Impact of Physical Exercise on Quality of Life, Self-Esteem, and Depression in Breast Cancer Survivors: A Pilot Study

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} div.type-section h2 { font-size: 20px; line-height: 26px; font-weight: 300; } div.type-section h3 { margin-left: 15px; margin-bottom: 0px; font-weight: 300; } .journal-tabs .tab-title.active a { } </style> <link rel="stylesheet" href="https://pub.mdpi-res.com/assets/css/slick.css?f38b2db10e01b157?1732615622"> <meta name="title" content="Impact of Physical Exercise on Quality of Life, Self-Esteem, and Depression in Breast Cancer Survivors: A Pilot Study"> <meta name="description" content="Controlled study designs usually report that physical exercise improves the health of women living with breast cancer. However, many of these women are not sufficiently active to experience the benefits of exercise. The main objective was to analyze the effect of a physical exercise program on quality of life, self-esteem, and depression in breast cancer survivors. Thirteen participants (46.54 ± 6.31 years old) completed the exercise intervention. Three patient-reported questionnaires were used: Supplementary Questionnaire Breast Cancer Module (QLQ-BR23), Beck Depression Inventory (BDI), and Rosenberg Self-Esteem Scale (RSES). All participants had significantly improved self-esteem (p = 0.004). Although there were no statistically significant changes in depression, there was a notable decrease in scores (6.39 ± 4.75 vs. 5.00 ± 4.75; p = 0.080). Regarding quality of life, significant improvements were observed in “future perspectives” (p = 0.047) and “arm symptoms” (p = 0.015). No significant changes were noted in the other variables. Our results suggest that physical exercise is an effective strategy that positively affects breast cancer survivors’ quality of life and self-esteem. The results reinforce the need for community-based exercise programs for breast cancer survivors. Healthcare professionals should promote physical exercise to improve health outcomes before, during, and after treatment." > <link rel="image_src" href="https://pub.mdpi-res.com/img/journals/onco-logo.png?bc79e3a255317213" > <meta name="dc.title" content="Impact of Physical Exercise on Quality of Life, Self-Esteem, and Depression in Breast Cancer Survivors: A Pilot Study"> <meta name="dc.creator" content="Eduarda Maria Rocha Teles de Castro Coelho"> <meta name="dc.creator" content="Helena Isabel Azevedo Mendes"> <meta name="dc.creator" content="Carla Afonso Varajidás"> <meta name="dc.creator" content="Sandra Celina Fernandes Fonseca"> <meta name="dc.type" content="Article"> <meta name="dc.source" content="Onco 2024, Vol. 4, Pages 207-216"> <meta name="dc.date" content="2024-08-22"> <meta name ="dc.identifier" content="10.3390/onco4030015"> <meta name="dc.publisher" content="Multidisciplinary Digital Publishing Institute"> <meta name="dc.rights" content="http://creativecommons.org/licenses/by/3.0/"> <meta name="dc.format" content="application/pdf" > <meta name="dc.language" content="en" > <meta name="dc.description" content="Controlled study designs usually report that physical exercise improves the health of women living with breast cancer. However, many of these women are not sufficiently active to experience the benefits of exercise. The main objective was to analyze the effect of a physical exercise program on quality of life, self-esteem, and depression in breast cancer survivors. Thirteen participants (46.54 ± 6.31 years old) completed the exercise intervention. Three patient-reported questionnaires were used: Supplementary Questionnaire Breast Cancer Module (QLQ-BR23), Beck Depression Inventory (BDI), and Rosenberg Self-Esteem Scale (RSES). All participants had significantly improved self-esteem (p = 0.004). Although there were no statistically significant changes in depression, there was a notable decrease in scores (6.39 ± 4.75 vs. 5.00 ± 4.75; p = 0.080). Regarding quality of life, significant improvements were observed in “future perspectives” (p = 0.047) and “arm symptoms” (p = 0.015). No significant changes were noted in the other variables. Our results suggest that physical exercise is an effective strategy that positively affects breast cancer survivors’ quality of life and self-esteem. The results reinforce the need for community-based exercise programs for breast cancer survivors. Healthcare professionals should promote physical exercise to improve health outcomes before, during, and after treatment." > <meta name="dc.subject" content="physical exercise" > <meta name="dc.subject" content="breast cancer" > <meta name="dc.subject" content="depression" > <meta name="dc.subject" content="self-esteem" > <meta name="dc.subject" content="quality of life" > <meta name ="prism.issn" content="2673-7523"> <meta name ="prism.publicationName" content="Onco"> <meta name ="prism.publicationDate" content="2024-08-22"> <meta name ="prism.volume" content="4"> <meta name ="prism.number" content="3"> <meta name ="prism.section" content="Article" > <meta name ="prism.startingPage" content="207" > <meta name ="prism.endingPage" content="216" > <meta name="citation_issn" content="2673-7523"> <meta name="citation_journal_title" content="Onco"> <meta name="citation_publisher" content="Multidisciplinary Digital Publishing Institute"> <meta name="citation_title" content="Impact of Physical Exercise on Quality of Life, Self-Esteem, and Depression in Breast Cancer Survivors: A Pilot Study"> <meta name="citation_publication_date" content="2024/9"> <meta name="citation_online_date" content="2024/08/22"> <meta name="citation_volume" content="4"> <meta name="citation_issue" content="3"> <meta name="citation_firstpage" content="207"> <meta name="citation_author" content="Coelho, Eduarda Maria Rocha Teles de Castro"> <meta name="citation_author" content="Mendes, Helena Isabel Azevedo"> <meta name="citation_author" content="Varajidás, Carla Afonso"> <meta name="citation_author" content="Fonseca, Sandra Celina Fernandes"> <meta name ="citation_lastpage" content="216" > <meta name="citation_doi" content="10.3390/onco4030015"> <meta name="citation_id" content="mdpi-onco4030015"> <meta name="citation_abstract_html_url" content="https://www.mdpi.com/2673-7523/4/3/15"> <meta name="citation_pdf_url" content="https://www.mdpi.com/2673-7523/4/3/15/pdf?version=1724298913"> <link rel="alternate" type="application/pdf" title="PDF Full-Text" href="https://www.mdpi.com/2673-7523/4/3/15/pdf?version=1724298913"> <meta name="fulltext_pdf" content="https://www.mdpi.com/2673-7523/4/3/15/pdf?version=1724298913"> <meta name="citation_fulltext_html_url" content="https://www.mdpi.com/2673-7523/4/3/15/htm"> <link rel="alternate" type="text/html" title="HTML Full-Text" href="https://www.mdpi.com/2673-7523/4/3/15/htm"> <meta name="fulltext_html" content="https://www.mdpi.com/2673-7523/4/3/15/htm"> <link rel="alternate" type="text/xml" title="XML Full-Text" href="https://www.mdpi.com/2673-7523/4/3/15/xml"> <meta name="fulltext_xml" content="https://www.mdpi.com/2673-7523/4/3/15/xml"> <meta name="citation_xml_url" content="https://www.mdpi.com/2673-7523/4/3/15/xml"> <meta name="twitter:card" content="summary" /> <meta name="twitter:site" content="@MDPIOpenAccess" /> <meta name="twitter:image" content="https://pub.mdpi-res.com/img/journals/onco-logo-social.png?bc79e3a255317213" /> <meta property="fb:app_id" content="131189377574"/> <meta property="og:site_name" content="MDPI"/> <meta property="og:type" content="article"/> <meta property="og:url" content="https://www.mdpi.com/2673-7523/4/3/15" /> <meta property="og:title" content="Impact of Physical Exercise on Quality of Life, Self-Esteem, and Depression in Breast Cancer Survivors: A Pilot Study" /> <meta property="og:description" content="Controlled study designs usually report that physical exercise improves the health of women living with breast cancer. However, many of these women are not sufficiently active to experience the benefits of exercise. The main objective was to analyze the effect of a physical exercise program on quality of life, self-esteem, and depression in breast cancer survivors. Thirteen participants (46.54 ± 6.31 years old) completed the exercise intervention. Three patient-reported questionnaires were used: Supplementary Questionnaire Breast Cancer Module (QLQ-BR23), Beck Depression Inventory (BDI), and Rosenberg Self-Esteem Scale (RSES). All participants had significantly improved self-esteem (p = 0.004). Although there were no statistically significant changes in depression, there was a notable decrease in scores (6.39 ± 4.75 vs. 5.00 ± 4.75; p = 0.080). Regarding quality of life, significant improvements were observed in “future perspectives” (p = 0.047) and “arm symptoms” (p = 0.015). No significant changes were noted in the other variables. Our results suggest that physical exercise is an effective strategy that positively affects breast cancer survivors’ quality of life and self-esteem. The results reinforce the need for community-based exercise programs for breast cancer survivors. Healthcare professionals should promote physical exercise to improve health outcomes before, during, and after treatment." /> <meta property="og:image" content="https://pub.mdpi-res.com/onco/onco-04-00015/article_deploy/html/images/onco-04-00015-g001-550.jpg?1724299036" /> <link rel="alternate" type="application/rss+xml" title="MDPI Publishing - Latest articles" href="https://www.mdpi.com/rss"> <meta name="google-site-verification" content="PxTlsg7z2S00aHroktQd57fxygEjMiNHydKn3txhvwY"> <meta name="facebook-domain-verification" content="mcoq8dtq6sb2hf7z29j8w515jjoof7" /> <script id="Cookiebot" data-cfasync="false" src="https://consent.cookiebot.com/uc.js" data-cbid="51491ddd-fe7a-4425-ab39-69c78c55829f" type="text/javascript" async></script>  <script type="text/plain" data-cookieconsent="statistics"> (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start': new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0], j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src= 'https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f); 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5px;"></span><a class="toEncode emailCaptcha visibility-hidden" data-author-id="13053213" href="/cdn-cgi/l/email-protection#2c034f4248014f4b4503400349414d4540015c5e4358494f584543420f1c1c1c1e1a1f1d1d1c4a1c1e1c191c4f1c481d1c1c4f1e1f1d1a1d1b1c1e1c1b18481d1f1d1b"><sup><i class="fa fa-envelope-o"></i></sup></a> and </span><span class="inlineblock "><div class='profile-card-drop' data-dropdown='profile-card-drop13053214' data-options='is_hover:true, hover_timeout:5000'> Sandra Celina Fernandes Fonseca</div><div id="profile-card-drop13053214" data-dropdown-content class="f-dropdown content profile-card-content" aria-hidden="true" tabindex="-1"><div class="profile-card__title"><div class="sciprofiles-link" style="display: inline-block"><div class="sciprofiles-link__link"><img class="sciprofiles-link__image" src="/bundles/mdpisciprofileslink/img/unknown-user.png" style="width: auto; height: 16px; border-radius: 50%;"><span class="sciprofiles-link__name">Sandra Celina Fernandes Fonseca</span></div></div></div><div class="profile-card__buttons" style="margin-bottom: 10px;"><a href="https://sciprofiles.com/profile/2645229?utm_source=mdpi.com&utm_medium=website&utm_campaign=avatar_name" class="button button--color-inversed" target="_blank"> SciProfiles </a><a href="https://scilit.net/scholars?q=Sandra%20Celina%20Fernandes%20Fonseca" class="button button--color-inversed" target="_blank"> Scilit </a><a href="https://www.preprints.org/search?search1=Sandra%20Celina%20Fernandes%20Fonseca&field1=authors" class="button button--color-inversed" target="_blank"> Preprints.org </a><a href="https://scholar.google.com/scholar?q=Sandra%20Celina%20Fernandes%20Fonseca" class="button button--color-inversed" target="_blank" rels="noopener noreferrer"> Google Scholar </a></div></div><sup> *</sup><span style="display: inline; margin-left: 5px;"></span><a class="toEncode emailCaptcha visibility-hidden" data-author-id="13053214" href="/cdn-cgi/l/email-protection#705f131e145d1317195f1c5f151d11191c5d00021f04151304191f1e5340404145474341134114404041464140414243434046404741424147451440434047"><sup><i class="fa fa-envelope-o"></i></sup></a><a href="https://orcid.org/0000-0001-9468-7269" target="_blank" rel="noopener noreferrer"><img src="https://pub.mdpi-res.com/img/design/orcid.png?0465bc3812adeb52?1732615622" title="ORCID" style="position: relative; width: 13px; margin-left: 3px; max-width: 13px !important; height: auto; top: -5px;"></a></span> </div> <div class="nrm"></div> <span style="display:block; height:6px;"></span> <div></div> <div style="margin: 5px 0 15px 0;" class="hypothesis_container"> <div class="art-affiliations"> <div class="affiliation "> <div class="affiliation-name ">Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), Department of Sports, Exercise and Health, University of Trás-os-Montes e Alto Douro, 5001-801 Vila Real, Portugal</div> </div> <div class="affiliation"> <div class="affiliation-item"><sup>*</sup></div> <div class="affiliation-name ">Author to whom correspondence should be addressed. </div> </div> </div> </div> <div class="bib-identity" style="margin-bottom: 10px;"> <em>Onco</em> <b>2024</b>, <em>4</em>(3), 207-216; <a href="https://doi.org/10.3390/onco4030015">https://doi.org/10.3390/onco4030015</a> </div> <div class="pubhistory" style="font-weight: bold; padding-bottom: 10px;"> <span style="display: inline-block">Submission received: 16 July 2024</span> / <span style="display: inline-block">Revised: 13 August 2024</span> / <span style="display: inline-block">Accepted: 20 August 2024</span> / <span style="display: inline-block">Published: 22 August 2024</span> </div> <div class="belongsTo" style="margin-bottom: 10px;"> (This article belongs to the Special Issue <a href=" /journal/onco/special_issues/787P661E1B ">The Evolving Landscape of Contemporary Cancer Therapies</a>)<br/> </div> <div class="highlight-box1"> 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href="/2673-7523/4/3/15/notes">Versions Notes</a> </div> </div> <div class="responsive-moving-container small hidden" data-id="article-counters" style="margin-top: 15px;"></div> <div class="html-dynamic"> <section> <div class="art-abstract art-abstract-new in-tab hypothesis_container"> <p> <div><section class="html-abstract" id="html-abstract"> <h2 id="html-abstract-title">Abstract</h2><b>:</b> <section id="SimpleSummary" type=""><h2 data-nested="1"> Simple Summary</h2><div class="html-p">This study implemented a 12-week exercise program for 13 female breast cancer survivors, aged 35–53, focusing on quality of life, self-esteem, and depression. Participants engaged in twice-weekly sessions of aerobic and resistance training exercises. Results showed significant improvements in quality of life, particularly in future health prospects and arm symptoms, and in self-esteem. Although depressive symptoms decreased, the change was not statistically significant. The study underscores the importance of physical exercise as a supportive method for managing breast cancer therapy and its side effects. It highlights the need to demystify exercise post-cancer diagnosis, especially among less active groups, promoting healthier lifestyles. Community-based programs and educational initiatives are recommended to enhance the adoption of physical activity, optimizing recovery and improving overall well-being for breast cancer survivors.</div></section><section id="Abstract" type=""><h2 data-nested="1"> Abstract</h2><div class="html-p">Controlled study designs usually report that physical exercise improves the health of women living with breast cancer. However, many of these women are not sufficiently active to experience the benefits of exercise. The main objective was to analyze the effect of a physical exercise program on quality of life, self-esteem, and depression in breast cancer survivors. Thirteen participants (46.54 ± 6.31 years old) completed the exercise intervention. Three patient-reported questionnaires were used: Supplementary Questionnaire Breast Cancer Module (QLQ-BR23), Beck Depression Inventory (BDI), and Rosenberg Self-Esteem Scale (RSES). All participants had significantly improved self-esteem (<span class="html-italic">p</span> = 0.004). Although there were no statistically significant changes in depression, there was a notable decrease in scores (6.39 ± 4.75 vs. 5.00 ± 4.75; <span class="html-italic">p</span> = 0.080). Regarding quality of life, significant improvements were observed in “future perspectives” (<span class="html-italic">p</span> = 0.047) and “arm symptoms” (<span class="html-italic">p</span> = 0.015). No significant changes were noted in the other variables. Our results suggest that physical exercise is an effective strategy that positively affects breast cancer survivors’ quality of life and self-esteem. The results reinforce the need for community-based exercise programs for breast cancer survivors. Healthcare professionals should promote physical exercise to improve health outcomes before, during, and after treatment.