Browsing by Author "Beutel, Anita"

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    An investigation of the rehabilitation needs, development, and preliminary outcomes of an education and exercise self-management intervention for breast cancer survivors
    (2025) Beutel, Anita; Shamley, Delva; Naidoo, Nirmala; Naidoo, Nirmala Niri
    An investigation of the rehabilitation needs, development, and preliminary outcomes of an education and exercise self-management intervention for breast cancer survivors. The central premise of this thesis was that breast cancer (BC) survivors face debilitating long-term side effects (LTSEs) after completing their medical cancer treatment (MCT), such as chronic pain and upper limb dysfunction, cancer-related fatigue, a reduction in health-related quality of life (HRQoL), reduced physical function, weight gain, and lymphoedema. It was hypothesised that BC survivors may not receive education and support to manage these and other LTSEs. It was also hypothesised that LTSEs of BC treatment can be improved by an education and exercise self-management intervention (SMI). Firstly, a qualitative study using focus group discussions was conducted to investigate the lived experience of LTSEs of BC treatment and the rehabilitation needs of survivors, in a semi-urban region of South Africa (SA)(n = 23). The findings of the qualitative study revealed that survivors were affected by LTSEs of MCT. These impacted their daily lives, and in some cases, the ability to provide for their families. Participants were unable to self-manage their symptoms as they had not been provided with information or rehabilitation for these sequelae of their cancer. Furthermore, many participants lacked support from cancer support organisations, and felt isolated. Transportation and financial challenges were identified, and survivors lived in geographically diverse areas. Attitudes towards and perspectives of participating in a rehabilitation intervention including an exercise component, were positive. However, specific exercise and rehabilitation preferences varied between participants. For example, some participants preferred to exercise in a group, while others preferred to exercise alone, or with a family member. Some participants preferred to receive survivorship information via email or through printed material, while others preferred to receive talks. Second, a systematic review and meta-analysis was conducted to determine the effectiveness of SMIs including an exercise component, to improve LTSEs and physical activity, in BC survivors following the completion of MCT. The systematic review and meta-analysis presented in this thesis (n = 10 studies) found that, as an alternative to supervised on-site interventions, SMIs including an exercise component are effective to improve LTSEs and increase physical activity, in early-stage BC survivors following MCT. Third, the results of the qualitative study and the systematic review were used to inform the content and structure; and the Medical Research Council (MRC) guidelines for intervention development were used to inform the process of developing an education and exercise SMI. As patient-centred SMIs based on cognitive behavioural and self-management principles have shown promise in previous chronic disease management programmes, the new intervention ‘Survive and Thrive' was informed by the abovementioned principles. Content validation was established by obtaining feedback from a multidisciplinary team of five South African clinical BC experts and refining the intervention accordingly. An acceptability evaluation was conducted through a small qualitative study including three BC survivors. Alterations were made to the intervention according to the results of this study. The final phase was a single-group, pre-test-post-test study (n = 33) to determine the feasibility, safety, and preliminary outcomes of the newly developed intervention, in early-stage BC survivors who had completed their MCT. The baseline findings of the intervention study suggest that prevalence and levels of pain and cancer-related fatigue were high, and HRQoL index scores and physical activity levels were low at baseline, compared to previous studies of BC survivors conducted in high-income countries. The intervention was feasible and safe to implement in this study. Furthermore, significant improvements were demonstrated post-intervention in terms of pain and fatigue prevalence, severity, and interference, HRQoL, self-efficacy, and exercise participation. The findings of this thesis revealed that physical LTSEs were a significant problem for South African BC survivors, and that they were largely unaddressed by the standard of care. Further, the findings demonstrated that a resource-efficient SMI was feasible, safe, and potentially effective to improve patient-reported outcomes in South African BC survivors.
