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Background:
Systematic Review

The Effect of Dragon Boating on the Quality of Life for Breast Cancer Survivors: A Systematic Review

by
Igor Herrero-Zapirain
1,
Sergio Álvarez-Pardo
2,*,
Arkaitz Castañeda-Babarro
3,
Adrian Moreno-Villanueva
2 and
Juan Francisco Mielgo-Ayuso
1
1
Department of Health Sciences, Faculty of Health Sciences, University of Burgos, 09001 Burgos, Spain
2
Faculty of Health Science, University Isabel I, 09003 Burgos, Spain
3
Health, Physical Activity and Sports Science Laboratory, Department of Physical Activity and Sports, Faculty of Psychology and Education, University of Deusto, 48007 Bilbao, Spain
*
Author to whom correspondence should be addressed.
Healthcare 2024, 12(13), 1290; https://doi.org/10.3390/healthcare12131290
Submission received: 20 May 2024 / Revised: 24 June 2024 / Accepted: 26 June 2024 / Published: 27 June 2024
(This article belongs to the Special Issue Non-pharmacological Approaches and Their Impact on Noncommunicable Diseases)
Browse Figure
Review Reports Versions Notes

Abstract

:
Physical activity improves breast cancer-related symptoms in women and decreases cancer-related mortality. The main objective of this systematic review is to synthesize and analyze the evidence of the effect of dragon boating on the quality of life of female breast cancer survivors. A systematic review based on the PRISMA method was conducted using four databases (Web of Science, Scopus, Cochrane and Pubmed). The search phrase used was “Breast Cancer” AND “Dragon Boat” AND “Quality of Life”. The search was conducted in June 2024. The PEDro method was used to ensure the quality of the publications. A total of 77 articles published until 2024 were selected, of which 10 met the inclusion criteria of assessing the application of dragon boating and that used a validated instrument to assess quality of life. There is no homogeneity in terms of the instrument used to measure QOL. The SF-36 was the most commonly used, followed by the FACT-B and the EORTC QLQ-C30. Five out of ten articles compared the improvement in quality of life between dragon boating and other physical activities, while 6 out of 10 analyzed the pre–post effect of dragon boat use. Dragon boating is a physical activity alternative that improves the quality of life of breast cancer survivors and reduces the symptomatology caused by the disease and its treatments. As dragon boat programs are applied over a longer period of time, the improvements in quality of life are greater. When compared with other types of physical activity, dragon boating does not show significant differences that position it as a better option for this population.

1. Introduction

Cancer is one of the biggest public health problems in the world, being in some developed countries the main cause of death; in countries like the United States, 1670 people die every day because of cancer [1]. Breast cancer (BC) is the most common cancer affecting women worldwide, where the incidence is increasing by 0.5% each year since the mid-2000s, with an estimated 2.26 million registered cases in the last year [1], above colorectal cancer and lung cancer [2]. In the year 2023 in Spain, it is estimated that there will be approximately 35,000 new diagnoses of BC following the rising trend [3]. The main cause of this increase in incidence is the decline in healthy lifestyles. Despite the high incidence, the 5-year survival rate for BC diagnosed at stage I is over 99%, 93% for stage II, 75% for stage III and 29% for stage IV, this rate being lower in black women and in underdeveloped countries [4]. One of the reasons why there is a high survival rate when there are so many new cases of BC each year is the increase in research, which includes measurements of physical activity, the level of sedentary lifestyle, and physical capacity related to healthcare, providing a more complete assessment of the patient, leading to the implementation of physical activity programs that are completed during the development of the disease, reducing the risk of death from this pathology by 40% [5].
However, breast cancer survivors (BCSs) experience difficulties and complications both during and after the disease, including lymphoedema [6,7,8], upper limb stiffness or lack of mobility [9,10], inability to perform daily living tasks [11], insomnia [12] and fatigue [13,14], as well as psychological affectations such as depression, anxiety [15] and fear of recurrence [16], among others, which contribute to a decrease in the quality of life (QOL) of these women and consequently their survival [17]. The study of QOL in BCSs is a determining factor for health professionals to better identify people at a high risk of recurrence or mortality, and on the other hand, there are certain modifiable aspects of QOL that predict survival, and therefore, there is the possibility of interventions to reduce the risk of recurrence or death, such as physical activity [17].
Different guidelines have been created for physical activity (PA) to improve prognosis, QOL, physical well-being, cancer-related symptoms and survival [18]. Among the PA options, dragon boat (DB) racing is a sport modality that has been gaining popularity among practitioners worldwide in recent years due to its specificity for this population [19]. DB is a rowing sport in which a boat is propelled by 10–20 crew members distributed on both sides of the boat, with a coxswain and a drummer setting the paddling rhythm [19,20]. Participants paddle unilaterally with a single-bladed paddle from a seated position. DB is incorporated in the official calendar of the International Canoe Federation (CIF), with a special category called DB12 BCS, in which 100% of the participants must prove to be BCSs. Due to the championships and events that take place around this sport, its popularity has increased within this population, offering not only the opportunity to participate in the sport but also the chance to participate in competition events around the season.
The benefits of DB include an increasing time spent on PA, improving team cohesion, a growing sense of belonging to a group, and improving physical and emotional well-being [21], which is related to an increase in participants’ perceived QOL [19,21,22,23,24,25,26]. Some authors argue that the QOL of DB participants is higher than that of the general population [27,28,29]. Other authors find no differences in the QOL of DB practitioners over the duration of a study [9,21,22,30]. These differences could be due to the fact that the authors have used different parameters when establishing the duration of the study, aspects such as days/week and hours/week of PA and the measurement instrument, so that no homogeneity is found between the studies. This leads us to ask whether DB is a sport that improves QOL more than other PA options such as walking or resistance training [31] and whether there is a protocol of time of practice or hours of application of the sport per week that ensures the positive effect of the sport.
The aim of this systematic review is to answer the question, how does DB influence the QOL of BCSs? At the same time, we intend to determine which workout protocols, in terms of the total duration of the training session, both in length and in the ratio of hours/day or days/week of application, are the most effective in obtaining improvements in QOL. Finally, we want to compare whether the choice of one test or another to measure the QOL conditions the result of the improvement in QOL in DB paddlers. To our knowledge, this is the first systematic review of the QOL in BCSs who practice DB. The findings may provide relevant information to establish guidelines for PA in BCSs whose main option is DB.

