The Role of Exercise Self-Efficacy in Exercise Participation Among Women With Persistent Fatigue After Breast Cancer: A Mixed-Methods Study.
Stephen Wechsler, Mei R Fu, Kathleen Lyons and 2 others
PMID 36222153WHAT IT FOUND
For breast cancer survivors with persistent fatigue, low confidence in their ability to exercise predicts less actual exercise.
Survivors with higher confidence viewed exercise as a fatigue management tool and had strong support systems, while those with lower confidence felt unsupported and struggled with commitment.
Key findings
01Higher levels of cancer-related fatigue significantly predicted lower exercise self-efficacy and fewer hours of moderate-intensity exercise per week.
02Exercise self-efficacy mediated the relationship between fatigue and exercise participation, meaning fatigue likely reduces exercise because it lowers the patient's confidence in their ability to exercise.
03Qualitative interviews revealed that survivors with higher self-efficacy perceived exercise as a strategy to manage fatigue and had multiple sources of support, whereas those with lower self-efficacy felt 'untethered' after treatment and lacked support.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study design was cross-sectional, so it cannot prove that fatigue causes low self-efficacy or that low self-efficacy causes reduced exercise; the relationships could be bidirectional. The Self-Efficacy for Exercise scale used was not previously validated in this specific population, and there is no established cutoff for clinically meaningful change. The sample size was modest (58 participants), and the threshold used to categorize high versus low self-efficacy (70%) was chosen subjectively. The qualitative subsample was small (11 participants), which limits the generalizability of the experiential themes.
Declared interests
The study was funded by the National Institute on Aging. The funders played no role in the design, conduct, or reporting of the study.
The easy way to misread this
Do not interpret these results as proof that fatigue directly causes reduced exercise. The study shows that fatigue is associated with lower confidence in exercising, and that this lower confidence is what predicts reduced exercise hours. Addressing fatigue alone may not improve adherence if the patient's self-efficacy remains low.