</div></section> </section> <div id="html-keywords"> <div class="html-gwd-group"><div id="html-keywords-title">Keywords: </div><a href="/search?q=physical+exercise">physical exercise</a>; <a href="/search?q=breast+cancer">breast cancer</a>; <a href="/search?q=depression">depression</a>; <a href="/search?q=self-esteem">self-esteem</a>; <a href="/search?q=quality+of+life">quality of life</a></div> <div> </div> </div> </div> </p> </div> </section> </div> <div class="hypothesis_container"> <ul class="menu html-nav" data-prev-node="#html-quick-links-title"> </ul> <div class="html-body"> <section id='sec1-onco-04-00015' type='intro'><h2 data-nested='1'> 1. Introduction</h2><div class='html-p'>Physical exercise is widely recognized as an effective and safe non-pharmacological intervention to mitigate the side effects of cancer and its treatments, primarily by enhancing patients’ quality of life [<a href="#B1-onco-04-00015" class="html-bibr">1</a>]. It significantly contributes to physical and psychological well-being in a non-invasive, non-toxic, and economically accessible manner for patients [<a href="#B2-onco-04-00015" class="html-bibr">2</a>].</div><div class='html-p'>The American Cancer Society recommends that cancer survivors engage in regular physical activities, maintaining 150–300 min of moderate physical activity per week, and avoid sedentary behavior [<a href="#B3-onco-04-00015" class="html-bibr">3</a>]. Physical exercise has been shown to reduce the risk of mortality (by 28–44%) and recurrence (by 21–35%) [<a href="#B4-onco-04-00015" class="html-bibr">4</a>]. According to the American Cancer Society [<a href="#B3-onco-04-00015" class="html-bibr">3</a>], both moderate and vigorous physical activities serve as protective factors against breast cancer. Cormie et al. [<a href="#B4-onco-04-00015" class="html-bibr">4</a>] further state that exercise alleviates side effects associated with treatments, such as fatigue, anxiety, depression, stress, sleep disturbances, self-image issues, and physical health problems. Gilchrist et al. [<a href="#B5-onco-04-00015" class="html-bibr">5</a>] emphasize that sedentary behavior can increase cancer mortality risk, which can be mitigated by substituting sedentary behavior with physical activity.</div><div class='html-p'>Several studies have shown that physical exercise interventions in women with breast cancer lead to significant improvements in their quality of life [<a href="#B6-onco-04-00015" class="html-bibr">6</a>,<a href="#B7-onco-04-00015" class="html-bibr">7</a>,<a href="#B8-onco-04-00015" class="html-bibr">8</a>,<a href="#B9-onco-04-00015" class="html-bibr">9</a>], notably in aerobic fitness [<a href="#B9-onco-04-00015" class="html-bibr">9</a>,<a href="#B10-onco-04-00015" class="html-bibr">10</a>], flexibility [<a href="#B7-onco-04-00015" class="html-bibr">7</a>], fatigue [<a href="#B6-onco-04-00015" class="html-bibr">6</a>,<a href="#B7-onco-04-00015" class="html-bibr">7</a>], depression [<a href="#B10-onco-04-00015" class="html-bibr">10</a>,<a href="#B11-onco-04-00015" class="html-bibr">11</a>], and anxiety [<a href="#B12-onco-04-00015" class="html-bibr">12</a>].</div><div class='html-p'>This investigation is important because physical exercise promotes a healthy lifestyle, thereby providing physiological and psychological well-being [<a href="#B13-onco-04-00015" class="html-bibr">13</a>,<a href="#B14-onco-04-00015" class="html-bibr">14</a>,<a href="#B15-onco-04-00015" class="html-bibr">15</a>,<a href="#B16-onco-04-00015" class="html-bibr">16</a>]. Additionally, it can help reduce the side effects of treatments and may also reduce the risk of recurrence and mortality from this disease [<a href="#B14-onco-04-00015" class="html-bibr">14</a>,<a href="#B15-onco-04-00015" class="html-bibr">15</a>,<a href="#B17-onco-04-00015" class="html-bibr">17</a>].</div><div class='html-p'>Despite the recognized benefits of exercise for cancer treatment, many women with breast cancer are insufficiently active to reap these advantages, often due to a lack of knowledge, motivation, access to specialists, and referrals from physicians. Community-based studies offer several significant scientific benefits, enhancing both research and community welfare. This research ensures that findings are relevant and applicable to local contexts, leading to more effective interventions. Active community participation increases engagement, acceptance, and adherence to health recommendations, resulting in more successful implementations of interventions. Additionally, it enhances ecological validity, make research outcomes more credible and useful for everyday situations. Scientific literature supports these advantages, highlighting the importance of community involvement in research [<a href="#B18-onco-04-00015" class="html-bibr">18</a>].</div><div class='html-p'>The main objective of this study was to analyze the effect of a physical exercise program on quality of life (body image, sexuality, future perspectives, side effects of chemotherapy, and breast and arm symptoms), self-esteem, and depression in breast cancer survivors.</div></section><section id='sec2-onco-04-00015' type=''><h2 data-nested='1'> 2. Materials and Methods</h2><section id='sec2dot1-onco-04-00015' type=''><h4 class='html-italic' data-nested='2'> 2.1. Study Design</h4><div class='html-p'>The present study utilized a longitudinal design, initially applying a baseline assessment to participants who joined the exercise program. This initial evaluation included body mass index (BMI), the International Physical Activity Questionnaire (IPAQ), Cancer History Questionnaire, Beck Depression Inventory, Rosenberg Self-Esteem Scale, and the Supplementary Questionnaire Breast Cancer Module. The pre-test was conducted before starting the physical exercise program, and the post-test was conducted at the end of the program, after 12 weeks. At the end of the program, the breast cancer survivors completed the Beck Depression Inventory, Rosenberg Self-Esteem Scale, and the Supplementary Questionnaire Breast Cancer Module again. The Borg Rating of Perceived Exertion Scale was used to control the intensity of exercise during the sessions.</div><div class='html-p'>These questionnaires were completed individually, without interaction or exchange of information between the participants. Prior explanations were given, and during the completion of the questionnaires, any doubts or questions that arose were addressed to ensure understanding.</div></section><section id='sec2dot2-onco-04-00015' type=''><h4 class='html-italic' data-nested='2'> 2.2. Exercise Intervention</h4><div class='html-p'>Based on the evidence and international clinical guidelines for exercise practice in breast cancer patients [<a href="#B19-onco-04-00015" class="html-bibr">19</a>,<a href="#B20-onco-04-00015" class="html-bibr">20</a>,<a href="#B21-onco-04-00015" class="html-bibr">21</a>,<a href="#B22-onco-04-00015" class="html-bibr">22</a>], a physical exercise program was structured specifically for this population over 12 weeks. The program consisted of two sessions per week, each lasting 60 min. The intensities of the exercises were measured using the Borg Rating of Perceived Exertion Scale at the end of the sessions, ranging between 12 and 14, which indicates a subjective perception of effort within the “somewhat hard” and “hard” intensity intervals. Most sessions took place in a classroom at a school in the city of Vila Real, while some sessions, on good weather days, were held in the city park. This aimed to provide a different training environment where participants could engage with various stimuli, enjoy social interaction, and connect with nature.