2. Methodology

2.1. Literature Search Strategies

This article is a systematic review that studies the effects that DB produces on the QOL of BCSs. An evaluation of the methodological quality of the study was carried out by three authors.
The following databases were used to perform a structured search: Pubmed, Web of Science and Scopus. These high-quality databases ensured adequate bibliographic support, and the search was completed without limiting them to any specific year, including results up to and including 1 May 2023. The search phrase was as follows: “Dragon Boat” AND “Breast Cancer” AND “Quality of Life”. This review was performed in accordance with PRISMA guidelines.

2.2. Study Selection

The article selection was completed by screening the title and abstracts of the articles from the databases, and completed with a full-text review of all the articles that were considered potentially relevant, with a final analysis of their compliance with the inclusion criteria.
All titles and abstracts obtained were then cross-checked for any duplication or lack of actual studies on the topic.

2.3. Inclusion and Exclusion Criteria

For this systematic review, only scientific articles have been included. The articles were finally selected as a result of a database search using the following inclusion criteria: (I) the participants in the study were female breast cancer survivors, (II) the effects produced in the participants’ QOL were due to the practice of DB, (III) the articles were written in English and Spanish, and (IV) a measurement instrument was used to assess the improvement in QOL.
Exclusion criteria were also applied: (I) studies that did not involve the active participation of the subjects in DB activity, (II) studies that measured the application of another exercise program in DB paddlers, (III) studies merely descriptive of the sport of DB, (IV) studies that did not use any instrument or protocol to measure the effects of DB on QOL in breast cancer survivors, and (IV) studies not published in Pubmed, Web of Science or Scopus.

2.4. Quality Assessment and Risk of Bias

Three separate authors assessed quality in terms of the methodology used, along with any risk of bias (I.H.-Z., S.A.-P. and A.C.-B.), and any lack of consensus was subject to assessment by a third party (J.M.-A. and A.M.-V.).
The methodological quality of the studies was assessed using the Physiotherapy Evidence Database (PEDro) scale. The scale scores the methodological quality of the studies and has a maximum score of 10. The scores were based on all the information available in the authors’ published version. A minimum of 3 out of 10 points is set as the minimum for inclusion in the review. The score for each study was determined by the authors (I.H.-Z., S.A.-P. and A.C.-B.). Disagreements were resolved by consensus or by a third and fourth reviewer (J.M.-A. and A.M.-V.).

2.5. Measuring Variables

The literature on the effects of DB on the QOL of BCS women was reviewed.

2.6. Data Extraction

Initially, inclusion/exclusion criteria applicable to all studies were used, and then data relating to the study source were extracted separately using a spreadsheet. These included the authors and year of publication, the topic of application, which variable they worked on, and the type of instrument used for data collection.
Any disputes were dealt with through discussion until an agreement was reached. For the purposes of review, we considered every study that had measured QOL using some measurement instrument that assessed the effects of active practice in DB by BCSs on QOL.

2.7. Synthesis

To analyze the articles included in the review, we took into account the sampler size, the population in which they were conducted, the instrument used for measurement, the type of intervention applied, the duration of the study, whether or not they had previous experience in DB and the effect of the intervention on QOL.

3. Results

The data extracted from the 10 articles included in the systematic review are explained in Table 1.
The characteristics of the articles included in the systematic review are detailed in Table 2.

3.1. Study Selecction

The literature search gathered a total of 77 articles (Figure 1), 19 of which came from Pubmed, 23 from Scopus, 3 from Cochrane and 32 from Web of Science. A total of 20 articles were eliminated as duplicates, leaving 57 articles, of which 3 were excluded by title and abstract selection. The remaining 54 full-text articles were assessed for eligibility. Therefore, 10 articles were included [9,21,22,27,28,29,30,31,32,33] for the following review.

3.2. Study Characteristics

Table 3 shows the general characteristics of the different articles selected in the current systematic review. The parameters of intervention time were analyzed, where 4 of 10 of the studies have an application of fewer than two months. The participation with or without lymphedema of the (N) is not specified in 6 out of 10 of the cases. On the other hand, the participation in races by the participants of these studies is 4 out of 10. In 6 of the 10 studies, the population shows previous experience in DB. The studies are divided into 3 of 10 in an observational study format and 6 of 10 in a pre–post format, these being the two most used formats. A control group was employed in 5 out of 10 of the studies, which the others did not have. Six different instruments were used in the selected studies, SF-36, FACT-B, and EORTC being the most commonly used instruments for measuring QOL.
Articles [9,27,28,29,30,32,33] obtained a good quality after analysis, with scores ranging from 6 to 8. The remaining articles [21,22,29] obtained a fair quality, with scores ranging from 4 to 5. It is worth noting that none of the articles included in the review scored points in item 3, which analyzes the concealed assignment (Table 3).
The extracted data were analyzed by grouping them into groups (length of the study, type of intervention, previous experience in DB, instrument used to measure QOL, effect of DB exercise on QOL), since they are considered the most important variables to take into account in these studies, given the importance of these variables in the future not only of the quality of life of the participants but also in the conditioning factor of the continuity of DB.

3.2.1. Length of Study

In terms of duration, there are differences between authors. We found four articles with less than 8 weeks intervention, two of which only consist of one data collection. On the other hand, four studies use the duration of a season (6–7 months) as a time measure to observe changes in subjects’ QOL. Baseline measurements are taken during the first weeks of the start of the season, and endline measurements are taken either during the last weeks or after the end of the competitive period.

