Need: An expanding research literature documents that physical activity can improve the health, quality of life, and physical functioning of cancer survivors. Cohort studies have even linked increased physical activity after breast cancer diagnosis to a lower risk of breast cancer recurrence and death from breast cancer. This evidence has led the American College of Sports medicine and the American Cancer Society to make exercise recommendations for cancer survivors (MSSE 2010; CA, 2012, but the majority of breast cancer survivors do not follow these recommendations (Bellizi).

Cancer survivors who are minority or low income may be particularly at risk for not meeting recommendations (Eltin...

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An expanding research literature documents that physical activity can improve the health, quality of life, and physical functioning of cancer survivors. Cohort studies have even linked increased physical activity after breast cancer diagnosis to a lower risk of breast cancer recurrence and death from breast cancer. This evidence has led the American College of Sports medicine and the American Cancer Society to make exercise recommendations for cancer survivors (MSSE 2010; CA, 2012, but the majority of breast cancer survivors do not follow these recommendations (Bellizi).

Cancer survivors who are minority or low income may be particularly at risk for not meeting recommendations (Elting). Currently there are few programs in the greater Houston area to help breast cancer survivors become more physically active; in particular there is a need for low-cost or free programs that are accessible to low-income and medically underserved breast cancer survivors.

We propose to improve the quality of life of sedentary breast cancer survivors, particularly those who are minority, medically underserved, and have low health literacy, by providing the Active Living after Breast Cancer program. This is a 12-session program, provided over a 16 week period, that teaches behavioral and cognitive skills to help breast cancer survivors increase their physical activity by incorporating moderate intensity physical activity into daily life. In addition, the program will provide support related to quality of life issues and health faced by breast cancer survivors, including lymphedema, psychological distress, nutrition, and fatigue, and will navigate participants to appropriate services when needed.

The University of Texas MD Anderson Cancer Center will serve as the training and evaluation center for the program, and will partner with Kelsey Research Foundation and Kelsey-Seybold clinic who will implement the program sessions, and Neighborhood Centers who will provide a location for the program sessions. The three agencies will work together to develop a network of clinics, agencies, and organizations who will refer potential participants to the program. Harris County Hospital District has already agreed to refer patients from their oncology clinics at LBJ and Ben Taub Hospitals.

Specific goals include: (1) Develop capacity in Kelsey-Seybold and Neighborhood Centers, Inc to provide the Active Living after Breast Cancer Program; (2) Provide the Active Living after Breast Cancer program to breast cancer survivors in the Houston area; (3) Develop a referral network for the Active Living after Breast Cancer among health care and community organizations with contact with breast cancer survivors, particularly those in underserved communities; (4) Increase physical activity and improve physical functioning and quality of life among breast cancer survivors participating in the Active Living after Breast Cancer program; (5) Conduct a program evaluation of Active Living after Breast Cancer to determine the extent to which the objectives described above have been met.

This program is innovative in that it uses a different approach to increasing physical activity than traditional rehabilitation or exercise programs. Rather than promote structured exercise at a gym or other facility several times a week, this program recommends increasing physical activity by incorporating short bouts of moderate intensity activity into daily life. Such an approach has been shown to improve fitness and health outcomes, and overcomes many barriers that people may have to being more physically activity, such as lack of access to a gym facility, lack of time, and deconditioning that makes it difficult to sustain exercise for an extended session. The program also combines this physical activity program with support and navigation services to help breast cancer survivors cope with salient cancer-related issues.

Helping breast cancer survivors become more physically active can have a positive impact on the physical functioning and quality of life, which can result in being better able to resume pre-diagnosis roles and activities, such as paid employment, caring for family members, and enjoying leisure time activities. An increase in physical activity also may help reduce the risk of recurrence and death from breast cancer. Futhermore, the structure of the project is innovative in that it incorporates partnerships among a research institution, community health care organizations, and community organizations to implement the project. Such partnerships could be replicated in other parts of the state to provide this program on a broader scale, improving outcomes for breast cancer survivors throughout Texas.

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