</div><div class='html-p'>The exercise sessions were divided into four parts, each with specific objectives: (i) warm-up (approximately 10 min) aimed to gradually increase the heart rate and body temperature and activate proper breathing while mobilizing large muscle groups. This part included aerobic choreography or walking, primarily focusing on cardiovascular/aerobic training. (ii) Mobilization (approximately 10 min) consisted of breathing exercises, stretching, and the main joint mobilizations (shoulder, elbow, wrist, hip, knee, and ankle). The goal was to improve the range of motion in the upper limbs and prevent osteoarticular injuries. (iii) Main part (approximately 30 min) combined training with a focus on muscular resistance (strength) using body weight, fitballs, resistance bands, and dumbbells of various weights. Exercises were selected to be easily transferable to daily tasks, such as squatting/sitting, standing, and pulling, along with core-strengthening exercises. During this part, the exercises were performed in a circuit format, each lasting one minute. Each exercise sequence was repeated three times. In this part, each participant was advised to choose the alternative that best suited their physical condition, resulting in two different intensities: beginner (easier) and advanced (harder). (iv) Relaxation (duration approximately 10 min) aimed to return each participant to a calm state through slow walking and stretching, reducing respiratory and heart rates, increasing joint range of motion, and improving flexibility</div><div class='html-p'>During the 12-week intervention, there were no dropouts from the intervention group.</div></section><section id='sec2dot3-onco-04-00015' type='subjects'><h4 class='html-italic' data-nested='2'> 2.3. Participants</h4><div class='html-p'>All study participants were recruited through the Breast Unit of the Centro Hospitalar de Trás-os-Montes e Alto Douro. They were informed that their participation in the study was voluntary and that all data provided and collected were confidential. Participants were free to withdraw from the study at any time. After being informed about the study’s objectives, all participants signed the informed consent statement in accordance with the Declaration of Helsinki.</div><div class='html-p'>The sample consisted of 13 women who had experienced oncological disease, specifically breast cancer, aged between 35–53 (46.54 ± 6.31) years. The average time from diagnosis to the start of the program was 20.46 (±30.66) months. All women underwent breast surgery, with 9 having conservative surgery and 4 undergoing mastectomies. Regarding treatment types, 10 women underwent combined chemotherapy and radiotherapy, 3 received radiotherapy, and 12 had hormone therapy.</div><div class='html-p'>The average body mass index (BMI) was 24.52 (±4.18) kg/m<sup>2</sup>, with 6 women being above the recommended weight. According to the IPAQ responses, 8 women had low physical activity levels, while 5 had moderate levels.</div><div class='html-p'>Participants were selected based on the following criteria: (i) women diagnosed with breast cancer; (ii) authorization from the oncologist to engage in physical exercise; (iii) agreement and signing of the informed consent form; and (iv) attending a minimum of six monthly exercise sessions.</div></section><section id='sec2dot4-onco-04-00015' type=''><h4 class='html-italic' data-nested='2'> 2.4. Measurements</h4><div class='html-p'>Initially, to better understand the sample and plan the intervention program in the most accurate and individualized manner, we assessed BMI (through weight and height measurements), the International Physical Activity Questionnaire-Short Version (to evaluate physical activity levels), and the Oncological Disease History Questionnaire (covering the date of oncological diagnosis, knowledge of the diagnosis, prognosis, physical symptoms, and current treatment). Subsequently, both at baseline and post-test, we applied three self-report questionnaires to evaluate the dependent variables under study.</div><dl class='html-bullet'><dt id=''>-</dt><dd><div class='html-p'>Beck Depression Inventory:</div></dd></dl><div class='html-p'>The Beck Depression Inventory (BDI) is a 21-item, self-report rating inventory that measures characteristic attitudes and symptoms of depression [<a href="#B23-onco-04-00015" class="html-bibr">23</a>]. This inventory was translated and validated into Portuguese by Vaz Serra and Abreu [<a href="#B24-onco-04-00015" class="html-bibr">24</a>]. Internal consistency for the BDI ranges from 0.73 to 0.92, with a mean of 0.86 [<a href="#B25-onco-04-00015" class="html-bibr">25</a>].</div><dl class='html-bullet'><dt id=''>-</dt><dd><div class='html-p'>Rosenberg Self-Esteem Scale (RSE):</div></dd></dl><div class='html-p'>The purpose of the 10-item RSE scale is to measure global self-esteem. Originally intended as a measure of self-esteem for adolescents, Rosenberg’s Self-Esteem Scale is probably the most widely used measure of self-esteem for adult populations. This scale was translated and validated into Portuguese by Santos [<a href="#B26-onco-04-00015" class="html-bibr">26</a>]. The RSE demonstrates a Guttman scale coefficient of reproducibility of 0.92, indicating excellent internal consistency [<a href="#B27-onco-04-00015" class="html-bibr">27</a>].</div><dl class='html-bullet'><dt id=''>-</dt><dd><div class='html-p'>Supplementary Questionnaire Breast Cancer Module (EORTC QLQ-BR23):</div></dd></dl><div class='html-p'>The Breast Cancer Module incorporates five multi-item scales to assess body image, sexual functioning, systemic therapy side effects, breast symptoms, and arm symptoms. In addition, single items assess sexual enjoyment, future perspective, and being upset by hair loss. This questionnaire was developed by Fayers et al. [<a href="#B28-onco-04-00015" class="html-bibr">28</a>] and translated by EORTC. The reliability of this instrument was assessed with Cronbach’s alpha values ranging from 0.564 (body image) to 0.812 (sexual functioning), indicating internal consistencies ranging from acceptable to high [<a href="#B29-onco-04-00015" class="html-bibr">29</a>].</div></section><section id='sec2dot5-onco-04-00015' type=''><h4 class='html-italic' data-nested='2'> 2.5. Statistical Analysis</h4><div class='html-p'>Statistical analysis was performed with the SPSS 26.0 (Statistical Package for the Social Sciences). Quantitative variables were described as mean and standard deviation (SD), and categorical variables were described in absolute frequency. Gaussian normal distribution was tested by the Kolmogorov–Smirnov test. To assess the impact of exercise intervention on the investigated parameters, a paired Student’s <span class='html-italic'>t</span>-test with a 95% confidence interval was employed.</div></section></section><section id='sec3-onco-04-00015' type='results'><h2 data-nested='1'> 3. Results</h2><div class='html-p'><a href="#onco-04-00015-f001" class="html-fig">Figure 1</a> presents descriptive statistics for the psychological variables of self-esteem and depression, based on pre-test and post-test assessments.</div><div class='html-p'><a href="#onco-04-00015-t001" class="html-table">Table 1</a> compares pre-test and post-test assessments, highlighting the effects of physical exercise on the psychological variables, self-esteem and depression.</div><div class='html-p'>The analysis of the results in <a href="#onco-04-00015-t001" class="html-table">Table 1</a> reveals a significant improvement in self-esteem when comparing pre-test and post-test scores (<span class='html-italic'>p</span> = 0.004). Regarding depression, no significant improvements were observed (<span class='html-italic'>p</span> = 0.080); however, a slight improvement was noted in the scores obtained in the post-test (6.39 vs. 5.00).</div><div class='html-p'><a href="#onco-04-00015-f002" class="html-fig">Figure 2</a> presents descriptive statistics for quality of life variables, based on pre-test and post-test assessments.</div><div class='html-p'><a href="#onco-04-00015-t002" class="html-table">Table 2</a> compares pre-test and post-test scores, illustrating changes in quality of life induced by physical exercise in the sample.</div><div class='html-p'>Regarding the functional scale, the results in <a href="#onco-04-00015-t002" class="html-table">Table 2</a> demonstrate an improvement in future health prospects (<span class='html-italic'>p</span> = 0.047). In the symptom scale, significant improvements were observed in arm symptoms (<span class='html-italic'>p</span> = 0.015). However, an analysis of the remaining subscales indicates that while there were improvements in body image, chemotherapy side-effects, breast symptoms, and sexual function, these results did not reach statistical significance.