3.2.2. Type of Intervention

With the exception of study [9], the rest of the studies have a prospective design, either observational, comparative or sequential. The way of obtaining data in most of the studies has been pre–post, in order to identify the changes produced by the application of DB between the first and second sample data collections. In the remaining two articles [9,28], data have been collected at a single point in time, by performing a comparative study with other subjects from other physical activities or with the general population.

3.2.3. Previous Experience in DB

Most of the studies have used subject groups already trained in DB and with a predisposition to practice this sport. As the authors state, participants who had been practicing DB for more than one season showed a better baseline in their QOL [29,31]. In only one intervention, the groups have been randomly assigned [33]. The choice of whether or not to practice DB has come from the subjects of the study, because they had practiced it before, they have been interested in it themselves or they have been asked by the researchers to carry out the study. As can be seen from the articles, most of the participants had previously practiced dragon boating, which is an indication that it is a sport that generates adherence in its practice in this population in particular, providing long-term benefits.

3.2.4. Instrument Used to Measure QOL

All the selected articles analyze the subjects’ QOL, but not all of them do so with the same instrument. As it can see in Table 2, the authors use different instruments to measure these data; among the most used, we find the SF-36 used in four studies, followed by the FACT-B and the EORTC QLQ C-30 used in three articles each. Five articles used more than one instrument to obtain the data.

3.3. Effect of DB Exercise on QOL

QOL tends to improve in subjects who practice DB. In 9 out of 10 of the studies, it was observed that practicing DB improves the participants’ QOL. In some cases, DB improves QOL more than physical activities like walking, pilates, yoga and resistance training [27,33]. In other studies, they state that DB improves QOL in a similar way to those who perform other physical activities, such as walking or resistance training [9,21,22]. As for the comparison between the DB groups and the control groups that do not perform PA, DB tends to significantly improve the QOL of the participants. On the other hand, DB participants show similar levels of QOL to the general population without BC.
The QOL tends to improve in those subjects who practice DB. In some studies, the QOL of dragon boaters improves more than that of those who perform physical activities like walking or resistance training [27,33]. In other studies, they claim that dragon boating improves QOL in the same way as other types of physical activity such as walking or resistance training [9,21,22]. QOL improves significantly when comparing dragon boaters to those who do not engage in any physical activity [27,32]. DB practitioners show similar levels of QOL to healthy women. DB proves to be a suitable option for BCSs with lymphedema, as well as for those without lymphedema [21,31]. Although BCSs with lymphedema do not have the same quality of life values as BCSs without lymphedema, dragon boating improves quality of life and is a physical activity option that demonstrates improvements in this population [27,28].
The appearance of lymphedema is lower in the groups that practice DB than in those who practice other types of physical activity or alternative therapies [27], or no activity at all [32]. When comparing the evolution of lymphedema before and after treatment, a significant improvement is observed in those women who practice DB, contributing to the improvement of QOL and reducing relative symptoms such as fatigue and insomnia [27,28], and late arm impairment [9], among others.

4. Discussion

The aim of this systematic review was to determine whether the practice of DB improves the QOL of BCSs who practice it. Furthermore, it aims to identify which aspects are relevant for this effect to occur. The main results indicate that DB improves the QOL of BCSs, improving the fitness level for daily functioning, causing them to feel better mentally and show greater self-acceptance and self-confidence [9,21,22,27,28,29,32,33]. The continued practice of DB is presented as a suitable activity because of its specificity for this population, improving the mobility and stiffness parameters of the operated-on arm [28], decreasing fatigue [13] and creating the feeling of belonging to a peer group [34]. However, in spite of the QOL improving after a DB intervention, no significant differences are found between DB and other PA such as walking or resistance training [9,21,22], with the exception of one study, in which they point out that DB improves QOL more than other physical activities performed twice a week, which would position this sport as one of the main options for this population [27].
BCSs suffer from complications during the disease and during its treatment, such as conditions that limit the mobility of the upper limb like lymphoedema, joint stiffness or pain, which affect their ability to perform daily life tasks and therefore diminish their QOL [28,35]. Resistance exercises of the upper limb have been shown to improve those pathologies derived from BC [6,7,8,9,10,11,36], so DB is presented as an optimal exercise alternative for this population, improving muscular strength in both the upper and lower extremities [8]. On the other hand, side effects such as depression, fatigue or insomnia produced by BC and its treatments decrease, offering them hope and the ability to regain control of their life, both when conventional PA is performed [12,13,15,16,37], and when DB is used as a PA option [28,29,38,39]. Finally, the social part and the feeling of belonging to a group promoted by PA tends to diminish the negative effects of BC by improving the QOL of BCSs, [34,40,41] since paddlers recognize that they feel among equals and do not tend to compare themselves with their peers, which would lead to a worse state of mind in terms of their healthcare [8,19,39,42,43,44].
DB is shown to be a good physical activity option for BCSs. Continuous physical activity that lasts longer than 6 months shows a more significant improvement in QOL [45,46] than research with a shorter duration, as in the case of BCSs who engage in physical activity lasting a year or more, who significantly increase their QOL [47] by improving their physical and social functioning and decreasing their anxiety and depression [48,49]. In this review, the same occurs if we compare studies covering a full season of DB [27,32] to those where its application is limited to 8–12 weeks [21,22,31]; we observe that the improvements in the QOL of DB participants improves more than the control groups, both sedentary and those who perform other PA. We can then say that a continuous DB practice of at least one season’s duration produces greater improvements in QOL than shorter time applications in BCSs. Among the characteristics that DB has to produce this adherence to the sport, we have the acceptance and respect that the paddlers feel from the members of the team, which increases the feeling of belonging [20,24], and on the other hand, sharing the activity with women who have suffered from the same disease makes them feel in a comfortable environment where they can share information, concerns and experiences [19,20,21,22,26]. In addition, it is an outdoor sport in the natural environment, which is an attraction for physical activity [21,50,51].
However, when it comes to comparing which physical activity increases subjects’ QOL the most, there are discrepancies between authors. One author stated DB participants increase their QOL more than those who practice other PA [27,33]; however, another one asserts that DB has benefits for BCSs, but finds no differences between those who practice DB and other PA [9]. One of the characteristics that differentiate the two studies is the duration of the activity, the first one being of longer duration, covering a DB season.
In most of the studies included in this review, the BC populations analyzed had previously practiced DB [9,28,30,31,32], and in two other articles, it does not specify whether they previously started in DB [27,29]; however, both do figure out the effect on QOL during a full season of DB. It is understood, therefore, that the population reviewed in most of the articles is a physically active population prior to the studies, namely, the people included in the studies were mostly DB practitioners prior to data collection; this must be taken into consideration, since the positive effects produced by PA, in this case DB, are not as significant as those in a sedentary population starting PA [52,53,54]. On the other hand, studies where participants were new to the sport discipline have had an 8-week application [21,22], in which no differences were found between DB and walking activity. It is essential to give enough importance to practicing PA not only during the course of the disease but also after overcoming it, where the risk of recurrence is lower if you maintain an active life and if you have an adequate body weight where there is more muscular mass and less fat mass, this being essential for increasing survival—which is where DB can play an important role.

