• Participation in physical activity is influenced by general, cancer-, and treatment stage-specific barriers, facilitators, perceptions and preferences. • Physical activity advice and support needs to accommodate patient preferences, and incorporate behaviour change strategies addressing individual barriers, facilitators and perceptions. • Healthcare professionals need to be equipped with the knowledge and skills to educate patients and their families with respect to the role of physical activity post-cancer. • Understanding similarities and differences between cancer types and treatment stage can assist healthcare professionals to facilitate individualised exercise advice and services.

Purpose: Improvements in breast cancer management continue to increase survival and life expectancy after treatment. Yet the adverse effects of treatment may persist long term, threatening physical, psychological, and social wellbeing, leading to impaired quality of life (QOL). Upper-body morbidity (UBM) such as pain, lymphoedema, restricted shoulder range of motion (ROM), and impaired function are widely reported after breast cancer treatment, but evidence demonstrating its impact on QOL is inconsistent. Therefore, the aim of the study was to conduct a systematic review and meta-analysis evaluating the effect of UBM on QOL following primary breast cancer treatment. Methods: The study was prospectively registered on PROSPERO (CRD42020203445). CINAHL, Embase, Emcare, PsycInfo, PubMed/Medline, and SPORTDiscus databases were searched for studies reporting QOL in individuals with and without UBM following primary breast cancer treatment. Primary analysis determined the standardised mean difference (SMD) in physical, psychological, and social wellbeing scores between UBM + /UBM − groups. Secondary analyses identified differences in QOL scores between groups, according to questionnaire. Results: Fifty-eight studies were included, with 39 conducive to meta-analysis. Types of UBM included pain, lymphoedema, restricted shoulder ROM, impaired upper-body function, and upper-body symptoms. UBM + groups reported poorer physical (SMD = − 0.99; 95%CI = − 1.26, − 0.71; p < 0.00001), psychological (SMD = − 0.43; 95%CI = − 0.60, − 0.27; p < 0.00001), and social wellbeing (SMD = − 0.62; 95%CI = − 0.83, − 0.40; p < 0.00001) than UBM − groups. Secondary analyses according to questionnaire showed that UBM + groups rated their QOL poorer or at equal to, UBM − groups across all domains. Conclusions: Findings demonstrate the significant, negative impact of UBM on QOL, pervading physical, psychological, and social domains. Implications for Cancer Survivors: Efforts to assess and minimise the multidimensional impact of UBM are warranted to mitigate impaired QOL after breast cancer.

Background: Regular exercise can mitigate the loss of strength, balance, and flexibility that contribute to age-related decline in physical function and mobility. However, traditional exercise interventions often report poor adherence rates. There is growing interest in classical ballet as an enjoyable exercise modality for adults in middle to late age. Classical ballet requires muscular strength, coordination, and flexibility. The current study investigated a classical ballet intervention on the balance, physical function, and range of motion of women aged over 50 years. Methods: Twenty-two healthy female participants (aged 56.2 (4.5) years (mean (SD)) completed a 10-week ballet intervention. Results: This single-arm study showed significant improvements (p<.05) in lower limb strength (measured by 5 times sit-to-stand and forward leap) and high adherence rates (95% adherence for participants who completed the intervention). No adverse events were reported. Improvements in balance were reported in the left leg only (as measured by center of pressure ellipse area in the parallel retiré condition). Conclusions: These results allude to the positive effects of ballet training on strength and balance in adults aged 50 years and over. High adherence rates suggest that ballet training was enjoyed and may thus be a long-term exercise modality for this population. Although this study was a single-arm design, it suggests promising results for future research wishing to evaluate the effectiveness of classical ballet training using randomized controlled trial designs.

Purpose: The “Ballet after breast cancer” study sought to investigate the feasibility and acceptability of a 16-week classical ballet intervention for breast cancer survivors, delivered face-to-face and/or online. Methods: Breast cancer survivors were recruited to take part in 2 × 1-h ballet classes per week for 16 weeks. Primary outcomes of feasibility and acceptability were assessed according to rates of enrolment and attendance and participant feedback via questionnaire. Secondary outcomes included quality of life (QOL), upper-body disability, shoulder range of motion (ROM), muscular strength, aerobic capacity, and physical activity levels. Associations between rate of attendance and changes in secondary measures were explored. Results: Thirty-one participants (62% of eligible individuals) enrolled in the program. Twenty-nine women commenced the intervention [53.3 ± 10.8 years (Mean ± SD)], attending 77.6% [67.6, 87.5] (Mean [95% CI]) of sessions. Based on these rates of enrolment and attendance, and participant feedback, the program was deemed feasible and acceptable to participants. Significant improvements in shoulder ROM and reductions in sedentary behaviour were achieved. Participants also reported improvements in physical capacity and psychological, social, and cognitive wellbeing. Conclusions: The “Ballet after breast cancer” program, delivered face-to-face and/or online, was feasible and acceptable to breast cancer survivors. Improvements in shoulder ROM achieved doing ballet were pertinent given the adverse effects of upper-body morbidity on breast cancer survivor QOL. Improvements in physical activity behaviour and perceived benefits to wellbeing also support the use of ballet to mitigate QOL impairment after treatment. Implications for cancer survivors: The physical demands and the fun, creative, and social characteristics of ballet promote improvement across multiple domains of health and wellbeing. Ballet shows promise as an activity to improve QOL and increase long-term engagement in health-promoting physical activity after breast cancer.

Our evaluation of the pilot study- “Ballet after breast cancer”, demonstrated that a classical ballet program delivered online and/or face-to-face is feasible and acceptable, with promise for improving health and wellbeing following breast cancer. The present study aimed to explore participant experiences of the 16-week ballet intervention, and their perceptions of the future potential of ballet in the context of breast cancer. Qualitative analysis of focus group discussions. Intervention participants were invited to take part in online focus groups to discuss: Perceived changes resulting from ballet participation, content of the ballet classes, delivery of the ballet program, suitability of ballet for future implementation during/after active cancer treatment. Themes were generated using an inductive approach, and feedback/recommendations for future implementation of “Ballet after breast cancer” were summarised. Seventeen women previously treated for breast cancer (54.4 ± 11.9 years; 54.2 ± 43.5 months post-diagnosis) took part in one of three focus groups. Themes generated through discussion included: Embracing normal; Connection to others; Acceptance without judgement; Engagement; Learning and progress. Participants described perceived improvements in physical, psychosocial, and cognitive wellbeing, and identified some limitations of online attendance compared to face-to-face. The personal attributes and experience of the ballet instructor were identifed as key determinants of program engagement and enjoyment. Participants reported a preference for classes specifically for people with lived experience of breast cancer. Recommendations to improve future ballet programs during/after breast cancer treatment included: Hybrid delivery model; Opportunities to socialise with classmates; Access to additional learning resources. Participants offered novel and valuable insight into their experiences of the “Ballet after breast cancer” program, providing guidance for future delivery of ballet across the cancer continuum.