Plyometric Strength-Endurance Exercise in Breast Cancer

EORTC QLQ-BR42: European Organisation for Research and Treatment of Cancer (EORTC) to assess breast cancer-specific quality of life.

Description:

The EORTC QLQ-BR42 is a validated 42-item questionnaire designed to assess breast cancer-specific quality of life. It evaluates physical, emotional, and functional well-being, as well as symptoms and treatment-related side effects relevant to contemporary breast cancer therapies. The measure covers domains such as body image, sexual functioning, systemic therapy side effects, breast symptoms, and arm symptoms.

Scoring:

Items are scored according to the EORTC scoring manual. Scores are linearly transformed to a 0-100 scale. Higher scores on functional scales indicate better functioning; higher scores on symptom scales indicate greater symptom burden.

6-Minute Walk Test (6MWT) Description: The Six-Minute Walk Test is a standardized assessment of cardiorespiratory capacity that measures the total distance walked (in meters) over a six-minute period at a self-paced speed. It reflects functional exercise tolerance and global physical endurance.

Score Range:

Minimum possible score: 0 meters Maximum possible score: No fixed upper limit (performance-dependent; healthy individuals may reach 300-700 meters) Interpretation: Higher scores indicate a better outcome, reflecting greater cardiorespiratory capacity.

FACIT-F (Functional Assessment of Chronic Illness Therapy - Fatigue) Description: The Functional Assessment of Chronic Illness Therapy - Fatigue Subscale (FACIT-Fatigue) is a validated patient-reported questionnaire assessing cancer-related fatigue and its impact on daily functioning. It contains 13 items, each rated on a Likert scale from 0 ("not at all") to 4 ("very much").

Score Range:

Minimum possible score: 0 points (indicates the worst fatigue) Maximum possible score: 52 points (indicates the least fatigue) Interpretation: Higher scores indicate a better outcome, representing less fatigue and better functional well-being.

Goniometry and flexibility testing Description: Goniometric and flexibility tests will be used to assess joint mobility of the upper and lower limbs and trunk. Goniometry quantifies joint range of motion in degrees using a standardized instrument (goniometer), while flexibility tests measure muscle and soft-tissue extensibility. These tests evaluate functional mobility relevant to daily activities.

Score Range:

Minimum: 0 degrees (no active movement) Maximum: varies by joint Interpretation:Higher scores indicate better mobility and joint range of motion.

Hand-held dynamometry (MicroFET II - Maximal isometric strength) Description: Maximal isometric strength will be assessed using a hand-held dynamometer (MicroFET II). This device measures force output (in Newtons or kilograms-force) during standardized resisted movements of the upper limb.

Score Range:

Minimum: 0 (no measurable force) Maximum: device-dependent; MicroFET II typically measures up to 300 pounds-force (≈1334 N), though functional values are lower in clinical practice.

Interpretation:

Higher scores indicate a better outcome, reflecting greater muscular strength.

Outcome measure: Joint position sense and force-matching tests Description: Proprioception will be evaluated using joint position sense testing (ability to reproduce specific joint angles) and force-matching tasks (ability to replicate a target force level). These tests assess neuromuscular control, sensorimotor acuity, and accuracy in joint and force detection.

Score Range: Joint position sense: error values typically expressed in degrees (°).

Minimum error: 0° (perfect accuracy) Maximum error: no fixed upper limit; depends on test range Force-matching: error expressed as difference from target force. Minimum error: 0 (perfect accuracy) Maximum: no predefined limit

Interpretation:

Lower error values indicate a better outcome (greater proprioceptive accuracy).

Outcome measure 1: Disabilities of the arm, shoulder and hand questionnaire (DASH) Description: The DASH is a 30-item patient-reported outcome measure assessing physical function and disability of the upper limb. It evaluates difficulty performing daily activities, symptom severity, and functional limitations.

Score Range:

Minimum: 0 (no disability → best outcome) Maximum: 100 (severe disability → worst outcome)

Interpretation:

Higher scores indicate a worse outcome (greater disability).

Outcome Measure 2: Constant-Murley shoulder score

Description:

The Constant-Murley Score is a clinician-reported composite measure evaluating shoulder function through four domains: pain, daily living activities, range of motion, and strength. Total score ranges from 0 to 100.