5. Conclusions

Physical activity has been heavily studied as a method of improving breast cancer survival and breast cancer-related symptoms. In summary, although some studies indicate that there may be improvement, the results are contradictory, and it is not possible to state with certainty that DB is a suitable activity to improve the QOL of BCSs by improving disease-related and treatment-related symptoms like lymphedema, joint stiffness, fatigue, insomnia and pain, although improving daily activities and sleep quality and belonging to a peer group have positive effects on QOL. DB is not the only activity that improves the QOL of BCSs, nor is it clear that it is a better option than other PA. As this is the first systematic review that analyzes DB as a vehicle for enhancing the QOL of BCSs, more research is needed to better understand the effects of DB on BCSs.
This systematic review is not without limitations. First, the heterogeneity of the intervention protocols of the articles included for analysis, together with the small number of articles included, makes it difficult to draw strict and rigorous conclusions; second, the BCSs in the included articles already practiced rowing before being diagnosed with BC, so we cannot extrapolate these data to a sedentary population that wants to initiate DB; and third, the need to live near the sea or near an area with water, where you can sail and practice this sport, makes it more difficult to perform compared to other physical activity options.
The practical applications of this study are to unify research analyzing the effect of DB in the QOL of BCSs and to serve as a starting point for future research.

Author Contributions

I.H.-Z., A.C.-B. and S.Á.-P.: Conception and design, analysis and interpretation of the data, draft, critical revision and approval of the final version of the article submitted for publication. I.H.-Z., S.Á.-P., A.C.-B., J.F.M.-A. and A.M.-V.: Analysis and interpretation of the data, draft, critical revision and approval of the final version of the article submitted for publication. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

