Resilience and renewal: the personal impact of physical activity in breast cancer survivors

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Beyond medical treatments, reclaiming identity and autonomy post-breast cancer is a complex process involving physical and emotional well-being. The research utilized a qualitative approach, conducting in-depth interviews with five female survivors aged 41 to 57, as well as a group interview with the three pysical activity instructors who led the participants´exercise sessions. Participants completed a 12-week resistance training protocol title EFICAN (Exercise and Cancer), a structured intervention specifically designed by the research team for this study, combining individual and small-group sessions. Survivors shared personal experiences of how physical activity influenced their post-treatment recovery, while the instructors provided complementary insights into the participants´observed changes. Thematic analysis was applied to identify patterns and core themes. Three primary themes emerged: (1) physical activity as a catalyst for empowerment and recovery, (2) the significance of social bonds formed during group activities, and (3) transformative changes in body perception and self-acceptance. Participants highlighted that exercise helped regain control over their bodies, mitigate side effects, and foster resilience. Group activities provided emotional support, reducing isolation and promoting psychological well-being. Instructors echoed these findings, describing visible improvements in participants’ confidence, emotional expression, and social engagement. The study findings align with existing literature, while the inclusion of instructors’ perspectives adds a novel contribution to the understanding of how physical activity supports psycho-social recovery. Integrating structured physical activity into post-treatment care can support emotional healing and strengthen social bonds. Clinical programs should celebrate individual achievements and include group-based exercises to enhance adherence and overall well-being. The study's small sample size may limit generalizability. Future research should explore diverse populations and incorporate quantitative methods to complement qualitative findings. Physical activity plays a crucial role in transitioning from surviving to thriving post-cancer. It supports not only physical health but also psychological resilience and social connection, reinforcing that survivors’ voices are essential in shaping recovery programs. Body image Social support Group exercise Survivor empowerment Emotional well-being Introduction Surviving breast cancer is a journey that transcends medical treatment and delves deep into the personal and emotional realm. While clinical approaches primarily focus on the physical aspects of recovery, the process of reestablishing identity and resilience remains a complex and deeply personal endeavor for survivors. The post-treatment phase is characterized by a redefinition of self as survivors confront profound transformations that extend beyond the biological realm. Physical activity emerges as a key element in this holistic recovery, contributing not only to physiological rehabilitation but also to emotional and social well-being. This research is grounded in the lived experiences of breast cancer survivors who participated in a physical activity intervention titled EFICAN (Exercise and Cancer). Developed by the research team in collaboration with clinical exercise professionals, EFICAN consisted of a 12-week resistance training program that included both individual sessions and small-group training. The protocol was designed to promote not only physiological rehabilitation but also psychosocial and emotional well-being in the post-treatment phase. The discourse surrounding breast cancer has shifted over the decades from solely clinical outcomes to a broader recognition of the psychological, social, and cultural dimensions of survivorship. Seminal texts, such as Audre Lorde's The Cancer Journals (1980, 2020), offer a poignant, first-person narrative that captures the multifaceted impact of breast cancer on identity and body image. Lorde's reflections highlight the struggle against societal expectations of femininity and the empowerment found in embracing one's post-cancer self. These insights underscore the importance of understanding recovery not just as physical healing but as a journey toward reclaiming one’s sense of self and agency (Lorde, 1980 ; 2020 ). Body image disruption is a significant and challenging consequence for many breast cancer survivors. The changes brought about by surgery, such as mastectomy and reconstruction, alongside treatment side effects like hair loss, can lead to a feeling of estrangement from one’s own body (Trachtenberg et al., 2019 ). This disconnection often impacts self-esteem and psychological well-being, as survivors grapple with shifting identities that do not conform to traditional standards of beauty. Research has shown that the physical appearance associated with breast cancer treatment can influence survivors’ self-perception and overall mental health, contributing to challenges related to social reintegration and emotional resilience (Blanco-Sánchez, 2010 ; Cano & Hasicic, 2016 ). The practice of physical activity provides an avenue for rebuilding this connection. Beyond the well-established physical benefits, such as improved cardiovascular health, muscle strength, and reduced fatigue (Casla et al., 2015 ; Ramirez et al., 2017 ; Soriano-Maldonado et al., 2023 ), exercise offers psychological advantages that are vital for survivors. Engaging in physical activity has been linked to reduced symptoms of anxiety and depression, fostering a sense of autonomy and empowerment (Spei et al., 2019 ). Physical activity also serves as a coping strategy that reinforces survivors’ resilience, allowing them to reclaim a sense of normalcy and control in their lives. In addition to these individual benefits, the social dimension of physical activity is particularly impactful. Participating in group exercise programs enables survivors to form meaningful connections, sharing experiences that promote a sense of community and belonging (Prados & Rivas, 2017 ). The camaraderie found in group settings helps reduce isolation and offers emotional support through shared understanding and mutual encouragement. This social support can be transformative, as it reinforces the idea that survivors are not alone in their journey. Instead, they are part of a network of individuals who understand the unique challenges and triumphs associated with breast cancer recovery (Smit et al., 2019 ). The narratives of women who have experienced the intersection of physical activity and breast cancer recovery provide an invaluable perspective on how exercise influences not only physical health but also emotional and social well-being. In particular, their stories shed light on the ways in which physical activity contributes to resilience and helps redefine body image. The act of engaging in regular physical activity becomes a symbol of personal strength and recovery, shifting the focus from the trauma of illness to the empowerment of reclaiming one's body. The theoretical framework of narrative inquiry supports this perspective by emphasizing the power of stories to convey complex human experiences (Clandinin, 2022 ). This approach recognizes that each individual’s story is shaped by personal, cultural, and social contexts, making it a valuable tool for understanding the lived experiences of breast cancer survivors. Through narratives, researchers can explore how survivors attribute meaning to their engagement with physical activity and how this influences their recovery process (Charmaz, 2012 ). Physical activity's role in improving quality of life has been corroborated by a variety of studies. Soriano-Maldonado et al. ( 2023 ) demonstrated that supervised physical activity programs lead to improved physical fitness and quality of life among breast cancer survivors, even years after treatment. Spei et al. ( 2019 ) highlighted that consistent physical activity not only enhances physical recovery but also promotes psychological well-being by mitigating symptoms such as fatigue and depression. Additionally, Prados and Rivas ( 2017 ) emphasized that participation in structured physical programs can help reconstruct a positive self-concept, facilitating the emotional adaptation necessary for post-cancer life. The current research aims to build upon this foundation by focusing on the personal narratives of breast cancer survivors. This study seeks to understand how these women perceive the role of physical activity in their recovery, emphasizing their emotional, social, and psychological experiences. By centering the voices of survivors, the research aims to reveal the deeper impact of physical activity beyond its physiological benefits, showcasing how it contributes to a holistic sense of renewal and resilience. Methodology Participants This study involved five women who had survived breast cancer, residing in the province of Almería. The participants ranged in age from 41 to 57 years ( M = 49.4; SD = 6.32). All women were diagnosed with breast cancer between the ages of 33 and 44, and at the time of the study, had completed surgery, chemotherapy, and/or radiotherapy at least 12 months prior to participation. Four of the participants were married, and one was separated and in a new relationship. All participants had children and were employed in various sectors, including healthcare, commerce, business consulting, and self-employment in domestic cleaning services. Two of the participants continued working during their cancer treatment, while the other three had periods of medical leave. Participants were recruited through regional cancer-related associations, local radio and press advertisements, social network announcements, and referral from oncologists of the Torrecárdenas University Hospital. Eligibility criteria included being a breast cancer survivor and having completed surgery, chemotherapy, and/or radiotherapy (i.e., core treatments) up to 10 years before recruitment. Exclusion criteria included having metastatic breast cancer, having a breast reconstruction intervention planned within the following six months, having any absolute contraindication for exercise, or engaging in more than 300 minutes per week of structured exercise. Instruments 1. Development of the Interview Guide The interview guide was developed based on the core tenets of Self-Determination Theory (SDT) (Ryan & Deci, 2000 ), with open-ended questions designed to explore participants’ experiences of autonomy, competence, and relatedness in relation to physical activity and post-cancer recovery. This theoretical framework informed both the content and structure of the questions. Following a narrative inquiry approach (Clandinin, 2022 ), the guide encouraged participants to share their experiences in a flexible and participant-led manner. The interview was structured around five thematic areas, which served as conversational prompts rather than rigid categories: Personal motivations and expectations prior to joining the EFICAN program; Experiences during participation, including perceived challenges, emotions, and group dynamics; Perceived impact on physical and emotional well-being, including changes in body perception and daily habits; Reflections on personal transformation throughout the program; Suggestions for improvement and broader applicability of the intervention. The initial version of the guide was reviewed by two specialists in qualitative research and psycho-oncology. Minor modifications were made based on their feedback to improve clarity and alignment with the study objectives. Although the guide was not formally pilot-tested, it was iteratively refined during the early interviews to enhance the depth and clarity of responses. 2. Interviews Two main instruments were used for data collection: in-depth interviews (see Supplementary Material 1) and a group interview (see Supplementary Material 2). In-depth interviews : Each of the five participants took part in a semi-structured, individual interview lasting between 60 and 90 minutes. These interviews aimed to explore the participants’ perceptions, emotions, and experiences related to their participantion in the EFICAN program- a structured 12-week resistance training intervention. Open-ended questions were used to encourage detailed, narrative responses (e.g., “Has your approach to physical activity changed after participating in EFICAN? If so, how?”). Group interview : A group interview was also conducted with the three facilitators of the EFICAN program, who led the physical activity sessions in which the women participated. This 90-minute session aimed to capture instructors' perspectives on the emotional, physical, and social progress of the participants throughout the program. All interviews were audio-recorded with the participants' informed consent and transcribed manually for subsequent analysis. 3. Monitoring of Physical Activity To promote consistent physical activity during the intervention period, all participants were encouraged to maintain their regular lifestyle and to undertake ≥ 10,000 steps per day, in line with existing guidelines (American College of Sports Medicine, 2011 ; Tudor-Locke et al., 2004). Daily step counts were tracked using an activity bracelet, a device previously validated with high accuracy (ICC > 0.99) when compared with time-motion tracking systems (Pino-Ortega et al., 2021 ). The step count data were not used as outcome measures but served as a motivational tool to promote adherence. Real-time feedback from the bracelets helped participants monitor their own activity levels, and instructors used these data descriptively to encourage engagement during weekly sessions. The information was not included in the formal data analysis but supported the implementation and continuity of the physical activity program. Procedure The study procedure began with the identification and selection of participants through local breast cancer support associations, media advertisements, and referrals from healthcare professionals. A detailed explanation of the study’s purpose and data collection process was provided. The in-depth interviews and the group interview were conducted in person, in a private room at the university’s sports center to ensure privacy and participant comfort. Interviews were carried out by the last author, accompanied by another member of the research team, who rotated across sessions. Both interviewers were trained in qualitative methods and had experience working with clinical populations. All sessions were audio-recorded using a Sony ICD-PX370 digital voice recorder with the participants’ consent and transcribed manually for thematic analysis. Prior to the interviews, participants received detailed information about the study objectives and procedures. Written informed consent was obtained during the initial meeting, before any data collection took place, in accordance with ethical guidelines outlined by Lincoln and Denzin ( 2015 ). Confidentiality and the voluntary nature of participation were ensured throughout the process. The study protocol was approved by the Almería Provincial Research Ethics Committee, Spain (Ref: Ejercicio-CáncerUAL98/2019). Participants completed a 12-week (two sessions per week) resistance training protocol, known