Fear of Physical Activity Limits Women Treated for Breast Cancer's Perceived Function

Author ORCID Identifier

Anne B. Fleischer ORCID iD iconhttps://orcid.org/0000-0003-4300-5824


Occupational Science and Occupational Therapy

Document Type


Publication Date




Learning objectives: The participant will be able to:

  1. Identify relationships between fear of physical activity and self-reported measures among women with breast cancer.
  2. Develop an understanding of the importance of personal factors for full functional recovery among women treated for breast cancer.

Background/Purpose: Women with breast cancer (WBC) report decreased function and quality of life (QOL) as well as increased anxiety and fear of physical activity (PA) following cancer treatment. This study explored the relationships between fear of PA and self-reported arm function, QOL, perceived stress, and objective measures of range of motion (ROM), strength, and muscular endurance in WBC.

Methods: Data from two observational studies were combined for analysis. Women diagnosed with stage 0-3 breast cancer 6-60 months prior to enrollment participated; WBC were excluded with metastatic disease, shoulder pathology, or history of shoulder/neck surgery. Self-reported function was measured with the Disabilities of the Arm, Shoulder, and Hand (DASH; n=24) or the Penn Shoulder Score (PENN; n=30). To combine self-reported shoulder function into one score, DASH and PENN scores were combined by inverting DASH scores, lower=better, to higher=better. Additional variables included FACT-B QOL, Perceived Stress Scale (PSS), Canadian Occupational Performance Measure (COPM), bilateral flexion, external and internal rotation ROM and strength, and muscular endurance. Independent samples t-tests evaluated differences in fear of PA among WBC who received physical therapy (yes/no);

had axillary node dissection (yes/no); and limb involved (dominant/non-dominant). Relationships between fear of PA and all variables were explored using Pearson’s correlations. Significance was set ≤0.05 a priori.

Results: Mean age and BMI of the 54 participants were 55 (SD12.36) and 28.56 (SD5.87). Mean DASH was 17.7 points (SD15); PENN score was 84.15 points (SD4.8); the combined self-reported function score was 83.67 points (SD10.6). No differences were found among the groups for fear of PA (p>0.05). Fear of PA was significantly correlated to DASH (p

Conclusions: Fear of PA was associated with self-reported function, QOL, and perceived stress in this population of WBC, while objective measures were not. These findings suggest that personal factors play a significant role in functional recovery.

Clinical Relevance: Rehabilitation professionals must address personal factors to ensure complete and successful functional recovery among WBC.

Conference Name

American Congress of Rehabilitation Medicine