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    Open Access
    The relationship between leisure time physical activity and health-related fitness : a single-blinded study
    (2013) Beutel, Anita; Burgess, Theresa; Talberg, Heather
    Mature adults are at risk of an accelerated age-related reduction in physical function. Declines in aerobic power, functional strength, motor abilities, flexibility and health-related quality of life are thought to be primarily due to reduced physical activity levels with increasing age. Leisure time physical activity (LTPA) has been extensively investigated and is widely advocated for the preservation of function with ageing. However there is a lack of evidence regarding the relationship between LTPA and the individual components of health-related fitness, particularly motor abilities. It is therefore unclear what types of LTPA (endurance, neuromuscular LTPA or games) should be prescribed by health professionals for the development of health-related fitness parameters. Aim: To examine the relationship between LTPA and components of health-related fitness in healthy mature adults. Specific Objectives: (a) To describe the preferred mode(s) and weekly duration of recent LTPA in currently active male and female participants. (b) To describe the preferred mode(s) and years of participation in long term LTPA, in currently active and inactive male and female participants. (c) To determine if there were significant differences in anthropometry and selected health-related fitness components, in currently active and inactive male and female participants. (d) To determine the relationships between recent participation in different types of LTPA (endurance, neuromuscular or games) and total weekly duration of LTPA; and anthropometry and selected components of health related fitness in currently active male and female participants. (e) To determine the relationships between former participation in different types of LTPA (endurance, neuromuscular or games) and years of LTPA participation; and anthropometry and selected components of health-related fitness in currently active and inactive male and female participants. Methods: This study had a descriptive, correlational design. Healthy adults aged between 40 and 60 who either participated in regular LTPA or no LTPA, were recruited for the study. Participants were excluded if they had any acute or chronic injuries; or used any medication that altered heart rate or physical function. Fifty six healthy mature adults between the ages of 40 and 58 years participated in this study. Twenty nine had participated in at least 30 minutes of LTPA, three times per week in the last three months (active group); and twenty seven had not participated in LTPA in the last three months (inactive group). Data were collected in two sessions. In session one, participants gave written informed consent; completed a physical activity readiness questionnaire (PAR-Q) to screen for safe exercise participation; and completed health-related quality of life and LTPA questionnaires. Body composition measurements were also performed. In session two, participants completed a battery of physical tests conducted by a blinded assessor, including: cardiorespiratory fitness (2 km walk test); static and dynamic balance (standing on one leg, tandem walking backwards); agility (Illinois agility test); co-ordination (timed bouncing of a ball along a wall from a fixed distance); upper limb function (modified push-up test); lower limb function (vertical jump test); back muscle endurance (static back extension test); and flexibility (sit-and-reach test).Results: Recently active participants had significantly reduced body mass index (BMI) (p = 0.04), body fat percentage (p = 0.003) and sum of seven skinfold (p = 0.004) measurements, compared to inactive participants. In addition, active participants scored significantly better in the tests for cardiorespiratory fitness (p = 0.0004) and upper limb function (p = 0.01) than inactive participants. Active females had significantly improved cardiorespiratory fitness (p = 0.0002) and agility (p = 0.0004) compared to inactive females. Of the health-related fitness components, only cardiorespiratory fitness and back muscle endurance were related to recent LTPA participation. Motor abilities such as agility and dynamic balance, upper- and lower limb function were associated with long term rather than recent LTPA, particularly with long term endurance, games and years of long term LTPA participation. Discussion and conclusion: Active participants had significantly improved body composition, cardiorespiratory fitness and upper limb function compared to inactive participants in this study. These results support previous research suggesting that regular participation in LTPA may help to slow the age-associated decline in physical function. However no significant differences were found in motor abilities between recently active and inactive participants, and no significant relationships were found between recent LTPA participation and motor abilities. Based on the findings in this study, long term LTPA and participation in games are advised for the development of motor abilities and functional strength, in healthy mature adults. As this study sample reported mainly endurance LTPA recently and on the long term, future research should aim to explore the independent contributions of different types of LTPA (endurance, neuromuscular or games) on aspects of health related fitness. Such information may be very useful clinically to improve the accuracy of exercise prescription. There is also a need to further evaluate the relationship between long-term LTPA and health-related fitness in a larger sample of mature adults.