</div></section><section id='sec4-onco-04-00015' type='discussion'><h2 data-nested='1'> 4. Discussion</h2><div class='html-p'>This study implemented a physical exercise program specifically designed for 13 female breast cancer survivors aged between 35 and 53, aiming to analyze its effect on quality of life, self-esteem, and depression. The program design adhered to the latest literature recommendations for this population, suggesting at least 150 min per week of moderate-intensity exercise or 75 min of vigorous-intensity exercise, including strength exercises targeting large muscle groups at least twice a week. We aimed to individualize the exercises and incorporate progressions and sequences to maximize benefits and minimize risks, given the specific nature of the sample. Additionally, we emphasized constant motivational reinforcement and individual feedback throughout the sessions, which helped retain all participants, despite the program’s demands (e.g., travel, availability, and schedule).</div><div class='html-p'>Before the intervention program, only four (31%) of the women in the sample reported engaging in physical exercise, averaging 2 to 3 times per week. The reduction in physical activity following a cancer diagnosis was noted and confirmed by authors such as Courneya et al. [<a href="#B29-onco-04-00015" class="html-bibr">29</a>]. Several studies reported lower levels of physical activity and increased sedentary behavior in individuals diagnosed with cancer [<a href="#B30-onco-04-00015" class="html-bibr">30</a>,<a href="#B31-onco-04-00015" class="html-bibr">31</a>].</div><div class='html-p'>In terms of the intensity reported throughout the intervention, it ranged from 12 to 14 on the Borg scale, indicating that participants trained with a subjective perception of effort within the intervals considered “somewhat hard” and “hard”. The literature identified light to moderate intensity as effective in reducing depressive symptoms and improving quality of life and psychological well-being [<a href="#B32-onco-04-00015" class="html-bibr">32</a>,<a href="#B33-onco-04-00015" class="html-bibr">33</a>] in women who have survived breast cancer. This demonstrates that lower exercise intensities also promote significant benefits.</div><div class='html-p'>The results of this study showed significant improvements in self-esteem. However, regarding depression, although there was a slight decrease in scores, the improvement was not statistically significant. There were also significant improvements in some quality of life subscales, namely “future prospects” and “arm symptoms”. However, slight, non-significant improvements were observed in other subscales, such as body image, physical effects of chemotherapy, breast symptoms, and sexual function. Steindorf et al. [<a href="#B34-onco-04-00015" class="html-bibr">34</a>] also reported no significant improvement in depression following a twice-weekly exercise intervention over 12 weeks in 80 women with breast cancer. However, they did note significant improvements in quality of life, body image, future prospects, and sexual function.</div><div class='html-p'>Sprod et al. [<a href="#B33-onco-04-00015" class="html-bibr">33</a>] compared the physiological and psychological outcomes after 3 and 6 months of exercise in 97 breast cancer survivors. They reported additional benefits in physiological and psychological components, particularly in depression, after 24 weeks of intervention. These findings align with those of Burgess et al. [<a href="#B35-onco-04-00015" class="html-bibr">35</a>], who concluded that women in remission showed similar levels of depressive symptoms and anxiety, compared to the general female population. Moreover, the meta-analysis by Krebber et al. [<a href="#B36-onco-04-00015" class="html-bibr">36</a>] shows that the prevalence of depression is higher during cancer treatments, decreasing after therapies end, affecting 9% of cancer survivors.</div><div class='html-p'>Regarding self-esteem, our results indicate significant improvements in this variable. Similar results have been reported in other studies. Courneya et al. [<a href="#B30-onco-04-00015" class="html-bibr">30</a>] evaluated the effects of physical exercise during breast cancer treatment and reported improvements in some quality of life components, particularly self-esteem. They also demonstrated that these effects were maintained in the long term, after 6 months. These results are relevant, as breast cancer survivors undergo challenging treatments that significantly affect self-esteem. The improvements in this quality of life aspect may be due to the group nature of the exercise sessions, fostering relationships among participants. Another reason could be the various motor tasks performed during the sessions, diverting focus from the disease.</div><div class='html-p'>The quality of life instrument used provided a specific dimension of quality of life using two scales: the functional scale and the symptoms scale. Statistically significant improvements in arm symptoms were recorded on the symptoms scale. However, improvements in chemotherapy side effects and breast symptoms were slight and not significant. Similar results were observed in the meta-analysis by Mishra et al. [<a href="#B37-onco-04-00015" class="html-bibr">37</a>], verifying the effectiveness of physical exercise on general quality of life and symptom scales in cancer survivors. Travier et al. [<a href="#B38-onco-04-00015" class="html-bibr">38</a>] evaluated the effects of an 18-week exercise program on 102 women with breast cancer and found slight, non-significant improvements in quality of life, depression, and anxiety in the intervention group.</div><div class='html-p'>On the functional scale, the improvements in sexual function, although not significant, were consistent with findings from other studies. Ramos and Patrão [<a href="#B39-onco-04-00015" class="html-bibr">39</a>] studied the impact of exercise on marital relationship quality and sexual satisfaction in about 30 women who underwent surgery (mastectomy or conservative surgery) and subsequent treatments. Our results can be attributed to the significant increase in self-esteem: issues with personal appreciation (appearance and self-esteem) can lead to greater inhibition, embarrassment, and body non-acceptance, resulting in sexual dissatisfaction. Thus, improvements in self-esteem may have indirectly affected the sample’s sexuality in our study.</div><div class='html-p'>Regarding future health prospects, significant improvements were observed in this dimension. Shobeiri et al. [<a href="#B40-onco-04-00015" class="html-bibr">40</a>] conducted a randomized clinical trial to assess the contribution of aerobic exercise to the quality of life of women with breast cancer, reporting that aerobic training improved overall health status and increased functional and symptom scale values in the intervention group, compared to the control group.</div><div class='html-p'>As for body image, dissatisfaction with appearance is a frequently reported concern among patients who have undergone surgery and treatments, negatively impacting identity, confidence, self-esteem, and body satisfaction. Our results showed a slight improvement, consistent with findings by Shobeiri et al. [<a href="#B40-onco-04-00015" class="html-bibr">40</a>] and Remondes-Costa et al. [<a href="#B41-onco-04-00015" class="html-bibr">41</a>]. Paulo et al. [<a href="#B8-onco-04-00015" class="html-bibr">8</a>] evaluated the impact of a physical exercise program on quality of life in breast cancer survivors, concluding that the intervention helped improve body image and issues related to depression. The pilot study by Pinto et al. [<a href="#B42-onco-04-00015" class="html-bibr">42</a>] also revealed that physical exercise improved the body image of women with this condition.</div><div class='html-p'>We know that self-esteem is directly related to body image, and physical exercise can provide psychological benefits, particularly in the mentioned variables. This may explain the results obtained in our study, despite the non-significant improvements in body image.