The data of the research are available in the tables of the manuscript or on request from the corresponding author.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Siegel, R.L.; Miller, K.D.; Wagle, N.S.; Jemal, A. Cancer statistics, 2023. CA Cancer J. Clin. 2023, 73, 17–48. [Google Scholar] [CrossRef] [PubMed]
  2. IARC—International Agency for Research on Cancer. Available online: https://www.iarc.who.int/ (accessed on 29 May 2023).
  3. Red Española de Registros de Cáncer (REDECAN). Estimación de la Incidencia de Cáncer en España 2023; Red Española de Registros de Cáncer (REDECAN): Murcia, Spain, 2023. [Google Scholar]
  4. Breast Cancer Statistics, 2022—Giaquinto—2022—CA: A Cancer Journal for Clinicians—Wiley Online Library. Available online: https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21754 (accessed on 18 July 2023).
  5. Friedenreich, C.M.; Stone, C.R.; Cheung, W.Y.; Hayes, S.C. Physical Activity and Mortality in Cancer Survivors: A Systematic Review and Meta-Analysis. JNCI Cancer Spectr. 2020, 4, pkz080. [Google Scholar] [CrossRef] [PubMed]
  6. Cheville, A.L.; Kollasch, J.; Vandenberg, J.; Shen, T.; Grothey, A.; Gamble, G.; Basford, J.R. A home-based exercise program to improve function, fatigue, and sleep quality in patients with Stage IV lung and colorectal cancer: A randomized controlled trial. J. Pain. Symptom Manag. 2013, 45, 811–821. [Google Scholar] [CrossRef] [PubMed]
  7. DiSipio, T.; Rye, S.; Newman, B.; Hayes, S. Incidence of unilateral arm lymphoedema after breast cancer: A systematic review and meta-analysis. Lancet Oncol. 2013, 14, 500–515. [Google Scholar] [CrossRef] [PubMed]
  8. Hasenoehrl, T.; Palma, S.; Ramazanova, D.; Kölbl, H.; Dorner, T.E.; Keilani, M.; Crevenna, R. Resistance exercise and breast cancer-related lymphedema-a systematic review update and meta-analysis. Support. Care Cancer 2020, 28, 3593–3603. [Google Scholar] [CrossRef] [PubMed]
  9. Melchiorri, G.; Viero, V.; Triossi, T.; Sorge, R.; Tancredi, V.; Cafaro, D.; Andreis, C.; Vulpiani, M.C.; Saraceni, V.M. New Approach to Evaluate Late Arm Impairment and Effects of Dragon Boat Activity in Breast Cancer Survivors—PubMed. 2017. Available online: https://pubmed.ncbi.nlm.nih.gov/29095268/ (accessed on 1 June 2023).
  10. Ribeiro, I.L.; Mañán, C.R.; Sepúlveda, F.G.; Naranjo, M.F.; Benavides, N.Y.; Gonzales, F.O.; Ramirez-Parada, K.L.; Lorca, L.A. Disminución de la funcionalidad de miembro superior y bajo nivel de actividad física en supervivientes de cáncer de mama: Un estudio de caso-control (Decreased upper limb function and low level of physical activity following treatment for breast cancer. Retos 2022, 44, 302–308. [Google Scholar] [CrossRef]
  11. Wang, S.; Hsu, C.J.; Trent, L.; Ryan, T.; Kearns, N.T.; Civillico, E.F.; Kontson, K.L. Evaluation of Performance-Based Outcome Measures for the Upper Limb: A Comprehensive Narrative Review. PM&R 2018, 10, 951–962.e3. [Google Scholar]
  12. Ma, Y.; Hall, D.L.; Ngo, L.H.; Liu, Q.; Bain, P.A.; Yeh, G.Y. Efficacy of cognitive behavioral therapy for insomnia in breast cancer: A meta-analysis. Sleep. Med. Rev. 2021, 55, 101376. [Google Scholar] [CrossRef] [PubMed]
  13. Dimeo, F.C.; Stieglitz, R.D.; Novelli-Fischer, U.; Fetscher, S.; Keul, J. Effects of physical activity on the fatigue and psychologic status of cancer patients during chemotherapy. Cancer 1999, 85, 2273–2277. [Google Scholar] [CrossRef]
  14. Ruiz-Casado, A.; Álvarez-Bustos, A.; de Pedro, C.G.; Méndez-Otero, M.; Romero-Elías, M. Cancer-related Fatigue in Breast Cancer Survivors: A Review. Clin. Breast Cancer 2020, 21, 10–25. [Google Scholar] [CrossRef] [PubMed]
  15. Williams, A.M.; Shah, R.; Shayne, M.; Huston, A.J.; Krebs, M.; Murray, N.; Thompson, B.D.; Doyle, K.; Korotkin, J.; van Wijngaarden, E.; et al. Associations between inflammatory markers and cognitive function in breast cancer patients receiving chemotherapy. J. Neuroimmunol. 2018, 314, 17–23. [Google Scholar] [CrossRef] [PubMed]
  16. Park, S.-Y.; Lim, J.-W. Cognitive behavioral therapy for reducing fear of cancer recurrence (FCR) among breast cancer survivors: A systematic review of the literature. BMC Cancer 2022, 22, 217. [Google Scholar] [CrossRef]
  17. Epplein, M.; Zheng, Y.; Zheng, W.; Chen, Z.; Gu, K.; Penson, D.; Lu, W.; Shu, X.-O. Quality of Life After Breast Cancer Diagnosis and Survival. J. Clin. Oncol. 2011, 29, 406–412. [Google Scholar] [CrossRef] [PubMed]
  18. Speck, R.M.; Courneya, K.S.; Mâsse, L.C.; Duval, S.; Schmitz, K.H. An update of controlled physical activity trials in cancer survivors: A systematic review and meta-analysis. J. Cancer Surviv. Res. Pract. 2010, 4, 87–100. [Google Scholar] [CrossRef]
  19. Fong, A.J.; Saxton, H.R.; Kauffeldt, K.D.; Sabiston, C.M.; Tomasone, J.R. “We’re all in the same boat together”: Exploring quality participation strategies in dragon boat teams for breast cancer survivors. Disabil. Rehabil. 2021, 43, 3078–3089. [Google Scholar] [CrossRef] [PubMed]