as EFICAN (Exercise and Cancer), a structured intervention was specifically designed by the research team in collaboration with certified exercise professionals experienced in oncological rehabilitation. The program included two sessions per week and was structured to progressively support both physical recovery and emotional well-being, combining two initial weeks of individual sessions with ten weeks of small-group training. Each session lasted approximately 60 minutes and was delivered by two qualified facilitators with academic degrees in Physical Activity and Sport Sciences and specialized training in oncology. The sessions took place at the university’s sports center and gymnasium, offering a familiar and supportive environment. Training sessions consisted of three parts: Preparatory part : aerobic activity, thoracic mobility exercises, core stability exercises, scapulohumeral joint stability exercises, and dynamic stability exercises. Resistance training part : circuit-based strength exercises. Cool-down part : dynamic/static stretching of major muscle groups. Transcripts of the interviews were subsequently shared with the participants for their review and validation, allowing them to make corrections or clarifications to their testimonies. Data analysis The study was conducted within the framework of Self-Determination Theory (Ryan & Deci, 2000 ), which provided a foundation for understanding how physical activity can fulfill the psychological needs of autonomy, competence, and relatedness among breast cancer survivors. This theoretical approach offered a basis for exploring how physical activity promotes resilience and well-being, particularly relevant for individuals recovering from significant health challenges. A thematic analysis was carried out following the phases outlined by Corbin and Strauss ( 2014 ). The data analysis was carried out using a hermeneutic-interpretative approach, focusing on the participants' narratives and their reconstruction through conversations and feedback. The methodology employed is based on a systematic process of data analysis, divided into two main stages: open coding and axial coding. In the first stage, Open Coding, the most relevant evidence extracted from the participants' narratives was identified and grouped. This initial process allowed for the creation of a category scheme, which was gradually agreed upon by both the participants and the researchers. The second stage, known as Axial Coding, involved a more detailed organization of the evidence within the previously agreed categories. During this phase, the categories were refined, allowing for a deeper and more nuanced interpretation of the information. The analysis was informed by a constructivist interpretative framework, particularly in relation to how participants constructed meaning around their bodily experiences and recovery processes. Thematic saturation was considered achieved when no new codes or categories emerged from the data. Following the criteria proposed by Guest et al. ( 2006 ), who argue that data saturation in homogenous samples with focused objectives may occur within the first six interviews, we observed a repetition of themes by the fourth individual interview. The group interview with the three physical activity instructors further validated and enriched the thematic structure, providing triangulation of perspectives. These processes supported the credibility and depth of the findings within the defined scope of the study. Adherence to COREQ Guidelines To ensure transparency and methodological rigor, the study followed the guidelines of the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist (Tong et al., 2007 ). The roles of the research team, participant recruitment procedures, and data collection methods, including in-depth and group interviews, were thoroughly documented. Reflexivity was maintained throughout the research process to acknowledge and manage potential biases and positionalities. In line with participatory and narrative research principles, co-construction of meaning with participants was emphasized, particularly in the final stages of narrative development. Cancer survivors were engaged in member-checking and narrative return processes to collaboratively shape the final versions of their testimonies, fostering auto-reflexivity and dialogical construction (Rivas & Leite, 2011). In addition, the last author kept a reflective journal, where personal impressions, assumptions, and emotional responses were recorded after each interview and during the data analysis phase. This process facilitated critical self-awareness and promoted transparency in the interpretative process. Furthermore, an audit trail was maintained throughout the study, documenting analytical decisions, codebook iterations, and theme refinements. These strategies contributed to the credibility and dependability of the findings by providing a transparent rationale for methodological choices and interpretive outcomes. Results The analysis of the narratives collected from the participants revealed profound insights into their experiences with physical activity post-breast cancer treatment. Three main themes emerged from the data: (1) physical activity as a catalyst for empowerment and recovery, (2) the social bonds formed through group activities, and (3) transformative changes in body perception and self-acceptance. Each theme underscores how the integration of physical activity contributed not only to the participants’ physical health but also to their psychological and emotional well-being. Physical Activity as a Catalyst for Empowerment and Recovery A recurring theme in the narratives was how physical activity served as a powerful tool for reclaiming autonomy and fostering resilience. The participants frequently expressed that engaging in exercise allowed them to feel in control of their bodies once more, contrasting sharply with the sense of helplessness often associated with their cancer treatment. One participant shared, “When I started participating in the program, I felt like I was taking back control over my life. The exercises reminded me that I am capable, that my body is still strong despite everything it’s been through.” This sentiment resonated across most of the interviews, suggesting that physical activity played a significant role in bridging the gap between surviving cancer and feeling alive again. The women spoke of how the routine of physical activity helped mitigate persistent side effects of treatment, such as fatigue and joint pain. One participant, who experienced prolonged fatigue due to her medication, noted, “The fatigue I had from the tamoxifen was almost nonexistent when I stayed active. Exercise gave me back energy I thought I had lost forever.” Additionally, the participants reported an increased sense of resilience as they observed physical improvements over time. Progress in strength, flexibility, and stamina translated into a boost in self-efficacy and a renewed sense of purpose. This was expressed by another participant who stated, “When I saw that I could lift more weight or stretch further than I did weeks before, it was like winning a battle. It made me realize that I am not just surviving, but thriving.” The incremental successes in physical activity provided tangible evidence of progress, reinforcing positive psychological outcomes and encouraging continued engagement in physical activity. The Social Bonds Formed Through Group Activities Beyond the individual benefits, the social aspect of participating in group physical activities emerged as a powerful motivator and source of emotional support. The shared experiences within these groups created a sense of camaraderie that went beyond the gym or fitness center. The participants emphasized the importance of connecting with others who had experienced similar challenges, highlighting the deep sense of understanding and solidarity that developed through these interactions. “Meeting other women who knew exactly how I felt was liberating. We didn’t need to explain the pain or the fear; it was understood. We could just focus on being in the moment, moving, laughing, and supporting each other,” shared one participant. This bond provided a safe space for emotional expression and fostered a supportive community where shared laughter and mutual encouragement flourished. Participants emphasized the importance of the group format of the sessions, which fostered mutual encouragement, emotional connection, and a sense of shared progress. The anticipation of seeing familiar faces and sharing stories added a social incentive to attending the sessions regularly. “The exercise group was more than just a place to work out—it became a part of my support system,” stated one participant. This aligns with previous studies emphasizing the psychosocial benefits of group exercise in promoting adherence and emotional well-being. Moreover, the collective environment fostered a sense of normalcy and reduced the isolation often felt during and after cancer treatment. Participants expressed that the group’s shared understanding alleviated the burden of needing to explain themselves or their condition. “Being surrounded by people who understood without words was comforting. It felt like a space where we were all equals, not defined by our diagnosis,” shared another participant. This shared experience helped reinforce resilience and fostered a sense of belonging, which was critical for emotional recovery. Transformative Changes in Body Perception and Self-Acceptance The third theme that emerged from the analysis centered around the participants' evolving relationships with their bodies. Many women recounted initially experiencing feelings of disconnection, discomfort, or even rejection toward their post-treatment bodies. The physical scars and changes were daily reminders of their journey, often invoking mixed emotions of gratitude for survival intertwined with grief for what had been lost. One participant reflected on this transformation, saying, “At first, I couldn’t look at myself without feeling sad. The scars, the changes—they were reminders of what I went through. But as I continued with exercise, I started to see my body differently, not as damaged but as resilient.” This gradual shift in body perception was a common thread across the narratives. Physical activity played a significant role in helping participants reconnect with and appreciate their bodies for their strength and capacity, rather than focusing solely on their appearance. For many, the act of participating in exercise redefined their concept of health and wellness. Instead of seeing their bodies through the lens of societal beauty standards, the participants learned to value their bodies for their functionality and resilience. “My body is not perfect, but it’s mine, and it’s strong. Every time I push through a workout, I remind myself that it carried me through the hardest fight of my life,” shared one woman. This theme of self-acceptance underscores the psychological benefits of physical activity, which extend beyond mere fitness to encompass a broader, more inclusive sense of well-being. Additionally, the participants spoke about the newfound confidence they gained through physical activity. One woman described how this confidence affected other aspects of her life, stating, “Once I started feeling stronger and more capable in my workouts, I noticed that I approached other challenges with the same mindset. It was empowering.” This reflects the idea that physical resilience can translate into psychological resilience, helping individuals navigate post-cancer life with greater confidence. The redefined relationship with their bodies also influenced their social interactions and self-perception as women. One participant summed it up, saying, “I learned to accept myself, scars and all. It made me realize that my value isn’t diminished by what I’ve gone through—it’s enhanced by it.” This narrative highlights the profound impact that physical activity had on fostering self-acceptance and a positive body image. Instructors’ Perspectives: Observing Change and Resilience The group interview with the three physical activity instructors offered valuable insights into the implementation and impact of the EFICAN program from a facilitation perspective. All three instructors had completed specialized training in physical activity and cancer through the Professional Institute for Exercise and Cancer (IPEFC) prior to their involvement in the project. This preparatory experience helped them dismantle societal stigmas surrounding cancer and approach the participants with empathy, knowledge, and professionalism. Instructors described the initial two-week period of individual sessions with each participant as critical for building trust and tailoring exercises to the specific physical and emotional needs of each woman. They emphasized the importance of listening, emotional containment, and adapting sessions to each woman’s surgical history, physical limitations, and psychological state. One instructor shared: “Many times the hour went by and we hadn’t done any exercise—we had just talked, and that was what they needed.” Over time, the instructors observed notable changes in the women’s physical capacity, confidence, and social engagement. The sense of community that emerged among participants was a recurring theme: “At first, they were nervous and reserved, but soon they were chatting like lifelong friends,” one instructor explained. The group dynamic became a key source of motivation, often described as more meaningful than the exercise itself: “They came for the training, but stayed for the group.” Despite the structured nature of the protocol, the instructors implemented minor modifications and added motivational elements (e.g., games, partner exercises) to enhance enjoyment and adherence. They recognized the limitations imposed by the research design but also highlighted how participants expressed a desire for greater variety and more personalized challenges. Finally, the instructors reflected on the long-term impact of the program, noting that many women maintained active lifestyles after the intervention, often seeking new activities independently. One facilitator remarked: “Some of them are still training with me, others joined swimming or hiking groups—the important thing is that they didn’t want to stop.” These accounts reinforce the value of integrating emotional, relational, and contextual elements into exercise programs for cancer survivors. Discussion This study aimed to explore the multifaceted impacts of physical activity on the recovery process of breast cancer survivors, examining how engagement in exercise influenced their physical, psychological, and social well-being. These findings highlight the potential of structured physical activity programs like EFICAN to promote not only physical recovery, but also emotional resilience and social connectedness among breast cancer survivors. This section discusses these findings in the context of existing literature, highlights the implications for practice and policy, and suggests future research directions. Physical Activity as a Source of Empowerment and Recovery One of the key findings of this study was that physical activity emerged as a tool for empowerment among the participants. The narratives highlighted how exercise provided a sense of agency that was crucial for regaining control over their lives after the loss of autonomy experienced