</div><div class='html-p'>Studies such as the one by Schmitz et al. [<a href="#B43-onco-04-00015" class="html-bibr">43</a>] report that physical exercise enhances self-esteem among female breast cancer survivors, demonstrating an improvement in body image resulting from physical activity. Similarly, research by Ligibel [<a href="#B44-onco-04-00015" class="html-bibr">44</a>], Hayes et al. [<a href="#B45-onco-04-00015" class="html-bibr">45</a>], and Vallance et al. [<a href="#B46-onco-04-00015" class="html-bibr">46</a>] indicates that women who engage in physical exercise report feeling better and more satisfied with their appearance, with increased self-esteem and reduced symptoms of depression and anxiety. The fact that the exercise program in this study was conducted with women who had the same illness, treatments, and physical and emotional challenges may have contributed to improving future perspectives, self-esteem, body image satisfaction, self-perception, relationships with others, motivation to exercise, and the sharing of experiences, fears, and challenges throughout the program.</div><div class='html-p'>It is noteworthy, however, that despite both national and international recommendations from various health institutions, there is still a need to focus on motivational strategies to encourage individuals to take proactive steps for their own health. Even with studies scientifically proving the benefits of adopting active lifestyle habits, the general trend among the Portuguese population towards increasingly sedentary habits and occupations due to long work hours or family routines affects positive decision-making centered on quality of life and well-being. This often leads to neglecting basic needs in favor of other life aspects.</div><div class='html-p'>Motivating women with breast cancer to maintain a physically active lifestyle during and after diagnosis is crucial for promoting good emotional, social, and mental health. Group exercise can facilitate this, making the practice more enjoyable through conversation, experience exchange, interaction, and mutual progression, reducing the challenges posed by the disease. The new friendships, expanded social circles, and concern for each other contribute to feelings of usefulness, increasing confidence, good humor, self-esteem, and commitment to physical exercise. Additionally, the small physical changes observed during the program, such as improved arm mobility, increased muscle mass, and reduced fatigue, can be transferred to daily life, particularly in performing household tasks. These aspects help participants feel their lives are returning “to normal” and view the future more positively.</div><div class='html-p'>To ensure this practice, a collaborative effort is needed among professionals involved in this process, including oncologists, physiatrists, physiotherapists, exercise technicians, and exercise physiologists—a multidisciplinary team working for the common good of cancer patients. The main strength of our study is the implementation of a physical exercise program specifically aimed at the recovery of women with breast cancer, tailored to each individual’s health status.</div><div class='html-p'>The study’s limitations include the small number of participants, limiting the statistical treatment of the results. Another limitation could be the total duration of the program. The program duration was based on scientific literature, showing positive results in physical exercise programs after 12 weeks. Finally, the twice-weekly frequency may have been insufficient to provide more consistent results for this study.</div></section><section id='sec5-onco-04-00015' type='conclusions'><h2 data-nested='1'> 5. Conclusions</h2><div class='html-p'>This study highlights the practical application of structured exercise programs in improving the well-being of breast cancer survivors. By demonstrating significant improvements in self-esteem and certain aspects of quality of life, the research underscores the value of incorporating physical exercise into rehabilitation protocols. The community-based approach enhances engagement and adherence, making it a viable option for broader implementation. These findings provide a foundation for healthcare professionals to advocate for regular physical activity as part of comprehensive cancer care.</div><div class='html-p'>In addition, future research should focus on long-term follow-up to assess the sustained benefits of physical exercise on breast cancer survivors, using bigger samples. Investigating different types of exercise, varying intensities, and the inclusion of other supportive therapies could provide a more comprehensive understanding of how to optimize exercise interventions for this population.</div></section> </div> <div class="html-back"> <section class='html-notes'><h2 >Author Contributions</h2><div class='html-p'>Conceptualization, E.M.R.T.d.C.C. and C.A.V.; methodology E.M.R.T.d.C.C., C.A.V. and S.C.F.F.; formal analysis, E.M.R.T.d.C.C., C.A.V. and H.I.A.M.; investigation, H.I.A.M.; writing—original draft preparation, E.M.R.T.d.C.C., C.A.V. and H.I.A.M.; writing—review and editing, E.M.R.T.d.C.C., C.A.V., H.I.A.M. and S.C.F.F.; visualization and supervision E.M.R.T.d.C.C., C.A.V. and S.C.F.F.; project administration, E.M.R.T.d.C.C. All authors have read and agreed to the published version of the manuscript.</div></section><section class='html-notes'><h2>Funding</h2><div class='html-p'>E.M.R.T.C.C.: C.A.V. and S.C.F.F. were funded by National Funds by FCT—Foundation for Science and Technology under the following project: UIDB/04045/2020 (<a href='https://doi.org/10.54499/UIDB/04045/2020' target='_blank' rel="noopener noreferrer">https://doi.org/10.54499/UIDB/04045/2020</a>, accessed on 19 August 2024).</div></section><section class='html-notes'><h2 >Institutional Review Board Statement</h2><div class='html-p'>The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the e UTAD Ethics Committee (CE-UTAD) (Ref. Doc 34-CE-UTAD-2022, approval date: 12 May 2022).</div></section><section class='html-notes'><h2 >Informed Consent Statement</h2><div class='html-p'>Written informed consent was obtained from all subjects involved in the study.</div></section><section class='html-notes'><h2 >Data Availability Statement</h2><div class='html-p'>The data presented in this study are available within the article.</div></section><section class='html-notes'><h2 >Conflicts of Interest</h2><div class='html-p'>The authors declare no conflicts of interest.</div></section><section id='html-references_list'><h2>References</h2><ol class='html-xx'><li id='B1-onco-04-00015' class='html-x' data-content='1.'>Oei, S.L.; Thronicke, A.; Matthes, H.; Schad, F. Assessment of integrative non-pharmacological interventions and quality of life in breast cancer patients using real-world data. <span class='html-italic'>Breast Cancer</span> <b>2021</b>, <span class='html-italic'>28</span>, 608–617. 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"https://www.mdpi.com/2673-7523/4/3/15/display" href="#fig_body_display_onco-04-00015-f001"> <img data-large="/onco/onco-04-00015/article_deploy/html/images/onco-04-00015-g001.png" data-original="/onco/onco-04-00015/article_deploy/html/images/onco-04-00015-g001.png" alt="Onco 04 00015 g001" data-lsrc="/onco/onco-04-00015/article_deploy/html/images/onco-04-00015-g001-550.jpg" /> <a class="html-expand html-figpopup" data-counterslinkmanual = "https://www.mdpi.com/2673-7523/4/3/15/display" href="#fig_body_display_onco-04-00015-f001"></a> </div> </div> <div class="html-fig_description"> <b>Figure 1.</b> Mean and standard deviation in self-esteem and depression.  </div> </div> <div class="html-fig_show mfp-hide" id="fig_body_display_onco-04-00015-f001"> <div class="html-caption"> <b>Figure 1.</b> Mean and standard deviation in self-esteem and depression.</div> <div class="html-img"><img data-large="/onco/onco-04-00015/article_deploy/html/images/onco-04-00015-g001.png" data-original="/onco/onco-04-00015/article_deploy/html/images/onco-04-00015-g001.png" alt="Onco 04 00015 g001" data-lsrc="/onco/onco-04-00015/article_deploy/html/images/onco-04-00015-g001.png" /></div> </div> <div class="html-fig-wrap" id="onco-04-00015-f002"> <div class='html-fig_img'> <div class="html-figpopup html-figpopup-link" data-counterslinkmanual = "https://www.mdpi.com/2673-7523/4/3/15/display" href="#fig_body_display_onco-04-00015-f002"> <img data-large="/onco/onco-04-00015/article_deploy/html/images/onco-04-00015-g002.png" data-original="/onco/onco-04-00015/article_deploy/html/images/onco-04-00015-g002.png" alt="Onco 04 00015 g002" data-lsrc="/onco/onco-04-00015/article_deploy/html/images/onco-04-00015-g002-550.jpg" /> <a class="html-expand html-figpopup" data-counterslinkmanual = "https://www.mdpi.com/2673-7523/4/3/15/display" href="#fig_body_display_onco-04-00015-f002"></a> </div> </div> <div class="html-fig_description"> <b>Figure 2.