Blacklock, R., Rhodes, R., Blanchard, C., & Gaul, C. (2010). Effects of exercise intensity and self-efficacy on state anxiety with breast cancer survivors. Oncology Nursing Forum, 37, 206–212.

To determine if acute exercise reduces state anxiety in breast cancer survivors

Participants recruited were randomly assigned to a light or moderate intensity group and were asked to complete both moderate and light intensity exercise on two different days. Exercise sessions were done by cycling. Prior to exercise, questionnaires for anxiety and self-efficacy were completed. Participants cycled for 20 minutes, staying with standardized heart rate ranges as defined for light and moderate intensity. Questionnaires were repeated after each exercise session following an eight-minute rest.

• The study reported on a sample of 50 participants: 25 breast cancer survivors and 25 age-matched women without a cancer diagnosis.
• Mean participant age was 59 years in the breast cancer survivors and 56 years in the other women.
• Average time since diagnosis of breast cancer was five years.
• Of the sample, 40% had at least a bachelor’s degree and 80% were married or living with a partner.

• Single site
• Canada

The study has clinical applicability for late effects and survivorship.

A randomized, experimental, repeated-measures design was used.

• Spielberger State Anxiety Short Form
• Self-efficacy questionnaire adapted from a previous study: A total efficacy score was calculated by summing confidence ratings by the respondent within a possible score of 100 (reliability – 0.91).

There were no differences between day 1 and 2 for anxiety and self-efficacy. Repeated measures ANOVA on anxiety showed a main effect for time (p < 0.01), with anxiety decreasing across the time of exercise. The intensity of the exercise was not significant. There were no differences between breast cancer survivors and others. Self-efficacy measures showed a main effect for time (p < 0.01), but no differences between breast cancer survivors and others or between exercise intensities. Breast cancer survivors and others reported similar pre-exercise state anxiety levels. There was a significant reciprocal relationship between self-efficacy and state anxiety both pre- and post-exercise (p < 0.05).

Exercise appears to have a short-term effect in reducing anxiety and increasing perception of self-efficacy.

• The study had a small sample, with less than 100 participants.
• The study did not include control observations.
• The study period and intervention was very brief, consisting of only two days of exercise and observations.
• Utility of findings is questionable.
• Participants were generally physically fit and may have been biased toward exercise, limiting applicability of findings.

Studies with longer-term exercise interventions and in participants with higher levels of anxiety may be helpful in exploring these issues. Long-term findings suggest that the specific approach to management of anxiety during the cancer diagnostic phase does not appear to significantly impact anxiety and depression in women with low-risk abnormal findings. The timing of depression might suggest that extended follow-up after diagnostic testing and treatment may be associated with depression for some women. Which of the strategies examined here offer the best balance between benefits and harms is a matter of continuing debate.