during cancer treatment. These findings align with previous research showing that structured physical activity programs like EFICAN can alleviate common post-treatment symptoms such as fatigue, pain, and decreased energy levels (Spei et al., 2019 ). The women’s narratives suggest how consistent engagement in the EFICAN program contributed to reducing such effects, supporting the role of exercise as an effective non-pharmacological strategy for long-term symptom management. The participants’ descriptions of reclaiming their bodies through exercise resonate with the concept of post-traumatic growth (PTG), where individuals experience positive psychological change as a result of struggling with highly challenging life circumstances (Tedeschi & Calhoun, 2004 ). The women in this study expressed that the improvements they saw in their physical abilities translated into a mental resilience that extended beyond the gym. The sense of accomplishment gained from mastering new physical challenges contributed to enhanced self-efficacy, an essential component for developing PTG (Bandura & Wessels, 1997 ; Helgeson et al., 2006 ). Moreover, the importance of self-efficacy in breast cancer recovery is well-documented (Locke, 1997 ; BonAlilu et al., 2017; Rottmann et al., 2010 ). According to Bandura’s theory of self-efficacy (1997), belief in one’s ability to perform specific actions is crucial for motivation and perseverance. The participants’ ability to progress in their physical routines reinforced their belief in their capacity to overcome difficulties, which is vital for long-term recovery. This finding suggests that structured physical activity programs should emphasize achievable milestones to foster self-efficacy and, consequently, empower survivors. The Role of Social Support in Group Activities The narratives underscored the significant role that social support played in encouraging adherence to physical activity and fostering emotional well-being. Group exercise programs offered a platform for social connection, providing a sense of camaraderie that mitigated feelings of isolation and strengthened the participants’ commitment to maintaining an active lifestyle. This is consistent with findings by Soriano-Maldonado et al. ( 2023 ), who demonstrated that group-based physical activity contributed to sustained exercise participation and enhanced quality of life among breast cancer survivors. Social support has been widely acknowledged as a critical factor in coping with chronic illnesses (Helgeson & Cohen, 1999 ). The shared understanding and non-verbalized empathy found within these group settings offered participants an emotional reprieve. They could share stories, laugh, and engage in mutual encouragement without needing to explain their struggles, which reinforced a sense of belonging. These shared experiences aligned with the concept of “communal coping” (Lyons et al., 1998 ), where individuals collectively manage stressors by pooling their emotional and social resources. The group dynamic also promoted adherence to exercise programs, as noted by participants who expressed looking forward to meeting friends at exercise sessions. This aspect supports the findings of Thoits ( 2011 ), who argued that social relationships play a vital role in promoting health behavior adherence. The anticipation of positive social interactions and shared physical activity experiences created a feedback loop that reinforced continued participation, enhancing both physical and emotional resilience. Transformative Changes in Body Perception and Self-Acceptance Perhaps one of the most significant findings of this study was the transformative shift in body perception reported by participants. Initially, the women described feelings of disconnection and discomfort with their bodies, often viewing their post-treatment physical selves through a lens of trauma and loss. However, as they engaged in physical activity, this perception began to change. Exercise became a tool not just for physical rehabilitation but for redefining their relationship with their bodies, allowing them to view themselves as resilient and capable. This finding aligns with the body of work examining the impact of breast cancer on body image and self-esteem. Studies have shown that changes in physical appearance due to cancer treatment, such as scarring, hair loss, and mastectomy, can profoundly affect a woman’s self-concept and body image (Blanco-Sanchéz, 2010; Trachtenberg et al., 2019 ). However, engaging in physical activity has been linked to improvements in body image and self-esteem (Pudkasam et al., 2018 ). The narratives of the participants in this study echoed these findings, illustrating how physical activity helped them shift their focus from external appearance to internal strength and functionality. One participant’s statement, “My body is not perfect, but it’s mine, and it’s strong,” encapsulates the profound shift in body perception that exercise facilitated. This shift from viewing the body as a vessel of illness to a symbol of survival and strength aligns with research on embodied resilience (Kontos & Naglie, 2009 ). By participating in physical activities that challenged and celebrated their bodies' capabilities, the women in this study experienced a newfound appreciation for their physical selves. This highlights the importance of designing exercise programs that not only focus on physical outcomes but also encourage participants to recognize and celebrate their body’s resilience and progress. Psychological and Social Implications The study’s findings have several implications for the psychological and social dimensions of recovery for breast cancer survivors. The role of physical activity as a facilitator of psychological resilience was evident in the participants' stories. They described feeling more confident, suggesting that physical activity helped buffer against anxiety and contributed to a more positive outlook on life. This observation supports the findings of Ramirez et al. ( 2017 ), who reported that exercise helps regulate mood and reduce anxiety among cancer patients. The narratives suggest that engaging in structured physical activity may offer more than physical benefits; it can also introduce a sense of stability and predictability into the lives of breast cancer survivors. This routine appeared particularly meaningful during the transition from active treatment to post-treatment life—a phase often described as disorienting or uncertain due to the sudden reduction in medical oversight. Participation in the EFICAN program seemed to act as a bridge, offering continuity through scheduled sessions and a sense of purposeful structure during a vulnerable period of adjustment. The social benefits derived from group activities were equally significant. Participants frequently emphasized how these sessions served as a reminder that they were not alone in their journey. The shared experience fostered by group activities reinforced social bonds that contributed to emotional well-being and mitigated feelings of isolation. This social interaction aligns with findings from research on collective coping mechanisms (Lyons et al., 1998 ), which highlight the benefits of shared experiences in promoting psychological health and well-being. Beyond the survivors’ self-reported experiences, the perspectives of the physical activity instructors provided an additional layer of insight that enriched the interpretation of the findings. Their observations reinforced the emergence of empowerment, resilience, and emotional connection, while offering external validation of participants’ reported transformations. Instructors noted improvements not only in physical function but also in the women’s confidence, expressiveness, and motivation to maintain an active lifestyle. These accounts highlight the value of incorporating multi-perspective data when evaluating psycho-social interventions. Moreover, the instructors’ reflections on group cohesion, mutual support, and sustained engagement underscore the relevance of relational and emotional dynamics within exercise programs—a dimension already emphasized in recent literature on group-based rehabilitation in oncology (e.g., Cormie et al., 2017 ; Soriano-Maldonado et al., 2023 ). Integrating both participant and facilitator voices deepens our understanding of the mechanisms through which structured physical activity fosters recovery and well-being. Limitations and Future Research While the findings of this study offer valuable insights, several limitations must be acknowledged. The sample size was relatively small, consisting of only five participants, which may limit the generalizability of the results. Additionally, the study focused on a specific geographical region, which could affect the cultural context of the findings. Breast cancer survivors from this region—Almería, in southern Spain—may be influenced by strong family-oriented values, close-knit community networks, and access to public healthcare and sport facilities. These factors may have facilitated their participation in the EFICAN program and shaped their perceptions of recovery, social support, and physical activity. Future research should aim to include a larger and more diverse sample to enhance the transferability of the results and explore whether these findings hold true across different cultural and social settings. The study also relied on self-reported narratives, which, while rich in detail, may be subject to recall bias or social desirability bias. Future research could incorporate a mixed-methods approach, combining qualitative narratives with quantitative measures of physical and psychological outcomes to provide a more comprehensive understanding of the effects of physical activity on breast cancer survivors. Another area for future research involves exploring the long-term impacts of physical activity on psychological resilience and body perception. While this study highlighted the immediate benefits experienced by participants, understanding how these benefits evolve over time would be valuable for developing long-term support strategies for breast cancer survivors. Previous research has examined the effects of exercise on mental health, body image, and quality of life among breast cancer survivors, often using standardized instruments such as the Body Image Scale (Hopwood et al., 2001 ), the Functional Assessment of Cancer Therapy – Breast (FACT-B; Brady et al., 1997 ), or resilience scales like the Connor-Davidson Resilience Scale (CD-RISC; Connor & Davidson, 2003 ). Future studies could build upon our findings by incorporating such measures to validate and extend the qualitative insights, allowing for triangulation of data and broader generalizability. Practical Implications for Practice and Policy The insights gained from this study have significant implications for the development of post-treatment care programs for breast cancer survivors. The findings suggest that exercise programs should be designed not only to improve physical health but also to foster psychological and social well-being. Healthcare providers and policymakers should consider integrating structured, supportive group exercise programs into standard post-treatment care plans. These programs could include activities that emphasize gradual progression, celebrate individual achievements, and foster a sense of community among participants. Furthermore, training for exercise instructors should include elements of psychosocial support to ensure that they can create an inclusive and empathetic environment. This approach could help facilitate the type of social bonds that were found to be beneficial in this study, making exercise sessions more than just physical routines but spaces for holistic healing. Conclusions and Broader Significance This study reinforces the importance of viewing physical activity as a comprehensive tool for recovery in breast cancer survivors. Beyond its physical benefits, exercise provides a pathway for emotional healing, social support, and redefined body perception. The participants' narratives illustrate that physical activity fosters resilience, not just in terms of physical strength but as an essential component of psychological and emotional recovery. By celebrating their capabilities and forming supportive connections, these women were able to move from a mindset of merely surviving to one of thriving. The broader significance of this study lies in its potential to inform the development of survivor-focused interventions that prioritize holistic well-being. By incorporating physical, emotional, and social dimensions into recovery programs, healthcare providers can support breast cancer survivors in building a renewed sense of identity and resilience. The findings underscore the importance of shifting the conversation from surviving cancer to embracing life beyond it, where physical activity acts as a catalyst for empowerment, connection, and self-acceptance. Incorporating women's voices and experiences not only enriches our understanding of post-cancer recovery but also asserts their central role in the process, emphasizing that their strength and resilience are the driving force behind true empowerment and transformation. Abbreviations Not applicable. Declarations Ethics approval and consent to participate All participants provided informed consent, and the study was approved by the Ethics Committee of Almería Provincial Research Ethics Committee, Spain (approval code: Ejercicio-CáncerUAL98/2019). The research were conducted in accordance with the ethical standards of the Declaration of Helsinki and relevant guidelines and regulations. Consent for publication Not applicable. Availability of data and materials The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions, in accordance with the explicit wishes of the participating women. Competing Interests The authors declare no competing interests. Funding The Patronato Municipal de Deportes, Ayuntamiento de Almería, Grant/Award Number: 2024/17975N; University of Almería (UALtranfierE Program), Grant/Award Numbers: TRFE-SI-2022/010, TRFE-SI-2023/010. Andalucia Goverment: Grant/Award Number: DOC_01290. The Sede provincial de Almería de la Asociación Española Contra el Cáncer and the AECC Scientific Foundation, Grant/Award Number: PRDAM222381ESTE Author contributions Conceptualization M.J.L.; Data curation M.J.L., A.I.H.R., C.C.P., M.E.P.M.; Formal analysis M.J.L., A.I.H.R., C.C.P., M.E.P.M.; Funding acquisition M.E.P.M.; Investigation M.J.L., A.I.H.R., C.C.P., M.E.P.M.; Methodology M.J.L., M.E.P.M.; Project administration M.J.L., A.I.H.R., M.E.P.M.; Software M.J.L., A.I.H.R., C.C.P., M.E.P.M.; Resources M.J.L., A.I.H.R., C.C.P., M.E.P.M.; Supervision M.E.P.M.; Writing – original draft M.J.L.; Writing – review & editing M.J.L., A.I.H.R., C.C.P., M.E.P.M. Acknowledgements A special mention to the women who participated, collaborated, and reviewed this manuscript, generously contributing their life stories to this research. References American College of Sports Medicine. (2011). Starting a Walking Program , 1–2, Available at: https://www.acsm.org/docs/default-source/files-for-resource-library/starting-a-walking-program.pdf?sfvrsn=85e9d2d9_2#:~:text=Start%20slowly%20and%20build%20up,for%20at%20least%20five%20minutes Bandura A, Wessels S. ). Self-efficacy. Cambridge University Press; 1997. Blanco-Sánchez R. (2010). Imagen corporal femenina y sexualidad en mujeres con cáncer de mama. Index de Enfermería , 19 (1), 24–28. Available at: https://scielo.isciii.es/scielo.php?