.7±0.9, respectively). High significant difference (P>0.001) was found between study and control groups as regard health and functioning dimension, social and economic dimension psychological/spiritual dimension, family dimension of QOL, and total QOL.
Concerning post-program pulmonary function tests: the mean ± SD of FVC/L, FVC (% predicted), FEV1/L, FEV1 (% predicted), PEF (L/sec), and PEF (% predicted) were higher among study group (2.9±0.6, 85.6±10.4, 2.9±0.5, 97.6±12.9, 5.3±0.8, and 90.1±11.5, respectively) than control group (2.3±0.5, 78.9 ±12.5, 2.2±0.6, 87.7±15.6, 4.5±1.2, and 76.8±17.1, respectively). High significant difference (P>0.001) was found between study and control groups patients as regard PEF (L/sec), and PEF (% predicted). Significant difference (P>0.05) was found between study and control groups patients as regard FVC/L, FVC (% predicted), FEV1/L, and FEV1 (% predicted).
Regarding post-program mean ± SD of VO2max, workload, test time and ROM, VO2max, workload, test time, and shoulder ROM-abduction of the affected breast were higher among study group (29.8±7.3, 161.7±23.4, 13.9±1.9, and 86.0±6.7, respectively) than control group patients (14.6±4.3, 69.2±19.3, 6.5±1.5, and 71.0±9.6, respectively). High significant difference
(P>0.001) was found between study and control groups patients as regard pre-post program, VO2max, workload, test time, and shoulder ROM-abduction of the affected breast
Regarding pre-post program mean ± SD levels of anxiety, before program implementation, levels of anxiety were higher among study group patients (58.0±2.3) than after program implementation (29.8±3.1). High significant improvement (P>0.001) was found among study groups patients as regard pre-post program levels of anxiety. No significant difference was found among control group patients as regard pre-post program levels of anxiety.
Regarding pre-post program mean ± SD scores of QOL, scores of health and functioning dimension, social and economic dimension, psychological/spiritual dimension, family dimension of QOL, and total QOL were higher among study group patients (24.9±1.1, 22.3±2.5, 24.8±1.1, 26.5±1.8, and 24.3±0.9, respectively) than before program application (20.8±1.3, 20.9±2.5, 18.8±1.6, 24.0±1.8, and 20.8±1.0, respectively). High significant improvement (P>0.001) was found among study group as regard pre-post program health and functioning dimension, psychological/spiritual dimension, family dimension of QOL, and total QOL. Also, significant difference (P>0.05) was found as regard social and economic dimension of QOL. While pre-program mean ± SD scores of health and functioning dimension, family dimension of QOL, and total QOL were higher among control group (21.2±1.4, 24.0±1.9, and 21.2±0.8) than post-program scores (18.3±1.8, 22.6±2.7, and 19.7±0.9). High significant difference (P>0.001) was found among control group as regard pre-post program health and functioning dimension of QOL, and total QOL. In addition, significant difference (P>0.05) was found as regard family dimension of QOL.
Regarding pre-post program pulmonary function tests, the mean ± SD of FVC/L, FVC (% predicted), FEV1/L, FEV1 (% predict), PEF (L/sec), and PEF (% predicted) were higher among study group patients (2.9±0.6, 85.6±10.4, 2.9±0.5, 97.6±12.9, 5.3±0.8, and 90.1±11.5, respectively) than before program implementation (2.5±0.4, 79.5±12.7, 2.2±0.4, 92.4±14.3, 4.7±0.7, and 80.8±11.2, respectively). High significant improvement (P>0.001) is found among study group as regard pre-post program PEF (L/sec) and PEF (% predicted). Significant improvement (P>0.05) was found as regard FVC/L, FVC (% predicted), FEV1/L, and FEV1 (% predict). No significant difference was found among control group patients as regard pre-post program pulmonary function tests.
Regarding pre-post program the mean ± SD of VO2max, work load, and test and ROM, VO2max, workload, test time, and shoulder ROM-abduction of the affected breast were higher among study group patients (29.8±7.3, 161.7±23.4, 13.9±1.9, and 86.0±6.7, respectively) than before program application (13.8±4.0, 60.0±14.1, 5.8±1.1, and 62.3±11.4, respectively). High significant improvement (P>0.001) was found among study group as regard pre-post program VO2max, workload, test time, and shoulder ROM-abduction. While among control group shoulder ROM-abduction was significantly (P>0.05) higher (71.0±9.6) than before program (54.3±9.4), and no significant difference was found as regard pre-post program maximum VO2max, workload, and test time.