  20. Sabiston, C.M.; McDonough, M.H.; Crocker, P.R.E. Psychosocial experiences of breast cancer survivors involved in a dragon boat program: Exploring links to positive psychological growth. J. Sport. Exerc. Psychol. 2007, 29, 419–438. [Google Scholar] [CrossRef] [PubMed]
  21. Carter, C.L.; Onicescu, G.; Cartmell, K.B.; Sterba, K.R.; Tomsic, J.; Fox, T.; Dunmeyer, E.; Alberg, A.J. Factors associated with cancer survivors’ selection between two group physical activity programs. J. Cancer Surviv. 2010, 4, 388–398. [Google Scholar] [CrossRef] [PubMed]
  22. Carter, C.L.; Onicescu, G.; Cartmell, K.B.; Sterba, K.R.; Tomsic, J.; Alberg, A.J. The comparative effectiveness of a team-based versus group-based physical activity intervention for cancer survivors. Support. Care Cancer 2012, 20, 1699–1707. [Google Scholar] [CrossRef] [PubMed]
  23. Kim, S.; Ko, Y.H.; Jun, E.Y. The impact of breast cancer on mother–child relationships in Korea. Psychooncology 2012, 21, 640–646. [Google Scholar] [CrossRef] [PubMed]
  24. Ginis, K.A.M.; Ma, J.K.; Latimer-Cheung, A.E.; Rimmer, J.H. A systematic review of review articles addressing factors related to physical activity participation among children and adults with physical disabilities. Health Psychol. Rev. 2016, 10, 478–494. [Google Scholar] [CrossRef]
  25. Pudkasam, S.; Polman, R.; Pitcher, M.; Fisher, M.; Chinlumprasert, N.; Stojanovska, L.; Apostolopoulos, V. Physical activity and breast cancer survivors: Importance of adherence, motivational interviewing and psychological health. Maturitas 2018, 116, 66–72. [Google Scholar] [CrossRef] [PubMed]
  26. Weisenbach, B.B.; McDonough, M.H. Breast cancer survivors’ decisions to join a dragon boating team. J. Sport Exerc. Psychol. 2014, 36, 564–573. [Google Scholar] [CrossRef] [PubMed]
  27. Iacorossi, L.; Gambalunga, F.; Molinaro, S.; De Domenico, R.; Giannarelli, D.; Fabi, A. The Effectiveness of the Sport ‘Dragon Boat Racing’ in Reducing the Risk of Lymphedema Incidence: An Observational Study. Cancer Nurs. 2019, 42, 323–331. [Google Scholar] [CrossRef] [PubMed]
  28. Koehler, L.; Rosenberg, S.; Cater, J.; Mikolajczyk, K.; Moran, A.; Metz, C.; Monson, S. Quality of life in breast cancer survivors: An assessment of international breast cancer dragon boat racers. Lymphology 2020, 53, 195–203. [Google Scholar] [CrossRef] [PubMed]
  29. Ray, H.A.; Verhoef, M.J. Dragon boat racing and health-related quality of life of breast cancer survivors: A mixed methods evaluation. BMC Complement. Altern. Med. 2013, 13, 205. [Google Scholar] [CrossRef] [PubMed]
  30. Denieffe, S.; Castineira, C.; Denny, M. The Impact of Dragon Boating for Fatigue in Cancer Survivors. J. Nurse Pract. 2021, 17, 1019–1022. [Google Scholar] [CrossRef]
  31. Boeer, B.; Seller, A.; Schoenfisch, B.; Krainick-Strobel, U.; Dietrich, A.; Brucker, S.Y.; Wallwiener, D.; Niess, A.; Hahn, M. The impact of rehabilitation sport on breast cancer-related lymphoedema and quality of life. Arch. Gynecol. Obstet. 2023, 307, 1529–1537. [Google Scholar] [CrossRef] [PubMed]
  32. Culos-Reed, S.N.; Shields, C.; Brawley, L.R. Breast cancer survivors involved in vigorous team physical activity: Psychosocial correlates of maintenance participation. Psychooncology 2005, 14, 594–605. [Google Scholar] [CrossRef] [PubMed]
  33. Moro, T.; Casolo, A.; Bordignon, V.; Sampieri, A.; Schiavinotto, G.; Vigo, L.; Ghisi, M.; Paoli, A.; Cerea, S. Keep calm and keep rowing: The psychophysical effects of dragon boat program in breast cancer survivors. Support. Care Cancer 2024, 32, 218. [Google Scholar] [CrossRef] [PubMed]
  34. Zanghì, M.; Petrigna, L.; Maugeri, G.; D’agata, V.; Musumeci, G. The Practice of Physical Activity on Psychological, Mental, Physical, and Social Wellbeing for Breast-Cancer Survivors: An Umbrella Review. Int. J. Environ. Res. Public Health 2022, 19, 10391. [Google Scholar] [CrossRef] [PubMed]
  35. Ridner, S.H. Quality of life and a symptom cluster associated with breast cancer treatment-related lymphedema. Support. Care Cancer 2005, 13, 904–911. [Google Scholar] [CrossRef] [PubMed]
  36. Li, Y.; Yang, D.; Yin, X.; Zhang, X.; Huang, J.; Wu, Y.; Wang, M.; Yi, Z.; Li, H.; Li, H.; et al. Clinicopathological Characteristics and Breast Cancer-Specific Survival of Patients with Single Hormone Receptor-Positive Breast Cancer. JAMA Netw. Open 2020, 3, e1918160. [Google Scholar] [CrossRef] [PubMed]
  37. Lin, N.U.; Vanderplas, A.; Hughes, M.E.; Theriault, R.L.; Edge, S.B.; Wong, Y.N.; Blayney, D.W.; Niland, J.C.; Winer, E.P.; Weeks, J.C. Clinicopathologic features, patterns of recurrence, and survival among women with triple-negative breast cancer in the National Comprehensive Cancer Network. Cancer 2012, 118, 5463–5472. [Google Scholar] [CrossRef]
  38. Hawley-Hague, H.; Horne, M.; Campbell, M.; Demack, S.; Skelton, D.A.; Todd, C. Multiple levels of influence on older adults’ attendance and adherence to community exercise classes. Gerontologist 2014, 54, 599–610. [Google Scholar] [CrossRef] [PubMed]
  39. Mitchell, T.L.; Yakiwchuk, C.V.; Griffin, K.L.; Gray, R.E.; Fitch, M.I. Survivor Dragon Boating: A Vehicle to Reclaim and Enhance Life After Treatment for Breast Cancer. Health Care Women Int. 2007, 28, 122. [Google Scholar] [CrossRef] [PubMed]