%20pid=S1132-12962010000100005&script=sci_arttext Brady MJ, Cella DF, Mo F, Bonomi AE, Tulsky DS, Lloyd SR, Deasy S, Cobleigh M, Shiomoto G. Reliability and validity of the Functional Assessment of Cancer Therapy-Breast quality-of-life instrument. J Clin Oncol. 1997;15(3):974–86. https://doi.org/10.1200/JCO.1997.15.3.974 . BorjAlilu S, Kaviani A, Helmi S, Karbakhsh M, Mazaheri MA. Exploring the role of self-efficacy for coping with breast cancer: A systematic review. Archives Breast Cancer. 2017;42–57. https://doi.org/10.19187/abc.20174242-57 . Cano JE, Hasicic C. (2016). El cuerpo como lienzo: praxis de mujeres artistas con cáncer de mama. En II Jornadas de Género y Diversidad Sexual (GEDIS) . La Plata. http://sedici.unlp.edu.ar/handle/10915/57147 Casla S, López-Tarruella S, Jerez Y, Marquez-Rodas I, Galvao DA, Newton RU, Martin M. Supervised physical exercise improves VO 2max, quality of life, and health in early stage breast cancer patients: a randomized controlled trial. Breast Cancer Res Treat. 2015;153:371–82. https://doi.org/10.1007/s10549-015-3541-x . Charmaz K. (2012). The power and potential of grounded theory. Medical Sociology Online , 6(3), 1–15. Available at: https://www.epicpeople.org/wp-content/uploads/2023/06/Charmaz-2012.pdf Clandinin J. Engaging in Narrative Inquiry. Routledge; 2022. Connor KM, Davidson JRT. Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18(2):76–82. https://doi.org/10.1002/da.10113 . Cormie P, Zopf EM, Zhang X, Schmitz KH. The impact of exercise on cancer mortality, recurrence, and treatment-related adverse effects. Epidemiol Rev. 2017;39(1):71–92. https://doi.org/10.1093/epirev/mxx007 . Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods. 2006;18(1):59–82. https://doi.org/10.1177/1525822X05279903 . Helgeson VS, Cohen S. Social support and adjustment to cancer: Reconciling descriptive, correlational, and intervention research. In: Suinn RM, VandenBos GR, editors. Cancer patients and their families: Readings on disease course, coping, and psychological interventions. American Psychological Association; 1999. pp. 53–79. https://doi.org/10.1037/10338-003 . Helgeson VS, Reynolds KA, Tomich PL. A meta-analytic review of benefit finding and growth. J Consult Clin Psychol. 2006;74(5):797–816. https://doi.org/10.1037/0022-006X.74.5.797 . Hopwood P, Fletcher I, Lee A, Al Ghazal S. A body image scale for use with cancer patients. Eur J Cancer. 2001;37(2):189–97. https://doi.org/10.1016/S0959-8049(00)00353-1 . Kontos P, Naglie G. Tacit knowledge of caring and embodied selfhood. Sociol Health Illn. 2009;31(5):688–704. https://doi.org/10.1111/j.1467-9566.2009.01158.x . Lincoln YS, Denzin NK. The Sage handbook of qualitative research. 5th ed. Sage; 2015. Locke EA. (1997). Self-efficacy: The exercise of control. Personnel psychology, 50 (3), 801. Available at: https://www.proquest.com/docview/220140280?pq-origsite=gscholar&fromopenview=true&sourcetype=Scholarly%20Journals Lorde A. The Cancer Journals. Hipólita Ediciones; 1980. Lorde A. The cancer journals. Penguin; 2020. Lyons RF, Mickelson KD, Sullivan MJ, Coyne JC. Coping as a communal process. J Social Personal Relationships. 1998;15(5):579–605. https://doi.org/10.1177/0265407598155001 . Pino-Ortega J, Gómez-Carmona CD, Rico-González M. Accuracy of Xiaomi Mi Band 2.0, 3.0 and 4.0 to measure step count and distance for physical activity and healthcare in adults over 65 years. Gait Posture. 2021;87:6–10. https://doi.org/10.1016/j.gaitpost.2021.04.015 . Prados ME, Rivas JI. Investigar narrativamente en educación física con relatos corporales. Revista del Instituto de Investigaciones en Educación. 2017;8(10):82–99. http://dx.doi.org/10.30972/riie.8103654 . 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. https://doi.org/10.1016/j.maturitas.2018.07.010 . Ramirez K, Acevedo F, Herrera ME, Ibáñez C, Sánchez C. Actividad física y cáncer de mama: un tratamiento dirigido. Revista médica de Chile. 2017;145(1):75–84. http://dx.doi.org/10.4067/S0034-98872017000100011 . Flores JIR, Méndez AEL. (2011). La devolución en los procesos de construcción interactiva de los relatos. ESBRINA–RECERCA, 75 . Available at: https://acortar.link/WvuaVy Rottmann N, Dalton SO, Christensen J, Frederiksen K, Johansen C. Self-efficacy, adjustment style and well-being in breast cancer patients: a longitudinal study. Qual Life Res. 2010;19:827–36. https://doi.org/10.1007/s11136-010-9653-1 . Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68–78. https://doi.org/10.1037/0003-066X.55.1.68 . Smit A, Coetzee BJS, Roomaney R, Bradshaw M, Swartz L. Women's stories of living with breast cancer: a systematic review and meta-synthesis of qualitative evidence. Soc Sci Med. 2019;222:231–45. https://doi.org/10.1016/j.socscimed.2019.01.020 . Soriano-Maldonado A, Díez-Fernández DM, Esteban-Simón A, Rodríguez-Pérez MA, Artés-Rodríguez E, Casimiro-Artés MA, Casimiro-Andújar AJ. Effects of a 12-week supervised resistance training program, combined with home-based physical activity, on physical fitness and quality of life in female breast cancer survivors: the EFICAN randomized controlled trial. J Cancer Surviv. 2023;17(5):1371–85. https://doi.org/10.1007/s11764-022-01192-1 . Spei ME, Samoli E, Bravi F, La Vecchia C, Bamia C, Benetou V. Physical activity in breast cancer survivors: a systematic review and meta-analysis on overall and breast cancer survival. Breast. 2019;44:144–52. https://doi.org/10.1016/j.breast.2019.02.001 . Corbin J, Strauss A. Basics of qualitative research: Techniques and procedures for developing grounded theory. Sage; 2014. Tedeschi RG, Calhoun LG. Posttraumatic growth: Conceptual foundations and empirical evidence. Psychol Inq. 2004;15(1):1–18. https://doi.org/10.1207/s15327965pli1501_01 . Thoits PA. Mechanisms linking social ties and support to physical and mental health. J Health Soc Behav. 2011;52(2):145–61. https://doi.org/10.1177/0022146510395592 . Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57. https://doi.org/10.1093/intqhc/mzm042 . Trachtenberg LJ, Esplen MJ, Piran N. The embodied identities of young women diagnosed and treated for breast cancer. Women's Reproductive Health. 2019;6(3):182–203. https://doi.org/10.1080/23293691.2019.1619054 . Tudor-Locke C, Bassett DR. How many steps/day are enough? Preliminary pedometer indices for public health. Sports Med. 2004;34:1–8. https://doi.org/10.2165/00007256-200434010-00001 . Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5998778","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":443486690,"identity":"76586304-b386-405a-b4ad-a2916063df7f","order_by":0,"name":"María-Jesús Lirola","email":"","orcid":"","institution":"Universidad Internacional De La Rioja","correspondingAuthor":false,"prefix":"","firstName":"María-Jesús","middleName":"","lastName":"Lirola","suffix":""},{"id":443486691,"identity":"f5ba27f5-4db5-4049-b3d0-05c8a183ecf7","order_by":1,"name":"Antonia Irene Hernández-Rodríguez","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAtElEQVRIiWNgGAWjYBACNgkILcfAwNxAmhZjBgZGIrUwQLUkNhCthU+6+djngpo76RuOH2xg+PCHGIfJHEuePePYs9wNZxIbGGe2EaNFIseYmYftcO6GA4kNzLzEuI1NIv8zM8+/w+kG5x82MP8hymESOczMvG2HEwxuAG1hYCNKS5oxM2/fYcOZNx42HOwlxi/yM5IfM/N8OyzPdz754IMfxDgMBRwgVcMoGAWjYBSMAhwAAAdyNe0KuVp4AAAAAElFTkSuQmCC","orcid":"","institution":"University of Almería","correspondingAuthor":true,"prefix":"","firstName":"Antonia","middleName":"Irene","lastName":"Hernández-Rodríguez","suffix":""},{"id":443486693,"identity":"b33ec4e7-8223-47e0-b44b-7fab08ddded5","order_by":2,"name":"Cristina Cuenca-Piqueras","email":"","orcid":"","institution":"University of Almería","correspondingAuthor":false,"prefix":"","firstName":"Cristina","middleName":"","lastName":"Cuenca-Piqueras","suffix":""},{"id":443486696,"identity":"a5ebf676-0dc7-416b-ab20-9b0ae53f6ce6","order_by":3,"name":"María Esther Prados Megías","email":"","orcid":"","institution":"University of Almería","correspondingAuthor":false,"prefix":"","firstName":"María","middleName":"Esther Prados","lastName":"Megías","suffix":""}],"badges":[],"createdAt":"2025-02-10 11:38:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5998778/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5998778/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12905-025-03791-3","type":"published","date":"2025-05-27T15:57:24+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":83783563,"identity":"3a400827-c1e3-4e75-949c-24e7d0f6e2d3","added_by":"auto","created_at":"2025-06-02 16:11:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":902559,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5998778/v1/04adc490-be7f-471f-85e3-99c15c4e71a9.pdf"},{"id":80762173,"identity":"333e3545-cd0c-4001-908d-b4f6480f2603","added_by":"auto","created_at":"2025-04-16 19:55:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":74415,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterial1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5998778/v1/3ecea995bb6db177feaada61.pdf"},{"id":80762176,"identity":"763460fe-c3f5-4bb9-8aaa-29894783ddfc","added_by":"auto","created_at":"2025-04-16 19:55:49","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":518451,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterial2.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5998778/v1/f4319c990020c96622d07e9a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Resilience and renewal: the personal impact of physical activity in breast cancer survivors","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSurviving breast cancer is a journey that transcends medical treatment and delves deep into the personal and emotional realm. While clinical approaches primarily focus on the physical aspects of recovery, the process of reestablishing identity and resilience remains a complex and deeply personal endeavor for survivors. The post-treatment phase is characterized by a redefinition of self as survivors confront profound transformations that extend beyond the biological realm. Physical activity emerges as a key element in this holistic recovery, contributing not only to physiological rehabilitation but also to emotional and social well-being. This research is grounded in the lived experiences of breast cancer survivors who participated in a physical activity intervention titled EFICAN (Exercise and Cancer). Developed by the research team in collaboration with clinical exercise professionals, EFICAN consisted of a 12-week resistance training program that included both individual sessions and small-group training. The protocol was designed to promote not only physiological rehabilitation but also psychosocial and emotional well-being in the post-treatment phase.\u003c/p\u003e \u003cp\u003eThe discourse surrounding breast cancer has shifted over the decades from solely clinical outcomes to a broader recognition of the psychological, social, and cultural dimensions of survivorship. Seminal texts, such as Audre Lorde's \u003cem\u003eThe Cancer Journals\u003c/em\u003e (1980, 2020), offer a poignant, first-person narrative that captures the multifaceted impact of breast cancer on identity and body image. Lorde's reflections highlight the struggle against societal expectations of femininity and the empowerment found in embracing one's post-cancer self. These insights underscore the importance of understanding recovery not just as physical healing but as a journey toward reclaiming one\u0026rsquo;s sense of self and agency (Lorde, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e1980\u003c/span\u003e; \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBody image disruption is a significant and challenging consequence for many breast cancer survivors. The changes brought about by surgery, such as mastectomy and reconstruction, alongside treatment side effects like hair loss, can lead to a feeling of estrangement from one\u0026rsquo;s own body (Trachtenberg et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). This disconnection often impacts self-esteem and psychological well-being, as survivors grapple with shifting identities that do not conform to traditional standards of beauty. Research has shown that the physical appearance associated with breast cancer treatment can influence survivors\u0026rsquo; self-perception and overall mental health, contributing to challenges related to social reintegration and emotional resilience (Blanco-S\u0026aacute;nchez, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Cano \u0026amp; Hasicic, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe practice of physical activity provides an avenue for rebuilding this connection. Beyond the well-established physical benefits, such as improved cardiovascular health, muscle strength, and reduced fatigue (Casla et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Ramirez et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Soriano-Maldonado et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), exercise offers psychological advantages that are vital for survivors. Engaging in physical activity has been linked to reduced symptoms of anxiety and depression, fostering a sense of autonomy and empowerment (Spei et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Physical activity also serves as a coping strategy that reinforces survivors\u0026rsquo; resilience, allowing them to reclaim a sense of normalcy and control in their lives.\u003c/p\u003e \u003cp\u003eIn addition to these individual benefits, the social dimension of physical activity is particularly impactful. Participating in group exercise programs enables survivors to form meaningful connections, sharing experiences that promote a sense of community and belonging (Prados \u0026amp; Rivas, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). The camaraderie found in group settings helps reduce isolation and offers emotional support through shared understanding and mutual encouragement. This social support can be transformative, as it reinforces the idea that survivors are not alone in their journey. Instead, they are part of a network of individuals who understand the unique challenges and triumphs associated with breast cancer recovery (Smit et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe narratives of women who have experienced the intersection of physical activity and breast cancer recovery provide an invaluable perspective on how exercise influences not only physical health but also emotional and social well-being. In particular, their stories shed light on the ways in which physical activity contributes to resilience and helps redefine body image. The act of engaging in regular physical activity becomes a symbol of personal strength and recovery, shifting the focus from the trauma of illness to the empowerment of reclaiming one's body.\u003c/p\u003e \u003cp\u003eThe theoretical framework of narrative inquiry supports this perspective by emphasizing the power of stories to convey complex human experiences (Clandinin, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). This approach recognizes that each individual\u0026rsquo;s story is shaped by personal, cultural, and social contexts, making it a valuable tool for understanding the lived experiences of breast cancer survivors. Through narratives, researchers can explore how survivors attribute meaning to their engagement with physical activity and how this influences their recovery process (Charmaz, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePhysical activity's role in improving quality of life has been corroborated by a variety of studies. Soriano-Maldonado et al. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) demonstrated that supervised physical activity programs lead to improved physical fitness and quality of life among breast cancer survivors, even years after treatment. Spei et al. (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) highlighted that consistent physical activity not only enhances physical recovery but also promotes psychological well-being by mitigating symptoms such as fatigue and depression. Additionally, Prados and Rivas (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) emphasized that participation in structured physical programs can help reconstruct a positive self-concept, facilitating the emotional adaptation necessary for post-cancer life.\u003c/p\u003e \u003cp\u003eThe current research aims to build upon this foundation by focusing on the personal narratives of breast cancer survivors. This study seeks to understand how these women perceive the role of physical activity in their recovery, emphasizing their emotional, social, and psychological experiences. By centering the voices of survivors, the research aims to reveal the deeper impact of physical activity beyond its physiological benefits, showcasing how it contributes to a holistic sense of renewal and resilience.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThis study involved five women who had survived breast cancer, residing in the province of Almer\u0026iacute;a. The participants ranged in age from 41 to 57 years (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;49.4; SD\u0026thinsp;=\u0026thinsp;6.32). All women were diagnosed with breast cancer between the ages of 33 and 44, and at the time of the study, had completed surgery, chemotherapy, and/or radiotherapy at least 12 months prior to participation. Four of the participants were married, and one was separated and in a new relationship. All participants had children and were employed in various sectors, including healthcare, commerce, business consulting, and self-employment in domestic cleaning services. Two of the participants continued working during their cancer treatment, while the other three had periods of medical leave.\u003c/p\u003e \u003cp\u003eParticipants were recruited through regional cancer-related associations, local radio and press advertisements, social network announcements, and referral from oncologists of the Torrec\u0026aacute;rdenas University Hospital. Eligibility criteria included being a breast cancer survivor and having completed surgery, chemotherapy, and/or radiotherapy (i.e., core treatments) up to 10 years before recruitment. Exclusion criteria included having metastatic breast cancer, having a breast reconstruction intervention planned within the following six months, having any absolute contraindication for exercise, or engaging in more than 300 minutes per week of structured exercise.\u003c/p\u003e \u003cp\u003e \u003cb\u003eInstruments\u003c/b\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e1. Development of the Interview Guide\u003c/h3\u003e\n\u003cp\u003eThe interview guide was developed based on the core tenets of Self-Determination Theory (SDT) (Ryan \u0026amp; Deci, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2000\u003c/span\u003e), with open-ended questions designed to explore participants\u0026rsquo; experiences of autonomy, competence, and relatedness in relation to physical activity and post-cancer recovery. This theoretical framework informed both the content and structure of the questions. Following a narrative inquiry approach (Clandinin, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), the guide encouraged participants to share their experiences in a flexible and participant-led manner. The interview was structured around five thematic areas, which served as conversational prompts rather than rigid categories:\u003c/p\u003e \u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003ePersonal motivations and expectations prior to joining the EFICAN program;\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eExperiences during participation, including perceived challenges, emotions, and group dynamics;\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003ePerceived impact on physical and emotional well-being, including changes in body perception and daily habits;\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eReflections on personal transformation throughout the program;\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eSuggestions for improvement and broader applicability of the intervention.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e \u003cp\u003eThe initial version of the guide was reviewed by two specialists in qualitative research and psycho-oncology. Minor modifications were made based on their feedback to improve clarity and alignment with the study objectives. Although the guide was not formally pilot-tested, it was iteratively refined during the early interviews to enhance the depth and clarity of responses.\u003c/p\u003e\n\u003ch3\u003e2. Interviews\u003c/h3\u003e\n\u003cp\u003eTwo main instruments were used for data collection: in-depth interviews (see Supplementary Material 1) and a group interview (see Supplementary Material 2).\u003c/p\u003e \u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eIn-depth interviews\u003c/b\u003e: Each of the five participants took part in a semi-structured, individual interview lasting between 60 and 90 minutes. These interviews aimed to explore the participants\u0026rsquo; perceptions, emotions, and experiences related to their participantion in the EFICAN program- a structured 12-week resistance training intervention. Open-ended questions were used to encourage detailed, narrative responses (e.g., \u0026ldquo;Has your approach to physical activity changed after participating in EFICAN? If so, how?\u0026rdquo;).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eGroup interview\u003c/b\u003e: A group interview was also conducted with the three facilitators of the EFICAN program, who led the physical activity sessions in which the women participated. This 90-minute session aimed to capture instructors' perspectives on the emotional, physical, and social progress of the participants throughout the program.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e \u003cp\u003e All interviews were audio-recorded with the participants' informed consent and transcribed manually for subsequent analysis.\u003c/p\u003e\n\u003ch3\u003e3. Monitoring of Physical Activity\u003c/h3\u003e\n\u003cp\u003eTo promote consistent physical activity during the intervention period, all participants were encouraged to maintain their regular lifestyle and to undertake\u0026thinsp;\u0026ge;\u0026thinsp;10,000 steps per day, in line with existing guidelines (American College of Sports Medicine, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Tudor-Locke et al., 2004). Daily step counts were tracked using an activity bracelet, a device previously validated with high accuracy (ICC\u0026thinsp;\u0026gt;\u0026thinsp;0.99) when compared with time-motion tracking systems (Pino-Ortega et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). The step count data were not used as outcome measures but served as a motivational tool to promote adherence. Real-time feedback from the bracelets helped participants monitor their own activity levels, and instructors used these data descriptively to encourage engagement during weekly sessions. The information was not included in the formal data analysis but supported the implementation and continuity of the physical activity program.\u003c/p\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003eThe study procedure began with the identification and selection of participants through local breast cancer support associations, media advertisements, and referrals from healthcare professionals. A detailed explanation of the study\u0026rsquo;s purpose and data collection process was provided. The in-depth interviews and the group interview were conducted in person, in a private room at the university\u0026rsquo;s sports center to ensure privacy and participant comfort. Interviews were carried out by the last author, accompanied by another member of the research team, who rotated across sessions. Both interviewers were trained in qualitative methods and had experience working with clinical populations. All sessions were audio-recorded using a Sony ICD-PX370 digital voice recorder with the participants\u0026rsquo; consent and transcribed manually for thematic analysis.\u003c/p\u003e \u003cp\u003ePrior to the interviews, participants received detailed information about the study objectives and procedures. Written informed consent was obtained during the initial meeting, before any data collection took place, in accordance with ethical guidelines outlined by Lincoln and Denzin (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Confidentiality and the voluntary nature of participation were ensured throughout the process. The study protocol was approved by the Almer\u0026iacute;a Provincial Research Ethics Committee, Spain (Ref: Ejercicio-C\u0026aacute;ncerUAL98/2019).\u003c/p\u003e \u003cp\u003eParticipants completed a 12-week (two sessions per week) resistance training protocol, known as EFICAN (Exercise and Cancer), a structured intervention was specifically designed by the research team in collaboration with certified exercise professionals experienced in oncological rehabilitation. The program included two sessions per week and was structured to progressively support both physical recovery and emotional well-being, combining two initial weeks of individual sessions with ten weeks of small-group training. Each session lasted approximately 60 minutes and was delivered by two qualified facilitators with academic degrees in Physical Activity and Sport Sciences and specialized training in oncology. The sessions took place at the university\u0026rsquo;s sports center and gymnasium, offering a familiar and supportive environment. Training sessions consisted of three parts:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003ePreparatory part\u003c/b\u003e: aerobic activity, thoracic mobility exercises, core stability exercises, scapulohumeral joint stability exercises, and dynamic stability exercises.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eResistance training part\u003c/b\u003e: circuit-based strength exercises.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eCool-down part\u003c/b\u003e: dynamic/static stretching of major muscle groups.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eTranscripts of the interviews were subsequently shared with the participants for their review and validation, allowing them to make corrections or clarifications to their testimonies.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eThe study was conducted within the framework of Self-Determination Theory (Ryan \u0026amp; Deci, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2000\u003c/span\u003e), which provided a foundation for understanding how physical activity can fulfill the psychological needs of autonomy, competence, and relatedness among breast cancer survivors. This theoretical approach offered a basis for exploring how physical activity promotes resilience and well-being, particularly relevant for individuals recovering from significant health challenges.\u003c/p\u003e \u003cp\u003eA thematic analysis was carried out following the phases outlined by Corbin and Strauss (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). The data analysis was carried out using a hermeneutic-interpretative approach, focusing on the participants' narratives and their reconstruction through conversations and feedback. The methodology employed is based on a systematic process of data analysis, divided into two main stages: open coding and axial coding. In the first stage, Open Coding, the most relevant evidence extracted from the participants' narratives was identified and grouped. This initial process allowed for the creation of a category scheme, which was gradually agreed upon by both the participants and the researchers. The second stage, known as Axial Coding, involved a more detailed organization of the evidence within the previously agreed categories. During this phase, the categories were refined, allowing for a deeper and more nuanced interpretation of the information. The analysis was informed by a constructivist interpretative framework, particularly in relation to how participants constructed meaning around their bodily experiences and recovery processes.\u003c/p\u003e \u003cp\u003eThematic saturation was considered achieved when no new codes or categories emerged from the data. Following the criteria proposed by Guest et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2006\u003c/span\u003e), who argue that data saturation in homogenous samples with focused objectives may occur within the first six interviews, we observed a repetition of themes by the fourth individual interview. The group interview with the three physical activity instructors further validated and enriched the thematic structure, providing triangulation of perspectives. These processes supported the credibility and depth of the findings within the defined scope of the study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAdherence to COREQ Guidelines\u003c/h3\u003e\n\u003cp\u003eTo ensure transparency and methodological rigor, the study followed the guidelines of the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist (Tong et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). The roles of the research team, participant recruitment procedures, and data collection methods, including in-depth and group interviews, were thoroughly documented. Reflexivity was maintained throughout the research process to acknowledge and manage potential biases and positionalities. In line with participatory and narrative research principles, co-construction of meaning with participants was emphasized, particularly in the final stages of narrative development. Cancer survivors were engaged in member-checking and narrative return processes to collaboratively shape the final versions of their testimonies, fostering auto-reflexivity and dialogical construction (Rivas \u0026amp; Leite, 2011).\u003c/p\u003e \u003cp\u003eIn addition, the last author kept a reflective journal, where personal impressions, assumptions, and emotional responses were recorded after each interview and during the data analysis phase. This process facilitated critical self-awareness and promoted transparency in the interpretative process. Furthermore, an audit trail was maintained throughout the study, documenting analytical decisions, codebook iterations, and theme refinements. These strategies contributed to the credibility and dependability of the findings by providing a transparent rationale for methodological choices and interpretive outcomes.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe analysis of the narratives collected from the participants revealed profound insights into their experiences with physical activity post-breast cancer treatment. Three main themes emerged from the data: (1) physical activity as a catalyst for empowerment and recovery, (2) the social bonds formed through group activities, and (3) transformative changes in body perception and self-acceptance. Each theme underscores how the integration of physical activity contributed not only to the participants\u0026rsquo; physical health but also to their psychological and emotional well-being.