The INFLUENCE of PHYSICAL ACTIVITY on the HEALTH and WELL-BEING of BREAST CANCER SURVIVORS

Used a questionnaire (Short Form Health Survey, SF-36), internationally recognized, self-administered questionnaire containing 36 items covering eight physical and mental health domains, and two physical and mental summary scales. The raw scores are recorded, then aggregated and transformed into a scale from 0 to 100, and higher scores indicate better health.

Perceived Stress Scale (PSS-10)

The Perceived Stress Scale (PSS-10) was developed in order to identify life experiences linked to emotion, characterizing the level of stress in the last 30 days, and can be used in any individual over the age of 15.

Validated in Brazil, this scale consists of 10 multiple-choice items referring to the frequency with which individuals perceive certain situations, with answer options ranging from 1 to 5 (1 = never; 2 = almost never; 3 = sometimes; 4 = almost always and 5 = always). Questions 4, 5, 7 and 8 are scored inverted, as follows: 1=4, 2=3, 3=2, 4=1, 5=0 and the others are added directly in a progressive manner. The total of the scale is the sum of the scores of the 10 questions. The total score can vary from 0 to 40 and the higher the score, the greater the perceived stress. For the purposes of analysis in this study, the stress scale can be analyzed as a qualitative variable, with the total score.

Sleep quality

This project will use the Pittsburgh Sleep Quality Index (PSQI), an instrument validated and culturally adapted for the Brazilian population, which subjectively assesses the quality of the sleep pattern, in its general aspects, for the last month in adult individuals.

The PSQI instrument has 10 questions, of which questions 1 to 4 are open-ended and questions 5 to 10 are semi-open-ended, all of which have space to record comments if necessary. The questions are divided into 7 components: 1) subjective quality, 2) latency, 3) duration, 4) habitual sleep efficiency, 5) sleep disturbances, 6) use of sleep medication, 7) daytime sleepiness and daytime disturbances. Each component is scored from 0 to 3, giving a minimum value of 0 and a maximum of 21 points. The scores are classified as follows: 0-5 as good sleep quality, 6-10 as poor quality and 11-21 as sleep disturbance.

Level of Physical Activity (NAF) The level of physical activity was identified using the International Physical Activity Questionnaire (IPAQ), short version, made up of seven open questions. This instrument made it possible to measure the amount of time spent on moderate to vigorous physical activity each week, covering different daily contexts such as domestic activities, leisure, work, commuting and periods of inactivity.

The IPAQ showed good stability and accuracy, making it suitable for epidemiological studies in various age groups, including young people, adults and the elderly.

For analysis purposes, individuals who performed less than 150 minutes of physical activity per week were classified as inactive and those who performed more than 150 minutes as active, according to the IPAQ guidelines.

Upper limb strength test Palmar pressure

To assess muscle strength, the handgrip strength test (HGS) will be applied using a Jamar® hydraulic dynamometer. Patients will sit on a chair with their feet flat on the floor and knees positioned at approximately 90 degrees of flexion. The shoulder of the tested limb is adducted, the elbow is flexed 90 degrees and the hand of the non-tested limb is resting on the thigh of the same side. Participants will be asked to squeeze the handle for 3-5 seconds. Participants will perform three tests with each hand. The value used in this study will be the highest value obtained in any hand. Reference values for the dominant and non-dominant sides will be used to evaluate the measured values.

This test, of low complexity in application and execution, analyzes the movement of sitting and standing, common in everyday life, to assess the strength of the lower limbs.

A watch with a stopwatch and a chair were used. The test lasted 30 seconds, during which the patient had to perform as many repetitions as possible.

The patient began by sitting upright (without support), with their feet on the floor and arms crossed over their shoulders. The repetitions were counted out loud, considering only the correct executions, in which the individual stood up completely and returned to the chair, avoiding the back rubbing against the backrest. The patient was instructed to avoid sudden movements to prevent impacts.

The cut-off point for classifying the patient as independent and able to perform basic movements during training was 9 repetitions in 30 seconds.

The Wells Bench Flexibility Test is a validated and widely used method for assessing flexibility. It stands out for its simplicity, easy applicability, low cost and quick execution.

To carry out the test, a mattress, a Wells bench (a wooden box measuring 30x30 cm and 56 cm long, with a tape measure up to 50 cm) and a protocol sheet were used. The assessor positioned the patient sitting on the mat, with her feet resting on the bench and her legs extended. The patient had to flex her trunk, extending her arms with one hand over the other, trying to reach as far as possible. The movement was repeated three times, considering the greatest distance reached.

The cut-off point was determined according to each patient's age group, classifying flexibility into five levels: poor, below average, average, above average and excellent.

Cardiorespiratory Capacity Test (6 Minute Walk) The 6-minute walk test (6MWT) was used to assess cardiorespiratory capacity, providing an analysis of the respiratory, cardiac and metabolic systems based on the distance covered in 6 minutes.

The application took place on a marked course of 20 to 30 meters, where the participants walked for 6 minutes. Peak oxygen volume (VO2) was calculated using a formula that takes into account distance, age, weight, height and pressure rate (PTP).

Blood pressure was measured before and after the test with a Missouri® sphygmomanometer and stethoscope, and heart rate was monitored with a Polar® device. VO2 max (ml/kg.min) was classified according to validated parameters for females and age groups.

Weight: Weight was measured on a calibrated Filizola scale with a capacity of 150 kg and a precision of 100 g. The individual, wearing light clothing and barefoot, was positioned in the center of the scale, with their body erect. The variation allowed between measurements was 0.1 kg, and the weight was recorded and repeated.

Anthropometric measurements

Height: Height was measured using a stadiometer attached to the scale. The assessor ensured that the individual was not wearing any headgear and was barefoot. The individual stood with their feet together and knees extended, resting the back of their head and shoulders on a vertical surface. The reading was recorded and repeated, allowing for a maximum difference of 0.1 cm.

Anthropometric measurements

Waist circumference (WC): Waist circumference was measured using an inelastic tape, with the individual standing upright, with their waist uncovered and abdomen relaxed. The measurement was taken at the midpoint between the last rib and the iliac crest. The tape was adjusted and the reading taken at the end of breathing, with the procedure repeated and an acceptable variation of 0.5 cm.

In the survey, ESQUADA was used as a tool to assess the quality of the participants' diet. This 24-question questionnaire, valid for the Brazilian population, captures eating habits and analyzes aspects such as the frequency of meals, the choice of healthy foods and the consumption of industrialized items.

The questionnaire covers various aspects of the diet, such as the frequency of main meals, the choice of healthy foods and the consumption of industrialized items. The questions were designed to make it easier for participants to understand and self-assess.

The answers are scored according to specific criteria, resulting in a classification ranging from "Very Bad" to "Excellent". The categories are

• Very Bad: Several dietary inadequacies.
• Bad: Several dietary flaws, but some adequate choices.
• Good: Balanced diet, but with potential for improvement.
• Very Good: Meets most nutritional recommendations.
• Excellent: High quality diet, meeting all guidelines.