Score Range:

Minimum: 0 (worst shoulder function) Maximum: 100 (normal shoulder function)

Interpretation:

Higher scores indicate a better outcome (greater shoulder function).

Outcome measure: Presence of lymphedema (Yes/No), symptom severity, and limb circumference measurements.

Description:

Lymphedema will be assessed through a combination of:

• Presence/absence (Yes/No) of swelling;
• Subjective symptoms (heaviness, tightness, pain) measured using a visual analog scale (0-10);
• Circumference measurements (circumetry) at standardized anatomical points of the upper limb.

Score Range:

Visual analog scale: 0 (no symptoms) to 10 (worst symptoms). Circumference: no fixed minimum/maximum, values recorded in centimeters.

Interpretation:

Higher symptom scores and larger circumference values indicate worse lymphedema.

Outcome measure: Pittsburgh Sleep Quality Index (PSQI) Description: The PSQI evaluates overall sleep quality across seven components (sleep latency, duration, efficiency, disturbances, etc.). The questionnaire includes 19 items.

Score Range:

Minimum: 0 Maximum: 21 Higher scores = worse sleep quality. Interpretation: A global score > 5 typically indicates poor sleep quality.

Tampa Scale for Kinesiophobia - 11-item Version (TSK-11) Description: The TSK-11 assesses the fear of movement or reinjury, using 11 Likert-scale items rated from 1 (strongly disagree) to 4 (strongly agree).

Score Range:

Minimum: 11 Maximum: 44 Higher scores indicate greater fear of movement. Interpretation: Higher scores = worse outcome.

Measure 1: Enjoyment of physical activity (Physical Activity Enjoyment Scale - PACES-18)

Description:

18-item validated scale assessing enjoyment of physical activity; items rated on a 7-point Likert scale.

Score Range:

Min: 18 (lowest enjoyment) Max: 126 (highest enjoyment)

Interpretation:

Higher scores = greater enjoyment of physical activity. Measure 2: Leisure-Time Physical Activity (Leisure-Time Physical Activity Questionnaire)

Description:

Self-reported weekly minutes of moderate and vigorous physical activity performed during leisure time.

Score Range:

Min: 0 minutes/week Max: No fixed upper limit

Interpretation:

Higher scores = greater leisure-time physical activity (better outcome).

Description: Adherence will be calculated using the formula:

(Number of sessions completed / Number of scheduled sessions) × 100.

Score Range:

Minimum: 0% Maximum: 100%

Interpretation:

Higher percentages indicate better adherence.

Custom Likert-Scale Acceptability Questionnaire (Ad Hoc) Description: A custom Likert-type questionnaire (1-5) will evaluate the participant's perceived acceptability of the intervention, including clarity, comfort, and usability.

Score Range:

Minimum: 1 (least acceptable) Maximum: 5 (most acceptable) Interpretation: Higher scores indicate greater acceptability.

Custom Likert-Scale Satisfaction Questionnaire (Ad Hoc) Description: A custom Likert-scale questionnaire will assess participant satisfaction with the intervention, including perceived usefulness and overall experience.

Score Range:

Minimum: 1 (least satisfied) Maximum: 5 (most satisfied) Interpretation: Higher scores indicate greater satisfaction

Systematic adverse event log Description: Systematic recording of any adverse events occurring during the program, documented according to standard clinical criteria.

Score Range: Not applicable (qualitative/quantitative event logging)

Interpretation:

Higher number or severity of adverse events indicates poorer safety.

Outcome measure: Brief Pain Inventory (BPI) Description: The Brief Pain Inventory assesses pain intensity (0-10) and pain interference with daily activities.

Score Range:

Intensity: 0 = no pain; 10 = worst imaginable Interference score: 0 = no interference; 10 = complete interference Interpretation: Higher scores indicate worse pain and greater functional impact.

Pelvic Floor Distress Inventory (PFDI) Description: The Pelvic Floor Distress Inventory evaluates symptoms of pelvic floor dysfunction, including urinary, colorectal, and pelvic organ prolapse symptoms.

Score Range:

Minimum: 0 Maximum: 300 (depending on subscales used) Interpretation: Higher scores indicate greater symptom burden (worse outcome).