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePhysical Activity as a Catalyst for Empowerment and Recovery\u003c/h2\u003e \u003cp\u003eA recurring theme in the narratives was how physical activity served as a powerful tool for reclaiming autonomy and fostering resilience. The participants frequently expressed that engaging in exercise allowed them to feel in control of their bodies once more, contrasting sharply with the sense of helplessness often associated with their cancer treatment.\u003c/p\u003e \u003cp\u003eOne participant shared, \u003cem\u003e\u0026ldquo;When I started participating in the program, I felt like I was taking back control over my life. The exercises reminded me that I am capable, that my body is still strong despite everything it\u0026rsquo;s been through.\u0026rdquo;\u003c/em\u003e This sentiment resonated across most of the interviews, suggesting that physical activity played a significant role in bridging the gap between surviving cancer and feeling alive again.\u003c/p\u003e \u003cp\u003eThe women spoke of how the routine of physical activity helped mitigate persistent side effects of treatment, such as fatigue and joint pain. One participant, who experienced prolonged fatigue due to her medication, noted, \u003cem\u003e\u0026ldquo;The fatigue I had from the tamoxifen was almost nonexistent when I stayed active. Exercise gave me back energy I thought I had lost forever.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eAdditionally, the participants reported an increased sense of resilience as they observed physical improvements over time. Progress in strength, flexibility, and stamina translated into a boost in self-efficacy and a renewed sense of purpose. This was expressed by another participant who stated, \u003cem\u003e\u0026ldquo;When I saw that I could lift more weight or stretch further than I did weeks before, it was like winning a battle. It made me realize that I am not just surviving, but thriving.\u0026rdquo;\u003c/em\u003e The incremental successes in physical activity provided tangible evidence of progress, reinforcing positive psychological outcomes and encouraging continued engagement in physical activity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eThe Social Bonds Formed Through Group Activities\u003c/h2\u003e \u003cp\u003e Beyond the individual benefits, the social aspect of participating in group physical activities emerged as a powerful motivator and source of emotional support. The shared experiences within these groups created a sense of camaraderie that went beyond the gym or fitness center. The participants emphasized the importance of connecting with others who had experienced similar challenges, highlighting the deep sense of understanding and solidarity that developed through these interactions.\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Meeting other women who knew exactly how I felt was liberating. We didn\u0026rsquo;t need to explain the pain or the fear; it was understood. We could just focus on being in the moment, moving, laughing, and supporting each other,\u0026rdquo;\u003c/em\u003e shared one participant. This bond provided a safe space for emotional expression and fostered a supportive community where shared laughter and mutual encouragement flourished.\u003c/p\u003e \u003cp\u003e Participants emphasized the importance of the group format of the sessions, which fostered mutual encouragement, emotional connection, and a sense of shared progress. The anticipation of seeing familiar faces and sharing stories added a social incentive to attending the sessions regularly. \u003cem\u003e\u0026ldquo;The exercise group was more than just a place to work out\u0026mdash;it became a part of my support system,\u0026rdquo;\u003c/em\u003e stated one participant. This aligns with previous studies emphasizing the psychosocial benefits of group exercise in promoting adherence and emotional well-being.\u003c/p\u003e \u003cp\u003eMoreover, the collective environment fostered a sense of normalcy and reduced the isolation often felt during and after cancer treatment. Participants expressed that the group\u0026rsquo;s shared understanding alleviated the burden of needing to explain themselves or their condition. \u003cem\u003e\u0026ldquo;Being surrounded by people who understood without words was comforting. It felt like a space where we were all equals, not defined by our diagnosis,\u0026rdquo;\u003c/em\u003e shared another participant. This shared experience helped reinforce resilience and fostered a sense of belonging, which was critical for emotional recovery.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eTransformative Changes in Body Perception and Self-Acceptance\u003c/h2\u003e \u003cp\u003eThe third theme that emerged from the analysis centered around the participants' evolving relationships with their bodies. Many women recounted initially experiencing feelings of disconnection, discomfort, or even rejection toward their post-treatment bodies. The physical scars and changes were daily reminders of their journey, often invoking mixed emotions of gratitude for survival intertwined with grief for what had been lost.\u003c/p\u003e \u003cp\u003eOne participant reflected on this transformation, saying, \u003cem\u003e\u0026ldquo;At first, I couldn\u0026rsquo;t look at myself without feeling sad. The scars, the changes\u0026mdash;they were reminders of what I went through. But as I continued with exercise, I started to see my body differently, not as damaged but as resilient.\u0026rdquo;\u003c/em\u003e This gradual shift in body perception was a common thread across the narratives. Physical activity played a significant role in helping participants reconnect with and appreciate their bodies for their strength and capacity, rather than focusing solely on their appearance.\u003c/p\u003e \u003cp\u003eFor many, the act of participating in exercise redefined their concept of health and wellness. Instead of seeing their bodies through the lens of societal beauty standards, the participants learned to value their bodies for their functionality and resilience. \u003cem\u003e\u0026ldquo;My body is not perfect, but it\u0026rsquo;s mine, and it\u0026rsquo;s strong. Every time I push through a workout, I remind myself that it carried me through the hardest fight of my life,\u0026rdquo;\u003c/em\u003e shared one woman. This theme of self-acceptance underscores the psychological benefits of physical activity, which extend beyond mere fitness to encompass a broader, more inclusive sense of well-being.\u003c/p\u003e \u003cp\u003e Additionally, the participants spoke about the newfound confidence they gained through physical activity. One woman described how this confidence affected other aspects of her life, stating, \u003cem\u003e\u0026ldquo;Once I started feeling stronger and more capable in my workouts, I noticed that I approached other challenges with the same mindset. It was empowering.\u0026rdquo;\u003c/em\u003e This reflects the idea that physical resilience can translate into psychological resilience, helping individuals navigate post-cancer life with greater confidence.\u003c/p\u003e \u003cp\u003eThe redefined relationship with their bodies also influenced their social interactions and self-perception as women. One participant summed it up, saying, \u003cem\u003e\u0026ldquo;I learned to accept myself, scars and all. It made me realize that my value isn\u0026rsquo;t diminished by what I\u0026rsquo;ve gone through\u0026mdash;it\u0026rsquo;s enhanced by it.\u0026rdquo;\u003c/em\u003e This narrative highlights the profound impact that physical activity had on fostering self-acceptance and a positive body image.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eInstructors\u0026rsquo; Perspectives: Observing Change and Resilience\u003c/h2\u003e \u003cp\u003eThe group interview with the three physical activity instructors offered valuable insights into the implementation and impact of the EFICAN program from a facilitation perspective. All three instructors had completed specialized training in physical activity and cancer through the Professional Institute for Exercise and Cancer (IPEFC) prior to their involvement in the project. This preparatory experience helped them dismantle societal stigmas surrounding cancer and approach the participants with empathy, knowledge, and professionalism.\u003c/p\u003e \u003cp\u003eInstructors described the initial two-week period of individual sessions with each participant as critical for building trust and tailoring exercises to the specific physical and emotional needs of each woman. They emphasized the importance of listening, emotional containment, and adapting sessions to each woman\u0026rsquo;s surgical history, physical limitations, and psychological state. One instructor shared: \u003cem\u003e\u0026ldquo;Many times the hour went by and we hadn\u0026rsquo;t done any exercise\u0026mdash;we had just talked, and that was what they needed.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eOver time, the instructors observed notable changes in the women\u0026rsquo;s physical capacity, confidence, and social engagement. The sense of community that emerged among participants was a recurring theme: \u003cem\u003e\u0026ldquo;At first, they were nervous and reserved, but soon they were chatting like lifelong friends,\u0026rdquo;\u003c/em\u003e one instructor explained. The group dynamic became a key source of motivation, often described as more meaningful than the exercise itself: \u003cem\u003e\u0026ldquo;They came for the training, but stayed for the group.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eDespite the structured nature of the protocol, the instructors implemented minor modifications and added motivational elements (e.g., games, partner exercises) to enhance enjoyment and adherence. They recognized the limitations imposed by the research design but also highlighted how participants expressed a desire for greater variety and more personalized challenges.\u003c/p\u003e \u003cp\u003eFinally, the instructors reflected on the long-term impact of the program, noting that many women maintained active lifestyles after the intervention, often seeking new activities independently. One facilitator remarked: \u003cem\u003e\u0026ldquo;Some of them are still training with me, others joined swimming or hiking groups\u0026mdash;the important thing is that they didn\u0026rsquo;t want to stop.\u0026rdquo;\u003c/em\u003e These accounts reinforce the value of integrating emotional, relational, and contextual elements into exercise programs for cancer survivors.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to explore the multifaceted impacts of physical activity on the recovery process of breast cancer survivors, examining how engagement in exercise influenced their physical, psychological, and social well-being. These findings highlight the potential of structured physical activity programs like EFICAN to promote not only physical recovery, but also emotional resilience and social connectedness among breast cancer survivors. This section discusses these findings in the context of existing literature, highlights the implications for practice and policy, and suggests future research directions.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003ePhysical Activity as a Source of Empowerment and Recovery\u003c/h2\u003e \u003cp\u003eOne of the key findings of this study was that physical activity emerged as a tool for empowerment among the participants. The narratives highlighted how exercise provided a sense of agency that was crucial for regaining control over their lives after the loss of autonomy experienced during cancer treatment. These findings align with previous research showing that structured physical activity programs like EFICAN can alleviate common post-treatment symptoms such as fatigue, pain, and decreased energy levels (Spei et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). The women\u0026rsquo;s narratives suggest how consistent engagement in the EFICAN program contributed to reducing such effects, supporting the role of exercise as an effective non-pharmacological strategy for long-term symptom management.\u003c/p\u003e \u003cp\u003eThe participants\u0026rsquo; descriptions of reclaiming their bodies through exercise resonate with the concept of post-traumatic growth (PTG), where individuals experience positive psychological change as a result of struggling with highly challenging life circumstances (Tedeschi \u0026amp; Calhoun, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). The women in this study expressed that the improvements they saw in their physical abilities translated into a mental resilience that extended beyond the gym. The sense of accomplishment gained from mastering new physical challenges contributed to enhanced self-efficacy, an essential component for developing PTG (Bandura \u0026amp; Wessels, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e1997\u003c/span\u003e; Helgeson et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2006\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMoreover, the importance of self-efficacy in breast cancer recovery is well-documented (Locke, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e1997\u003c/span\u003e; BonAlilu et al., 2017; Rottmann et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). According to Bandura\u0026rsquo;s theory of self-efficacy (1997), belief in one\u0026rsquo;s ability to perform specific actions is crucial for motivation and perseverance. The participants\u0026rsquo; ability to progress in their physical routines reinforced their belief in their capacity to overcome difficulties, which is vital for long-term recovery. This finding suggests that structured physical activity programs should emphasize achievable milestones to foster self-efficacy and, consequently, empower survivors.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eThe Role of Social Support in Group Activities\u003c/h2\u003e \u003cp\u003eThe narratives underscored the significant role that social support played in encouraging adherence to physical activity and fostering emotional well-being. Group exercise programs offered a platform for social connection, providing a sense of camaraderie that mitigated feelings of isolation and strengthened the participants\u0026rsquo; commitment to maintaining an active lifestyle. This is consistent with findings by Soriano-Maldonado et al. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), who demonstrated that group-based physical activity contributed to sustained exercise participation and enhanced quality of life among breast cancer survivors.\u003c/p\u003e \u003cp\u003eSocial support has been widely acknowledged as a critical factor in coping with chronic illnesses (Helgeson \u0026amp; Cohen, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e1999\u003c/span\u003e). The shared understanding and non-verbalized empathy found within these group settings offered participants an emotional reprieve. They could share stories, laugh, and engage in mutual encouragement without needing to explain their struggles, which reinforced a sense of belonging. These shared experiences aligned with the concept of \u0026ldquo;communal coping\u0026rdquo; (Lyons et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e1998\u003c/span\u003e), where individuals collectively manage stressors by pooling their emotional and social resources.