</b> Mean and standard deviation of quality of life variables.  </div> </div> <div class="html-fig_show mfp-hide" id="fig_body_display_onco-04-00015-f002"> <div class="html-caption"> <b>Figure 2.</b> Mean and standard deviation of quality of life variables.</div> <div class="html-img"><img data-large="/onco/onco-04-00015/article_deploy/html/images/onco-04-00015-g002.png" data-original="/onco/onco-04-00015/article_deploy/html/images/onco-04-00015-g002.png" alt="Onco 04 00015 g002" data-lsrc="/onco/onco-04-00015/article_deploy/html/images/onco-04-00015-g002.png" /></div> </div> <div class="html-table-wrap" id="onco-04-00015-t001"> <div class="html-table_wrap_td"> <div class="html-tablepopup html-tablepopup-link" data-counterslinkmanual = "https://www.mdpi.com/2673-7523/4/3/15/display" href='#table_body_display_onco-04-00015-t001'> <img data-lsrc="https://pub.mdpi-res.com/img/table.png" /> <a class="html-expand html-tablepopup" data-counterslinkmanual = "https://www.mdpi.com/2673-7523/4/3/15/display" href="#table_body_display_onco-04-00015-t001"></a> </div> </div> <div class="html-table_wrap_discription"> <b>Table 1.</b> Comparison of pre-test and post-test scores of self-esteem and depression. </div> </div> <div class="html-table_show mfp-hide " id="table_body_display_onco-04-00015-t001"> <div class="html-caption"><b>Table 1.</b> Comparison of pre-test and post-test scores of self-esteem and depression.</div> <table > <thead ><tr ><th rowspan='2' align='center' valign='middle' style='border-top:solid thin;border-bottom:solid thin' class='html-align-center' > </th><th colspan='2' align='center' valign='middle' style='border-top:solid thin;border-bottom:solid thin' class='html-align-center' >Pre-Test (<span class='html-italic'>n</span> = 13)</th><th colspan='2' align='center' valign='middle' style='border-top:solid thin;border-bottom:solid thin' class='html-align-center' >Post-Test (<span class='html-italic'>n</span> = 13)</th><th rowspan='2' align='center' valign='middle' style='border-top:solid thin;border-bottom:solid thin' class='html-align-center' >Mean Difference ± SD</th><th rowspan='2' align='center' valign='middle' style='border-top:solid thin;border-bottom:solid thin' class='html-align-center' ><span class='html-italic'>p</span></th></tr><tr ><th align='center' valign='middle' style='border-bottom:solid thin' class='html-align-center' >Mean</th><th align='center' valign='middle' style='border-bottom:solid thin' class='html-align-center' >SD</th><th align='center' valign='middle' style='border-bottom:solid thin' class='html-align-center' >Mean</th><th align='center' valign='middle' style='border-bottom:solid thin' class='html-align-center' >SD</th></tr></thead><tbody ><tr ><td align='center' valign='middle' class='html-align-center' >Self-esteem</td><td align='center' valign='middle' class='html-align-center' >16.31</td><td align='center' valign='middle' class='html-align-center' >±3.86</td><td align='center' valign='middle' class='html-align-center' >17.16</td><td align='center' valign='middle' class='html-align-center' >±3.67</td><td align='center' valign='middle' class='html-align-center' >0.85 ± 0.52</td><td align='center' valign='middle' class='html-align-center' >0.004 *</td></tr><tr ><td align='center' valign='middle' style='border-bottom:solid thin' class='html-align-center' >Depression</td><td align='center' valign='middle' style='border-bottom:solid thin' class='html-align-center' >6.39</td><td align='center' valign='middle' style='border-bottom:solid thin' class='html-align-center' >±4.75</td><td align='center' valign='middle' style='border-bottom:solid thin' class='html-align-center' >5.00</td><td align='center' valign='middle' style='border-bottom:solid thin' class='html-align-center' >±4.75</td><td align='center' valign='middle' style='border-bottom:solid thin' class='html-align-center' >−1.39 ± 1.29</td><td align='center' valign='middle' style='border-bottom:solid thin' class='html-align-center' >0.080</td></tr></tbody> </table> <div class='html-table_foot html-p'><div class='html-p' style='text-indent:0em;'><span class='html-fn-content'>* <span class='html-italic'>p</span> < 0.05.</span></div><div style='clear:both;'></div></div> </div> <div class="html-table-wrap" id="onco-04-00015-t002"> <div class="html-table_wrap_td"> <div class="html-tablepopup html-tablepopup-link" data-counterslinkmanual = "https://www.mdpi.com/2673-7523/4/3/15/display" href='#table_body_display_onco-04-00015-t002'> <img data-lsrc="https://pub.mdpi-res.com/img/table.png" /> <a class="html-expand html-tablepopup" data-counterslinkmanual = "https://www.mdpi.com/2673-7523/4/3/15/display" href="#table_body_display_onco-04-00015-t002"></a> </div> </div> <div class="html-table_wrap_discription"> <b>Table 2.</b> Comparison of pre-test and post-test scores for quality of life. </div> </div> <div class="html-table_show mfp-hide " id="table_body_display_onco-04-00015-t002"> <div class="html-caption"><b>Table 2.</b> Comparison of pre-test and post-test scores for quality of life.</div> <table > <thead ><tr ><th rowspan='2' align='center' valign='middle' style='border-top:solid thin;border-bottom:solid thin' class='html-align-center' > </th><th colspan='2' align='center' valign='middle' style='border-top:solid thin;border-bottom:solid thin' class='html-align-center' >Pre-Test (<span class='html-italic'>n</span> = 13)</th><th colspan='2' align='center' valign='middle' style='border-top:solid thin;border-bottom:solid thin' class='html-align-center' >Post-Test (<span class='html-italic'>n</span> = 13)</th><th rowspan='2' align='center' valign='middle' style='border-top:solid thin;border-bottom:solid thin' class='html-align-center' >Mean Difference ± SD</th><th rowspan='2' align='center' valign='middle' style='border-top:solid thin;border-bottom:solid thin' class='html-align-center' ><span class='html-italic'>p</span></th></tr><tr ><th align='center' valign='middle' style='border-bottom:solid thin' class='html-align-center' >Mean</th><th align='center' valign='middle' style='border-bottom:solid thin' class='html-align-center' >SD</th><th align='center' valign='middle' style='border-bottom:solid thin' class='html-align-center' >Mean</th><th align='center' valign='middle' style='border-bottom:solid thin' class='html-align-center' >SD</th></tr></thead><tbody ><tr ><td align='left' valign='middle' class='html-align-left' >Functional Scale</td><td colspan='6' align='center' valign='middle' class='html-align-center' > </td></tr><tr ><td align='left' valign='middle' class='html-align-left' >-Body image</td><td align='center' valign='middle' class='html-align-center' >1.23</td><td align='center' valign='middle' class='html-align-center' >±0.37</td><td align='center' valign='middle' class='html-align-center' >1.31</td><td align='center' valign='middle' class='html-align-center' >±0.74</td><td align='center' valign='middle' class='html-align-center' >0.08 ± 0.37</td><td align='center' valign='middle' class='html-align-center' >0.746</td></tr><tr ><td align='left' valign='middle' class='html-align-left' >-Sexual function</td><td align='center' valign='middle' class='html-align-center' >1.65</td><td align='center' valign='middle' class='html-align-center' >±0.88</td><td align='center' valign='middle' class='html-align-center' >1.73</td><td align='center' valign='middle' class='html-align-center' >±0.90</td><td align='center' valign='middle' class='html-align-center' >0.08 ± 0.32</td><td align='center' valign='middle' class='html-align-center' >0.436</td></tr><tr ><td align='left' valign='middle' class='html-align-left' >-Sexual pleasure</td><td align='center' valign='middle' class='html-align-center' >2.33</td><td align='center' valign='middle' class='html-align-center' >±1.12</td><td align='center' valign='middle' class='html-align-center' >2.10</td><td align='center' valign='middle' class='html-align-center' >±1.10</td><td align='center' valign='middle' class='html-align-center' >−0.23 ± 0.42</td><td align='center' valign='middle' class='html-align-center' >0.436</td></tr><tr ><td align='left' valign='middle' style='border-bottom:solid thin' class='html-align-left' >-Future health prospect</td><td align='center' valign='middle' style='border-bottom:solid thin' class='html-align-center' >2.69</td><td align='center' valign='middle' style='border-bottom:solid thin' class='html-align-center' >±1.11</td><td align='center' valign='middle' style='border-bottom:solid