  40. Sebri, V.; Durosini, I.; Mazzoni, D.; Pravettoni, G. Breast Cancer Survivors’ Motivation to Participate in a Tailored Physical and Psychological Intervention: A Qualitative Thematic Analysis. Behav. Sci. 2022, 12, 271. [Google Scholar] [CrossRef] [PubMed]
  41. Wassersug, R.J.; Oliffe, J.L. The social context for psychological distress from iatrogenic gynecomastia with suggestions for its management. J. Sex. Med. 2009, 6, 989–1000. [Google Scholar] [CrossRef]
  42. Harris, S.R. Were all in the same boat: A review of the benefits of dragon boat racing for women living with breast cancer. Evid. Based Complement. Altern. Med. 2012, 2012, 167651. [Google Scholar] [CrossRef] [PubMed]
  43. McDonough, M.H.; Sabiston, C.M.; Ullrich-French, S. The development of social relationships, social support, and posttraumatic growth in a dragon boating team for breast cancer survivors. J. Sport Exerc. Psychol. 2011, 33, 627–648. [Google Scholar] [CrossRef] [PubMed]
  44. Parry, D.C. The Contribution of Dragon Boat Racing to Women’s Health and Breast Cancer Survivorship. Qual. Health Res. 2008, 18, 222–233. [Google Scholar] [CrossRef] [PubMed]
  45. Courneya, K.S.; Segal, R.J.; Mackey, J.R.; Gelmon, K.; Reid, R.D.; Friedenreich, C.M.; Ladha, A.B.; Proulx, C.; Vallance, J.K.H.; Lane, K.; et al. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: A multicenter randomized controlled trial. J. Clin. Oncol. 2007, 25, 4396–4404. [Google Scholar] [CrossRef] [PubMed]
  46. Stefani, L.; Galanti, G.; Di Tante, V.; Klika, R.J.; Maffulli, N. Dragon Boat training exerts a positive effect on myocardial function in breast cancer survivors. Physician Sportsmed. 2015, 43, 307–311. [Google Scholar] [CrossRef] [PubMed]
  47. Bourke, L.; E Homer, K.; A Thaha, M.; Steed, L.; Rosario, D.J.; A Robb, K.; Saxton, J.M.; Taylor, S.J.C. Interventions to improve exercise behaviour in sedentary people living with and beyond cancer: A systematic review. Br. J. Cancer 2014, 110, 831–841. [Google Scholar] [CrossRef] [PubMed]
  48. Amritanshu, R.R.; Rao, R.M.; Nagaratna, R.; Veldore, V.H.; Rani, M.U.U.; Gopinath, K.S.; Ajaikumar, B. Effect of Long-term Yoga Practice on Psychological outcomes in Breast Cancer Survivors. Indian J. Palliat. Care 2017, 23, 231–236. [Google Scholar] [CrossRef] [PubMed]
  49. Carayol, M.; Ninot, G.; Senesse, P.; Bleuse, J.-P.; Gourgou, S.; Sancho-Garnier, H.; Sari, C.; Romieu, I.; Romieu, G.; Jacot, W. Short- and long-term impact of adapted physical activity and diet counseling during adjuvant breast cancer therapy: The ‘APAD1’ randomized controlled trial. BMC Cancer 2019, 19, 737. [Google Scholar] [CrossRef] [PubMed]
  50. Hansen-Ketchum, P.A.; Halpenny, E.A. Engaging with nature to promote health: Bridging research silos to examine the evidence. Health Promot. Int. 2011, 26, 100–108. [Google Scholar] [CrossRef] [PubMed]
  51. Ray, H.; Jakubec, S.L. Nature-based experiences and health of cancer survivors. Complement. Ther. Clin. Pract. 2014, 20, 188–192. [Google Scholar] [CrossRef] [PubMed]
  52. Canário, A.C.G.; Cabral, P.U.L.; de Paiva, L.C.; Florencio, G.L.D.; Spyrides, M.H.; Gonçalves, A.K.d.S. Physical activity, fatigue and quality of life in breast cancer patients. Rev. Assoc. Médica Bras. 2016, 62, 38–44. [Google Scholar] [CrossRef] [PubMed]
  53. Hagstrom, A.D.; Marshall, P.W.M.; Lonsdale, C.; Papalia, S.; Cheema, B.S.; Toben, C.; Baune, B.T.; Singh, M.A.F.; Green, S. The effect of resistance training on markers of immune function and inflammation in previously sedentary women recovering from breast cancer: A randomized controlled trial. Breast Cancer Res. Treat. 2016, 155, 471–482. [Google Scholar] [CrossRef]
  54. Hidde, M.C.; Lyden, K.; Henry, K.; Leach, H.J. Reallocating time to physical activity and sleep: Associations with quality of life in cancer survivors. Support. Care Cancer 2022, 30, 7527–7534. [Google Scholar] [CrossRef]
Healthcare 12 01290 g001
Figure 1. A flowchart of the process of selection, screening, suitability and inclusion of articles included in the systematic review. PRISMA 2020 guidelines.
Figure 1. A flowchart of the process of selection, screening, suitability and inclusion of articles included in the systematic review. PRISMA 2020 guidelines.
Healthcare 12 01290 g001
Table 1. Summary of studies included in systematic review investigating effect of DG on QOL in BCSs.
Table 1. Summary of studies included in systematic review investigating effect of DG on QOL in BCSs.
Autor and YearSampler SizePopulationToolInterventionFollow Up (Duration)DB Previous ExperienceQOL
Melchiorri et al., 2017 [9]N = 64
47 Unilateral mastectomy surgery
G1= 15 Operated DB
G2= 16 Operated FA
G3= 17 BCS no PA
+
G4= 17 Healthy women		G1: BCS Operated 54.1 ± 5.8
TSS = 8.2 ± 2.3
G2: BCS Operated 53.7 ± 12.1
TSS = 8.6 ± 2.4
G3: BCS Non-Operated 60.4 ± 11.3
TSS = 7.2 ± 1.2
G4: Healthy women 51.1 ± 8.3		SF-36Retrospective observational study1 dayYes↑DB
Operated >
Non-Operated
G1 > G2
Carter et al., 2010 [21]N= 120
DB N = 68
WK N = 52		Cancer survivor
56% Breast cancer
DB = 54.2 ± 9.7
TSD = 5.0 ± 5.7