\u003c/p\u003e \u003cp\u003e The group dynamic also promoted adherence to exercise programs, as noted by participants who expressed looking forward to meeting friends at exercise sessions. This aspect supports the findings of Thoits (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2011\u003c/span\u003e), who argued that social relationships play a vital role in promoting health behavior adherence. The anticipation of positive social interactions and shared physical activity experiences created a feedback loop that reinforced continued participation, enhancing both physical and emotional resilience.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eTransformative Changes in Body Perception and Self-Acceptance\u003c/h2\u003e \u003cp\u003ePerhaps one of the most significant findings of this study was the transformative shift in body perception reported by participants. Initially, the women described feelings of disconnection and discomfort with their bodies, often viewing their post-treatment physical selves through a lens of trauma and loss. However, as they engaged in physical activity, this perception began to change. Exercise became a tool not just for physical rehabilitation but for redefining their relationship with their bodies, allowing them to view themselves as resilient and capable.\u003c/p\u003e \u003cp\u003eThis finding aligns with the body of work examining the impact of breast cancer on body image and self-esteem. Studies have shown that changes in physical appearance due to cancer treatment, such as scarring, hair loss, and mastectomy, can profoundly affect a woman\u0026rsquo;s self-concept and body image (Blanco-Sanch\u0026eacute;z, 2010; Trachtenberg et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). However, engaging in physical activity has been linked to improvements in body image and self-esteem (Pudkasam et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). The narratives of the participants in this study echoed these findings, illustrating how physical activity helped them shift their focus from external appearance to internal strength and functionality.\u003c/p\u003e \u003cp\u003eOne participant\u0026rsquo;s statement, \u003cem\u003e\u0026ldquo;My body is not perfect, but it\u0026rsquo;s mine, and it\u0026rsquo;s strong,\u0026rdquo;\u003c/em\u003e encapsulates the profound shift in body perception that exercise facilitated. This shift from viewing the body as a vessel of illness to a symbol of survival and strength aligns with research on embodied resilience (Kontos \u0026amp; Naglie, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). By participating in physical activities that challenged and celebrated their bodies' capabilities, the women in this study experienced a newfound appreciation for their physical selves. This highlights the importance of designing exercise programs that not only focus on physical outcomes but also encourage participants to recognize and celebrate their body\u0026rsquo;s resilience and progress.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003ePsychological and Social Implications\u003c/h2\u003e \u003cp\u003eThe study\u0026rsquo;s findings have several implications for the psychological and social dimensions of recovery for breast cancer survivors. The role of physical activity as a facilitator of psychological resilience was evident in the participants' stories. They described feeling more confident, suggesting that physical activity helped buffer against anxiety and contributed to a more positive outlook on life. This observation supports the findings of Ramirez et al. (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), who reported that exercise helps regulate mood and reduce anxiety among cancer patients.\u003c/p\u003e \u003cp\u003eThe narratives suggest that engaging in structured physical activity may offer more than physical benefits; it can also introduce a sense of stability and predictability into the lives of breast cancer survivors. This routine appeared particularly meaningful during the transition from active treatment to post-treatment life\u0026mdash;a phase often described as disorienting or uncertain due to the sudden reduction in medical oversight. Participation in the EFICAN program seemed to act as a bridge, offering continuity through scheduled sessions and a sense of purposeful structure during a vulnerable period of adjustment.\u003c/p\u003e \u003cp\u003eThe social benefits derived from group activities were equally significant. Participants frequently emphasized how these sessions served as a reminder that they were not alone in their journey. The shared experience fostered by group activities reinforced social bonds that contributed to emotional well-being and mitigated feelings of isolation. This social interaction aligns with findings from research on collective coping mechanisms (Lyons et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e1998\u003c/span\u003e), which highlight the benefits of shared experiences in promoting psychological health and well-being.\u003c/p\u003e \u003cp\u003eBeyond the survivors\u0026rsquo; self-reported experiences, the perspectives of the physical activity instructors provided an additional layer of insight that enriched the interpretation of the findings. Their observations reinforced the emergence of empowerment, resilience, and emotional connection, while offering external validation of participants\u0026rsquo; reported transformations. Instructors noted improvements not only in physical function but also in the women\u0026rsquo;s confidence, expressiveness, and motivation to maintain an active lifestyle. These accounts highlight the value of incorporating multi-perspective data when evaluating psycho-social interventions. Moreover, the instructors\u0026rsquo; reflections on group cohesion, mutual support, and sustained engagement underscore the relevance of relational and emotional dynamics within exercise programs\u0026mdash;a dimension already emphasized in recent literature on group-based rehabilitation in oncology (e.g., Cormie et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Soriano-Maldonado et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Integrating both participant and facilitator voices deepens our understanding of the mechanisms through which structured physical activity fosters recovery and well-being.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and Future Research\u003c/h2\u003e \u003cp\u003eWhile the findings of this study offer valuable insights, several limitations must be acknowledged. The sample size was relatively small, consisting of only five participants, which may limit the generalizability of the results. Additionally, the study focused on a specific geographical region, which could affect the cultural context of the findings. Breast cancer survivors from this region\u0026mdash;Almer\u0026iacute;a, in southern Spain\u0026mdash;may be influenced by strong family-oriented values, close-knit community networks, and access to public healthcare and sport facilities. These factors may have facilitated their participation in the EFICAN program and shaped their perceptions of recovery, social support, and physical activity. Future research should aim to include a larger and more diverse sample to enhance the transferability of the results and explore whether these findings hold true across different cultural and social settings.\u003c/p\u003e \u003cp\u003eThe study also relied on self-reported narratives, which, while rich in detail, may be subject to recall bias or social desirability bias. Future research could incorporate a mixed-methods approach, combining qualitative narratives with quantitative measures of physical and psychological outcomes to provide a more comprehensive understanding of the effects of physical activity on breast cancer survivors.\u003c/p\u003e \u003cp\u003eAnother area for future research involves exploring the long-term impacts of physical activity on psychological resilience and body perception. While this study highlighted the immediate benefits experienced by participants, understanding how these benefits evolve over time would be valuable for developing long-term support strategies for breast cancer survivors. Previous research has examined the effects of exercise on mental health, body image, and quality of life among breast cancer survivors, often using standardized instruments such as the Body Image Scale (Hopwood et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2001\u003c/span\u003e), the Functional Assessment of Cancer Therapy \u0026ndash; Breast (FACT-B; Brady et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e1997\u003c/span\u003e), or resilience scales like the Connor-Davidson Resilience Scale (CD-RISC; Connor \u0026amp; Davidson, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2003\u003c/span\u003e). Future studies could build upon our findings by incorporating such measures to validate and extend the qualitative insights, allowing for triangulation of data and broader generalizability.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003ePractical Implications for Practice and Policy\u003c/h2\u003e \u003cp\u003eThe insights gained from this study have significant implications for the development of post-treatment care programs for breast cancer survivors. The findings suggest that exercise programs should be designed not only to improve physical health but also to foster psychological and social well-being. Healthcare providers and policymakers should consider integrating structured, supportive group exercise programs into standard post-treatment care plans. These programs could include activities that emphasize gradual progression, celebrate individual achievements, and foster a sense of community among participants.\u003c/p\u003e \u003cp\u003eFurthermore, training for exercise instructors should include elements of psychosocial support to ensure that they can create an inclusive and empathetic environment. This approach could help facilitate the type of social bonds that were found to be beneficial in this study, making exercise sessions more than just physical routines but spaces for holistic healing.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eConclusions and Broader Significance\u003c/h2\u003e \u003cp\u003eThis study reinforces the importance of viewing physical activity as a comprehensive tool for recovery in breast cancer survivors. Beyond its physical benefits, exercise provides a pathway for emotional healing, social support, and redefined body perception. The participants' narratives illustrate that physical activity fosters resilience, not just in terms of physical strength but as an essential component of psychological and emotional recovery. By celebrating their capabilities and forming supportive connections, these women were able to move from a mindset of merely surviving to one of thriving.\u003c/p\u003e \u003cp\u003eThe broader significance of this study lies in its potential to inform the development of survivor-focused interventions that prioritize holistic well-being. By incorporating physical, emotional, and social dimensions into recovery programs, healthcare providers can support breast cancer survivors in building a renewed sense of identity and resilience. The findings underscore the importance of shifting the conversation from surviving cancer to embracing life beyond it, where physical activity acts as a catalyst for empowerment, connection, and self-acceptance. Incorporating women's voices and experiences not only enriches our understanding of post-cancer recovery but also asserts their central role in the process, emphasizing that their strength and resilience are the driving force behind true empowerment and transformation.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants provided informed consent, and the study was approved by the Ethics Committee of Almer\u0026iacute;a Provincial Research Ethics Committee, Spain (approval code: Ejercicio-C\u0026aacute;ncerUAL98/2019). The research were conducted in accordance with the ethical standards of the Declaration of Helsinki and relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions, in accordance with the explicit wishes of the participating women.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting Interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Patronato Municipal de Deportes, Ayuntamiento de Almer\u0026iacute;a, Grant/Award Number: 2024/17975N; University of Almer\u0026iacute;a (UALtranfierE Program), Grant/Award Numbers: TRFE-SI-2022/010, TRFE-SI-2023/010. Andalucia Goverment: Grant/Award Number: DOC_01290. The Sede provincial de Almer\u0026iacute;a de la Asociaci\u0026oacute;n Espa\u0026ntilde;ola Contra el C\u0026aacute;ncer and the AECC Scientific Foundation, Grant/Award Number: PRDAM222381ESTE\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthor contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization M.J.L.; Data curation M.J.L., A.I.H.R., C.C.P., M.E.P.M.; Formal analysis M.J.L., A.I.H.R., C.C.P., M.E.P.M.; Funding acquisition M.E.P.M.; Investigation\u0026nbsp;M.J.L., A.I.H.R., C.C.P., M.E.P.M.; Methodology M.J.L., M.E.P.M.; Project administration M.J.L., A.I.H.R., M.E.P.M.; Software\u0026nbsp;M.J.L., A.I.H.R., C.C.P., M.E.P.M.; Resources M.J.L., A.I.H.R., C.C.P., M.E.P.M.; Supervision M.E.P.M.; Writing \u0026ndash; original draft M.J.L.; Writing \u0026ndash; review \u0026amp; editing M.J.L., A.I.H.R., C.C.P., M.E.P.M.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA special mention to the women who participated, collaborated, and reviewed this manuscript, generously contributing their life stories to this research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAmerican College of Sports Medicine. (2011). \u003cem\u003eStarting a Walking Program\u003c/em\u003e, 1\u0026ndash;2, Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.acsm.org/docs/default-source/files-for-resource-library/starting-a-walking-program.pdf?sfvrsn=85e9d2d9_2#:~:text=Start%20slowly%20and%20build%20up,for%20at%20least%20five%20minutes\u003c/span\u003e\u003cspan address=\"https://www.acsm.org/docs/default-source/files-for-resource-library/starting-a-walking-program.pdf?sfvrsn=85e9d2d9_2#:~:text=Start%20slowly%20and%20build%20up,for%20at%20least%20five%20minutes\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBandura A, Wessels S. ). Self-efficacy. Cambridge University Press; 1997.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlanco-S\u0026aacute;nchez R. (2010). Imagen corporal femenina y sexualidad en mujeres con c\u0026aacute;ncer de mama. \u003cem\u003eIndex de Enfermer\u0026iacute;a\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e(1), 24\u0026ndash;28. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://scielo.isciii.es/scielo.php?%20pid=S1132-12962010000100005\u0026amp;script=sci_arttext\u003c/span\u003e\u003cspan address=\"https://scielo.isciii.es/scielo.php?%20pid=S1132-12962010000100005\u0026amp;script=sci_arttext\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrady MJ, Cella DF, Mo F, Bonomi AE, Tulsky DS, Lloyd SR, Deasy S, Cobleigh M, Shiomoto G. Reliability and validity of the Functional Assessment of Cancer Therapy-Breast quality-of-life instrument. J Clin Oncol. 1997;15(3):974\u0026ndash;86. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1200/JCO.1997.15.3.974\u003c/span\u003e\u003cspan address=\"10.1200/JCO.1997.15.3.974\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBorjAlilu S, Kaviani A, Helmi S, Karbakhsh M, Mazaheri MA. Exploring the role of self-efficacy for coping with breast cancer: A systematic review. Archives Breast Cancer. 2017;42\u0026ndash;57. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.19187/abc.20174242-57\u003c/span\u003e\u003cspan address=\"10.19187/abc.20174242-57\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCano JE, Hasicic C. (2016). El cuerpo como lienzo: praxis de mujeres artistas con c\u0026aacute;ncer de mama. En \u003cem\u003eII Jornadas de G\u0026eacute;nero y Diversidad Sexual (GEDIS)\u003c/em\u003e. La Plata. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://sedici.unlp.edu.ar/handle/10915/57147\u003c/span\u003e\u003cspan address=\"http://sedici.unlp.edu.ar/handle/10915/57147\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCasla S, L\u0026oacute;pez-Tarruella S, Jerez Y, Marquez-Rodas I, Galvao DA, Newton RU, Martin M. Supervised physical exercise improves VO 2max, quality of life, and health in early stage breast cancer patients: a randomized controlled trial. Breast Cancer Res Treat. 2015;153:371\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10549-015-3541-x\u003c/span\u003e\u003cspan address=\"10.1007/s10549-015-3541-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCharmaz K. (2012). The power and potential of grounded theory. \u003cem\u003eMedical Sociology Online\u003c/em\u003e, 6(3), 1\u0026ndash;15. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.epicpeople.org/wp-content/uploads/2023/06/Charmaz-2012.pdf\u003c/span\u003e\u003cspan address=\"https://www.epicpeople.org/wp-content/uploads/2023/06/Charmaz-2012.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClandinin J. Engaging in Narrative Inquiry. Routledge; 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eConnor KM, Davidson JRT. Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18(2):76\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/da.10113\u003c/span\u003e\u003cspan address=\"10.1002/da.10113\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCormie P, Zopf EM, Zhang X, Schmitz KH. The impact of exercise on cancer mortality, recurrence, and treatment-related adverse effects. Epidemiol Rev. 2017;39(1):71\u0026ndash;92. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/epirev/mxx007\u003c/span\u003e\u003cspan address=\"10.1093/epirev/mxx007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods. 2006;18(1):59\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1525822X05279903\u003c/span\u003e\u003cspan address=\"10.1177/1525822X05279903\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHelgeson VS, Cohen S. Social support and adjustment to cancer: Reconciling descriptive, correlational, and intervention research. In: Suinn RM, VandenBos GR, editors. Cancer patients and their families: Readings on disease course, coping, and psychological interventions. American Psychological Association; 1999. pp. 53\u0026ndash;79. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/10338-003\u003c/span\u003e\u003cspan address=\"10.1037/10338-003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHelgeson VS, Reynolds KA, Tomich PL. A meta-analytic review of benefit finding and growth. J Consult Clin Psychol. 2006;74(5):797\u0026ndash;816. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/0022-006X.74.5.797\u003c/span\u003e\u003cspan address=\"10.1037/0022-006X.74.5.797\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHopwood P, Fletcher I, Lee A, Al Ghazal S. A body image scale for use with cancer patients. Eur J Cancer. 2001;37(2):189\u0026ndash;97. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0959-8049(00)00353-1\u003c/span\u003e\u003cspan address=\"10.1016/S0959-8049(00)00353-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKontos P, Naglie G. Tacit knowledge of caring and embodied selfhood. Sociol Health Illn. 2009;31(5):688\u0026ndash;704. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1467-9566.2009.01158.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1467-9566.2009.01158.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLincoln YS, Denzin NK. The Sage handbook of qualitative research. 5th ed. Sage; 2015.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLocke EA. (1997). Self-efficacy: The exercise of control. \u003cem\u003ePersonnel psychology, 50\u003c/em\u003e(3), 801. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.proquest.com/docview/220140280?pq-origsite=gscholar\u0026amp;fromopenview=true\u0026amp;sourcetype=Scholarly%20Journals\u003c/span\u003e\u003cspan address=\"https://www.proquest.com/docview/220140280?pq-origsite=gscholar\u0026amp;fromopenview=true\u0026amp;sourcetype=Scholarly%20Journals\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLorde A. The Cancer Journals. Hip\u0026oacute;lita Ediciones; 1980.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLorde A. The cancer journals. Penguin; 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLyons RF, Mickelson KD, Sullivan MJ, Coyne JC. Coping as a communal process. J Social Personal Relationships. 1998;15(5):579\u0026ndash;605. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0265407598155001\u003c/span\u003e\u003cspan address=\"10.1177/0265407598155001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePino-Ortega J, G\u0026oacute;mez-Carmona CD, Rico-Gonz\u0026aacute;lez M. Accuracy of Xiaomi Mi Band 2.0, 3.0 and 4.0 to measure step count and distance for physical activity and healthcare in adults over 65 years. Gait Posture. 2021;87:6\u0026ndash;10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.gaitpost.2021.04.015\u003c/span\u003e\u003cspan address=\"10.1016/j.gaitpost.2021.04.015\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrados ME, Rivas JI. Investigar narrativamente en educaci\u0026oacute;n f\u0026iacute;sica con relatos corporales. Revista del Instituto de Investigaciones en Educaci\u0026oacute;n. 2017;8(10):82\u0026ndash;99. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.30972/riie.8103654\u003c/span\u003e\u003cspan address=\"10.30972/riie.8103654\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePudkasam 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\u0026ndash;72. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.maturitas.2018.07.010\u003c/span\u003e\u003cspan address=\"10.1016/j.maturitas.2018.07.010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRamirez K, Acevedo F, Herrera ME, Ib\u0026aacute;\u0026ntilde;ez C, S\u0026aacute;nchez C. Actividad f\u0026iacute;sica y c\u0026aacute;ncer de mama: un tratamiento dirigido. Revista m\u0026eacute;dica de Chile. 2017;145(1):75\u0026ndash;84. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.4067/S0034-98872017000100011\u003c/span\u003e\u003cspan address=\"10.4067/S0034-98872017000100011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFlores JIR, M\u0026eacute;ndez AEL. (2011). La devoluci\u0026oacute;n en los procesos de construcci\u0026oacute;n interactiva de los relatos. \u003cem\u003eESBRINA\u0026ndash;RECERCA, 75\u003c/em\u003e. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://acortar.link/WvuaVy\u003c/span\u003e\u003cspan address=\"https://acortar.link/WvuaVy\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRottmann N, Dalton SO, Christensen J, Frederiksen K, Johansen C. Self-efficacy, adjustment style and well-being in breast cancer patients: a longitudinal study. Qual Life Res. 2010;19:827\u0026ndash;36. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11136-010-9653-1\u003c/span\u003e\u003cspan address=\"10.1007/s11136-010-9653-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRyan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68\u0026ndash;78. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/0003-066X.55.1.68\u003c/span\u003e\u003cspan address=\"10.1037/0003-066X.55.1.68\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmit A, Coetzee BJS, Roomaney R, Bradshaw M, Swartz L. Women's stories of living with breast cancer: a systematic review and meta-synthesis of qualitative evidence. Soc Sci Med. 2019;222:231\u0026ndash;45. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.socscimed.2019.01.020\u003c/span\u003e\u003cspan address=\"10.1016/j.socscimed.2019.01.020\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSoriano-Maldonado A, D\u0026iacute;ez-Fern\u0026aacute;ndez DM, Esteban-Sim\u0026oacute;n A, Rodr\u0026iacute;guez-P\u0026eacute;rez MA, Art\u0026eacute;s-Rodr\u0026iacute;guez E, Casimiro-Art\u0026eacute;s MA, Casimiro-And\u0026uacute;jar AJ. Effects of a 12-week supervised resistance training program, combined with home-based physical activity, on physical fitness and quality of life in female breast cancer survivors: the EFICAN randomized controlled trial. J Cancer Surviv. 2023;17(5):1371\u0026ndash;85. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11764-022-01192-1\u003c/span\u003e\u003cspan address=\"10.1007/s11764-022-01192-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpei ME, Samoli E, Bravi F, La Vecchia C, Bamia C, Benetou V. Physical activity in breast cancer survivors: a systematic review and meta-analysis on overall and breast cancer survival. Breast. 2019;44:144\u0026ndash;52. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.breast.2019.02.001\u003c/span\u003e\u003cspan address=\"10.1016/j.breast.2019.02.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCorbin J, Strauss A. Basics of qualitative research: Techniques and procedures for developing grounded theory. Sage; 2014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTedeschi RG, Calhoun LG. Posttraumatic growth: Conceptual foundations and empirical evidence. Psychol Inq. 2004;15(1):1\u0026ndash;18. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1207/s15327965pli1501_01\u003c/span\u003e\u003cspan address=\"10.1207/s15327965pli1501_01\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThoits PA. Mechanisms linking social ties and support to physical and mental health. J Health Soc Behav. 2011;52(2):145\u0026ndash;61. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0022146510395592\u003c/span\u003e\u003cspan address=\"10.1177/0022146510395592\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349\u0026ndash;57. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/intqhc/mzm042\u003c/span\u003e\u003cspan address=\"10.1093/intqhc/mzm042\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTrachtenberg LJ, Esplen MJ, Piran N. The embodied identities of young women diagnosed and treated for breast cancer. Women's Reproductive Health. 2019;6(3):182\u0026ndash;203. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/23293691.2019.1619054\u003c/span\u003e\u003cspan address=\"10.1080/23293691.2019.1619054\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTudor-Locke C, Bassett DR. How many steps/day are enough? Preliminary pedometer indices for public health. Sports Med. 2004;34:1\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2165/00007256-200434010-00001\u003c/span\u003e\u003cspan address=\"10.2165/00007256-200434010-00001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Body image, Social support, Group exercise, Survivor empowerment, Emotional well-being","lastPublishedDoi":"10.21203/rs.3.rs-5998778/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5998778/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study investigates the multifaceted impact of physical activity on the holistic recovery of breast cancer survivors, emphasizing psychological, social, and physical dimensions. Beyond medical treatments, reclaiming identity and autonomy post-breast cancer is a complex process involving physical and emotional well-being. The research utilized a qualitative approach, conducting in-depth interviews with five female survivors aged 41 to 57, as well as a group interview with the three pysical activity instructors who led the participants\u0026acute;exercise sessions. Participants completed a 12-week resistance training protocol title EFICAN (Exercise and Cancer), a structured intervention specifically designed by the research team for this study, combining individual and small-group sessions. Survivors shared personal experiences of how physical activity influenced their post-treatment recovery, while the instructors provided complementary insights into the participants\u0026acute;observed changes. Thematic analysis was applied to identify patterns and core themes. Three primary themes emerged: (1) physical activity as a catalyst for empowerment and recovery, (2) the significance of social bonds formed during group activities, and (3) transformative changes in body perception and self-acceptance. Participants highlighted that exercise helped regain control over their bodies, mitigate side effects, and foster resilience. Group activities provided emotional support, reducing isolation and promoting psychological well-being. Instructors echoed these findings, describing visible improvements in participants\u0026rsquo; confidence, emotional expression, and social engagement. The study findings align with existing literature, while the inclusion of instructors\u0026rsquo; perspectives adds a novel contribution to the understanding of how physical activity supports psycho-social recovery. Integrating structured physical activity into post-treatment care can support emotional healing and strengthen social bonds. Clinical programs should celebrate individual achievements and include group-based exercises to enhance adherence and overall well-being. The study's small sample size may limit generalizability. Future research should explore diverse populations and incorporate quantitative methods to complement qualitative findings. Physical activity plays a crucial role in transitioning from surviving to thriving post-cancer. It supports not only physical health but also psychological resilience and social connection, reinforcing that survivors\u0026rsquo; voices are essential in shaping recovery programs.\u003c/p\u003e","manuscriptTitle":"Resilience and renewal: the personal impact of physical activity in breast cancer survivors","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-16 19:55:45","doi":"10.21203/rs.3.rs-5998778/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-02T07:15:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-02T07:10:20+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-15T21:34:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"71109729066433889309281525536892125227","date":"2025-04-15T20:45:02+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-15T18:18:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-14T00:01:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2025-04-12T09:40:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9904c070-291d-48ac-b0f8-d6eda376e78d","owner":[],"postedDate":"April 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-06-02T16:10:08+00:00","versionOfRecord":{"articleIdentity":"rs-5998778","link":"https://doi.org/10.1186/s12905-025-03791-3","journal":{"identity":"bmc-womens-health","isVorOnly":false,"title":"BMC Women's Health"},"publishedOn":"2025-05-27 15:57:24","publishedOnDateReadable":"May 27th, 2025"},"versionCreatedAt":"2025-04-16 19:55:45","video":"","vorDoi":"10.1186/s12905-025-03791-3","vorDoiUrl":"https://doi.org/10.1186/s12905-025-03791-3","workflowStages":[]},"version":"v1","identity":"rs-5998778","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5998778","identity":"rs-5998778","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}