thin' class='html-align-center' >2.15</td><td align='center' valign='middle' style='border-bottom:solid thin' class='html-align-center' >±0.80</td><td align='center' valign='middle' style='border-bottom:solid thin' class='html-align-center' >−0.54 ± 0.31</td><td align='center' valign='middle' style='border-bottom:solid thin' class='html-align-center' >0.047 *</td></tr><tr ><td align='left' valign='middle' class='html-align-left' >Symptom Scale</td><td colspan='6' align='center' valign='middle' class='html-align-center' > </td></tr><tr ><td align='left' valign='middle' class='html-align-left' >-Chemotherapy Side-Effects</td><td align='center' valign='middle' class='html-align-center' >1.55</td><td align='center' valign='middle' class='html-align-center' >±0.52</td><td align='center' valign='middle' class='html-align-center' >1.45</td><td align='center' valign='middle' class='html-align-center' >±0.38</td><td align='center' valign='middle' class='html-align-center' >−0.10 ± 0.20</td><td align='center' valign='middle' class='html-align-center' >0.324</td></tr><tr ><td align='left' valign='middle' class='html-align-left' >-Breast symptoms </td><td align='center' valign='middle' class='html-align-center' >1.38</td><td align='center' valign='middle' class='html-align-center' >±0.40</td><td align='center' valign='middle' class='html-align-center' >1.19</td><td align='center' valign='middle' class='html-align-center' >±0.23</td><td align='center' valign='middle' class='html-align-center' >−0.19 ± 0.27</td><td align='center' valign='middle' class='html-align-center' >0.127</td></tr><tr ><td align='left' valign='middle' style='border-bottom:solid thin' class='html-align-left' >-Arm symptoms </td><td align='center' valign='middle' style='border-bottom:solid thin' class='html-align-center' >1.87</td><td align='center' valign='middle' style='border-bottom:solid thin' class='html-align-center' >±0.73</td><td align='center' valign='middle' style='border-bottom:solid thin' class='html-align-center' >1.49</td><td align='center' valign='middle' style='border-bottom:solid thin' class='html-align-center' >±0.48</td><td align='center' valign='middle' style='border-bottom:solid thin' class='html-align-center' >−0.38 ± 0.35</td><td align='center' valign='middle' style='border-bottom:solid thin' class='html-align-center' >0.015 *</td></tr></tbody> </table> <div class='html-table_foot html-p'><div class='html-p' style='text-indent:0em;'><span 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Impact of Physical Exercise on Quality of Life, Self-Esteem, and Depression in Breast Cancer Survivors: A Pilot Study. <em>Onco</em> <b>2024</b>, <em>4</em>, 207-216. https://doi.org/10.3390/onco4030015 </p> <div style="display: block"> <b>AMA Style</b><br> <p> Coelho EMRTdC, Mendes HIA, Varajidás CA, Fonseca SCF. Impact of Physical Exercise on Quality of Life, Self-Esteem, and Depression in Breast Cancer Survivors: A Pilot Study. <em>Onco</em>. 2024; 4(3):207-216. https://doi.org/10.3390/onco4030015 </p> <b>Chicago/Turabian Style</b><br> <p> Coelho, Eduarda Maria Rocha Teles de Castro, Helena Isabel Azevedo Mendes, Carla Afonso Varajidás, and Sandra Celina Fernandes Fonseca. 2024. "Impact of Physical Exercise on Quality of Life, Self-Esteem, and Depression in Breast Cancer Survivors: A Pilot Study" <em>Onco</em> 4, no. 3: 207-216. https://doi.org/10.3390/onco4030015 </p> <b>APA Style</b><br> <p> Coelho, E. M. R. T. d. C., Mendes, H. I. A., Varajidás, C. A., & Fonseca, S. C. F. (2024). Impact of Physical Exercise on Quality of Life, Self-Esteem, and Depression in Breast Cancer Survivors: A Pilot Study. <em>Onco</em>, <em>4</em>(3), 207-216. https://doi.org/10.3390/onco4030015 </p> </div> </div> <h2><a name="metrics"></a>Article Metrics</h2> <div class="row"> <div class="small-12 columns"> <div id="loaded_cite_count" style="display:none">No</div> <div id="framed_div_cited_count" class="in-tab" style="display: none; overflow: auto;"></div> <div id="loaded" style="display:none">No</div> <div id="framed_div" class="in-tab" style="display: none; margin-top: 10px;"></div> </div> <div class="small-12 columns"> <div id="article_stats_div" style="display: none; margin-bottom: 1em;"> <h3>Article Access Statistics</h3> <div id="article_stats_swf" ></div> <div class="info-box"> Multiple requests from the same IP address are counted as one view. </div> </div> </div> </div> </div> </div> </article> </div> </div></div> <div class="webpymol-controls webpymol-controls-template" style="margin-top: 10px; display: none;"> <a class="bzoom">Zoom</a> <span style="display: inline-block; margin-left: 5px; margin-right: 5px;">|</span> <a class="borient"> Orient </a> <span style="display: inline-block; margin-left: 5px; margin-right: 5px;">|</span> <a class="blines"> As Lines </a> <span style="display: inline-block; margin-left: 5px; margin-right: 5px;">|</span> <a class="bsticks"> As Sticks </a> <span style="display: inline-block; margin-left: 5px; margin-right: 5px;">|</span> <a class="bcartoon"> As Cartoon </a> <span style="display: inline-block; margin-left: 5px; margin-right: 5px;">|</span> <a class="bsurface"> As Surface </a> <span style="display: inline-block; margin-left: 5px; margin-right: 5px;">|</span> <a class="bprevscene">Previous Scene</a> <span style="display: inline-block; margin-left: 5px; margin-right: 5px;">|</span> <a class="bnextscene">Next Scene</a> </div> <div id="scifeed-modal" class="reveal-modal reveal-modal-new" data-reveal aria-labelledby="modalTitle" aria-hidden="true" role="dialog"> </div> <div id="recommended-articles-modal" class="reveal-modal reveal-modal-new" data-reveal aria-labelledby="modalTitle" aria-hidden="true" role="dialog"> </div> <div id="author-biographies-modal" class="reveal-modal reveal-modal-new" data-reveal aria-labelledby="modalTitle" aria-hidden="true" role="dialog"> </div> <div id="cite-modal" class="reveal-modal reveal-modal-new" data-reveal aria-labelledby="Captcha" aria-hidden="true" role="dialog"> <div class="row"> <div class="small-12 columns"> <h2 style="margin: 0;">Cite</h2> </div> <div class="small-12 columns">  <form style="margin:0; padding:0; display:inline;" name="export-bibtex" method="POST" action="/export"> <input type="hidden" name="articles_ids[]" value="1461163"> <input type="hidden" name="export_format_top" value="bibtex"> <input type="hidden" name="export_submit_top" value=""> </form>  <form style="margin:0; padding:0; display:inline;" name="export-endnote" method="POST" action="/export"> <input type="hidden" name="articles_ids[]" value="1461163"> <input type="hidden" name="export_format_top" value="endnote_no_abstract"> <input type="hidden" name="export_submit_top" value=""> </form>  <form style="margin:0; padding:0; display:inline;" name="export-ris" method="POST" action="/export"> <input type="hidden" name="articles_ids[]" value="1461163"> <input type="hidden" name="export_format_top" value="ris"> <input type="hidden" name="export_submit_top" value=""> </form> <div> Export citation file: <a href="javascript:window.document.forms['export-bibtex'].submit()">BibTeX</a> | <a href="javascript:window.document.forms['export-endnote'].submit()">EndNote</a> | <a href="javascript:window.document.forms['export-ris'].submit()">RIS</a> </div> </div> <div class="small-12 columns"> <div class="in-tab"> <div><b>MDPI and ACS Style</b></div> <p> Coelho, E.M.R.T.d.C.; Mendes, H.I.A.; Varajidás, C.A.; Fonseca, S.C.F. Impact of Physical Exercise on Quality of Life, Self-Esteem, and Depression in Breast Cancer Survivors: A Pilot Study. <em>Onco</em> <b>2024</b>, <em>4</em>, 207-216. https://doi.org/10.3390/onco4030015 </p> <div style="display: block"> <b>AMA Style</b><br> <p> Coelho EMRTdC, Mendes HIA, Varajidás CA, Fonseca SCF. Impact of Physical Exercise on Quality of Life, Self-Esteem, and Depression in Breast Cancer Survivors: A Pilot Study. <em>Onco</em>. 2024; 4(3):207-216. https://doi.org/10.3390/onco4030015 </p> <b>Chicago/Turabian Style</b><br> <p> Coelho, Eduarda Maria Rocha Teles de Castro, Helena Isabel Azevedo Mendes, Carla Afonso Varajidás, and Sandra Celina Fernandes Fonseca. 2024. "Impact of Physical Exercise on Quality of Life, Self-Esteem, and Depression in Breast Cancer Survivors: A Pilot Study" <em>Onco</em> 4, no. 3: 207-216. https://doi.org/10.3390/onco4030015 </p> <b>APA Style</b><br> <p> Coelho, E. M. R. T. d. C., Mendes, H. I. A., Varajidás, C. A., & Fonseca, S. C. F. 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