WK = 58.2 ± 10.3
TSD = 6.6 ± 8.3		SF-36
FACT-B		Non-randomized intervention trial
Pre–post		8 weeks
2 h weekly		No↑DB
↑Walking
DB = WK
DB and walking = general population
Carter et al., 2012 [22]N = 120
DB N = 68
WK N = 52		Cancer survivor
56% Breast cancer
DB = 53.8 ± 9.7
TSD = 4.4 ± 5.1
WK = 58.2 ± 10.2
TSD = 7.3 ± 8.8		FACT-B
SF-36		Non-randomized intervention trial
Pre–post		8 weeks
2 h weekly		No↑DB
↑WK
DB = WK
Iacorossi et al.,
2019 [27]		N = 100 participants
50 G1 = DB +6 month
50 G2 = PA biweekly		W BCSs
54% < 60 year		EORTC QLQ C-30Observational study
Pre–post		≥6 monthsNo specific↑↑DB
↑PA
DB > PA
G1 > G2
Koehler et al.,
2020 [28]		N = 748 QuestionnaireW BSCs who participate in DBR
TSS = 9.0 ± 5.1		Lymph-ICFProspective, observational design1 dayYes↑Lymphedema
↑Non-lymphedema
Lymphedema non-lymphedema
↑DB
↑Overall average
Ray et al.,
2013 [29]		116 1° Interview
100 2° Interview		W BSC
89% < 70 year
TSD = 52% > 5 year		FACT-B
FACIT-Sp12
FACIT-F
+ Semi-structured Interview n = 15		Mixed methods sequential explanatory designPreseason–
Postseason
>6 months		Yes↑↑DB
Denieffe et al.,
2021 [30]		N = 49 analyzed
All test = 26		W BCS and DB participants
54.5 ± 8.3		EORTC QLQ C-30
FACTI-F		Prospective observational pilot study3 tests during
8 months		YesDB pre = DB post
DB pre = DB mid
DB mid = DB post
Culos-Reed et al., 2005 [31]156 1° Interview
56 2° Interview		W BCS
52.89 ± 7.61		SF-12Prospective observational
Pre–post test		12 weeks
1 h week		YesDB = Overall average
Boeer et al., 2022 [32]N = 98
DB = 28
CG = 70		Breast cancer survivor
DB = 60.0 ± 9.2
TSS = 4.7 ± 4.0
CG = 62.5 ± 9.2
TSS = 6.7 ± 5.1		SF-36
EORTC QLQ C30		Prospective, comparative, longitudinally
oriented case–control
Pre–post		6 months
Once weekly 1.5 h		YesEORTHC:
↑↑DB
↓Control
SF-36:
DB ↑
↓↓Control
DB > CG
Moro et al., 2024 [33]N = 31
DB = 18
HP = 13		Breast cancer survivor
DB = 56.40 ± 7.29
TSD = 7.33 ± 3.77
HP = 59.90 ± 9.67
TSD = 10.07 ± 7.38		SF-12Parallel randomized trial12 weeks
3 h weekly		No↑DB
DB > Control
BCS: breast cancer survivor; DBR: dragon boat race: DB: dragon boat; PA: physical activity: QOL: quality of life; ↑: improve QOL; ↓: decrease QOL; =: similar; ↑↑: improve significatively; ↓↓: decrease significatively; no similar; > more/less; CG: control group; WK: walking group; HP: home training program; TSD: time since diagnosis; TSS: time since surgery.
Table 2. Characteristics of the articles included in the systematic review.
Table 2. Characteristics of the articles included in the systematic review.
CharacteristicsVariablesNº of Articles
Length of the study<2 months4 studies (1, 3, 7, 8)
From 2 to 6 months2 studies (5, 10)
>6 months4 studies (2, 4, 6, 9)
Participants with lymphedemaYes 3 studies (1, 2, 9)
Not specified7 studies (3, 4, 5, 6, 7, 8, 10)
Participants in racesYes4 studies (1, 4, 5, 6)
No2 studies (7, 8)
Not specified4 studies (2, 3, 9, 10)
Participants levelNo previous experience in PA and DB4 studies (6, 7, 8, 10)
With previous experience in DB6 studies (1, 2, 4, 5, 6, 9)
Not specified1 study (3)
Type of interventionPre–post8 studies (2, 4, 5, 6, 7, 8, 9, 10)
Observational study2 studies (1, 3)
Instrument used to measure QOLFACT-B3 studies (4, 7, 8)
SF-364 studies (3, 7, 8, 9)
EORTC QLQ C-303 studies (2, 6, 9)
FACIT-F2 studies (4, 6)
Lymph-ICF1 study (1)
SF-122 studies (5, 10)
Semi-structured interviews1 study (4)
Control groupYes6 studies (2, 3, 4, 8, 9, 10)
No4 studies (1, 5, 6, 7)
DB: dragon boat; PA: physical activity: QOL: quality of life.
Table 3. Quality assessment of included studies (PEDro scale).
Table 3. Quality assessment of included studies (PEDro scale).
PEDro ItemsMelchiorri et al., 2017 [9]Carter et al., 2010 [21]Carter et al., 2012 [22]Iacorosi et al., 2019 [27]Koehler et al., 2020 [28]Ray et al., 2013 [29]Denieffe et al., 2021 [30]Culos-Reed et al., 2005 [31]Boeer et al., 2022 [32]Moro et al., 2024 [33]
11111111111
20000000001
30000000000
41111111111
50000000000
61000010000
71000110001
81001111011
91111111011
101111111111
111111111111
Total8556786468
QualityGoodRegularRegularGoodGoodGoodGoodRegularGoodGood
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Herrero-Zapirain, I.; Álvarez-Pardo, S.; Castañeda-Babarro, A.; Moreno-Villanueva, A.; Mielgo-Ayuso, J.F. The Effect of Dragon Boating on the Quality of Life for Breast Cancer Survivors: A Systematic Review. Healthcare 2024, 12, 1290. https://doi.org/10.3390/healthcare12131290

AMA Style

Herrero-Zapirain I, Álvarez-Pardo S, Castañeda-Babarro A, Moreno-Villanueva A, Mielgo-Ayuso JF. The Effect of Dragon Boating on the Quality of Life for Breast Cancer Survivors: A Systematic Review. Healthcare. 2024; 12(13):1290. https://doi.org/10.3390/healthcare12131290

Chicago/Turabian Style

Herrero-Zapirain, Igor, Sergio Álvarez-Pardo, Arkaitz Castañeda-Babarro, Adrian Moreno-Villanueva, and Juan Francisco Mielgo-Ayuso. 2024. "The Effect of Dragon Boating on the Quality of Life for Breast Cancer Survivors: A Systematic Review" Healthcare 12, no. 13: 1290. https://doi.org/10.3390/healthcare12131290

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