Factors associated with physical activity among Thai women with breast cancer postmastectomy at a University Hospital, Thailand

Factors associated with physical activity among Thai women with breast cancer postmastectomy at a University Hospital, Thailand | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Factors associated with physical activity among Thai women with breast cancer postmastectomy at a University Hospital, Thailand Fuengfa Khobkhun, Piyaporn Wichaidit, Doonyapat Sa-nguanraksa, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4854096/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 19 May, 2025 Read the published version in Scientific Reports → Version 1 posted 10 You are reading this latest preprint version Abstract The primary treatment for breast cancer patients is surgery and it often impacts physical activity (PA). This study aimed to investigate factors associated with the PA level of Thai women with breast cancer after surgical mastectomy at Siriraj Hospital, Thailand. Ninety-three participants were completed the questionnaires included personal information, the Global Physical Activity Questionnaire, perceived benefits, perceived barriers, perceived self-efficacy, interpersonal influence and situational influence, the Thai Body Image Index score, and the Thai Hospital Anxiety and Depression Scale. Data was analyzed using descriptive statistics and Chi-square statistics (Odds-Ratio and 95% Confidence Interval). The study found that after post-mastectomy Thai women had sufficient PA (2.8 metabolic equivalent of tasks (METs)). It was also found that PA at work was associated with occupation, higher incomes, moderate satisfaction as assessed by the Thai Body Image Index score, and higher levels of anxiety and depression. Additionally, participation in recreational activities was associated with older age, higher perceived self-efficacy, and greater interpersonal influence. By exploring these association, we can tailor supportive care strategies that address the PA needs of individuals affected by breast cancer and it is essential for developing comprehensive interventions that optimize patient health and well-being throughout the cancer journey. Biological sciences/Cancer Health sciences/Health care Breast cancer Physical activity Body Image Index Perceived self-efficacy Anxiety Depression Figures Figure 1 Introduction Breast cancer is the major female cancer globally, accounting for 11.7% of all new cancers 1 . When compared to Asian populations, Western populations, including those in Australia and New Zealand, North America, and Western Europe, have a significantly higher incidence of breast cancer 1 . However, due to the early detection and advancements in treatment, the fatality rate for breast cancer has significantly decreased in Western populations. However, the prevalence of breast cancer in Thailand is increasing at an alarming rate. In Thailand the annual incidence of breast cancer is showing an increasing trend, from 17.8 per 100,000 in 1998 to 26.6 per 100,000 in 2012 to 31.4 per 100,000 in 2015. The condition is most prevalent in the 40 to 60-year age group 2–3 . Cancer diagnosis and treatment have a significant impact on the psychological health of patients, especially when surgery is involved 4–6 . There are several types of mastectomy procedures involved in the treatment of breast cancer specifically: total (simple) mastectomy, modified radical mastectomy, radical mastectomy, skin-sparing mastectomy, and nipple-sparing mastectomy 5, 6 . The choice of mastectomy type depends on a range of factors, the reason for the procedure, the size and location of any tumors, and the overall health of the patient 5, 6 . After a mastectomy, breast reconstruction surgery can be performed to restore the appearance of the breast 5, 6 . Every year, more than 10,000 women in Thailand undergo a mastectomy 7 ; the psychological impact on patients, affecting various aspects of quality of life including self-image, self-esteem, and sexual relationships. The procedure is also associated with high rates of depression 8 . Physical activity (PA) has been well-documented for its substantial health benefits 9, 10 . PA is “any bodily movement produced by skeletal muscles that requires energy expenditure” 10 . It includes all forms of movement, from light activities like walking and gardening to vigorous activities like running and swimming. According to epidemiological studies inactivity and the underlying diseases which presence of cardiovascular risk factors including hypertension, insulin resistance, non-insulin dependent diabetes, dyslipidemia, and obesity are strongly linked 9, 11 . It has also been suggested that consistent PA is effective for the prevention and treatment of the aforementioned illnesses as well as chronic conditions like osteoporosis, also helping to reduce stress and improve self-esteem 12, 13 . PA has been shown to be effective in ensuring the reduction in sequelae of the complication from mastectomy, decreased need for both hospitalization and use of drugs, lowering hospital medical expenses. It has been suggested that PA is a possible intervention to enhance the quality of life of women with breast cancer both pre- and post- diagnosis, and after surgery 14 . Furthermore, exercise is “a subset of physical activity that is planned, structured, and repetitive” 10 . Exercise has been shown to help women with breast cancer and survivors improve their quality of life, cardiorespiratory fitness, physical functioning, and reduce tiredness 10, 14 . It may also increase overall and disease-free recovery in women with breast cancer, reduce breast cancer recurrence and improve quality of life in women with breast cancer postmastectomy 14, 15 . Women who have undergone mastectomy to treat breast cancer may have barriers to exercise in terms of biological mechanisms such as inflammation, immune function, and insulin sensitivity, body weight changes, other comorbidities, treatment effects, mental health, and quality of life 16 . In addition, given the nature of the breast cancer and the associated decline in physical function, women with breast cancer postmastectomy may not expect to derive benefit from exercise programs and struggle with outcome expectations despite exercise being routinely recommended for these women 16, 17 . Social support from family, friends, and healthcare professionals can encourage individuals to engage in regular PA by providing motivation and companionship 18, 19 . Cultural norms and values also play a critical role, with certain cultures placing a higher emphasis on PA than others 18, 19 . Additionally, studies in modern lifestyles, characterized by sedentary behaviour and increased screen time, underscore the importance of promoting PA to counteract these trends 20 . A lack of a patient-centred approach to prescribing PA may further limit motivation and outcome expectations in this population in Thailand. Understanding the adequate and appropriate level of PA and the factors that influence PA participation in women postmastectomy is essential for developing targeted interventions and support strategies to promote an active lifestyle in this population 21 . There are some key factors that are often associated with PA in post mastectomy women. First, personal motivation: women who are personally motivated and have a positive attitude towards PA are more likely to engage in regular exercise after mastectomy 8, 22 . Motivation could stem from a desire to regain strength, maintain a healthy lifestyle, or improve overall quality of life. Second, social support: having a strong support system, including friends, family, and healthcare professionals, can greatly influence a woman's decision to engage in PA after mastectomy 22 . Support from others can provide encouragement, guidance, and accountability. Third, body image and self-esteem: body image concerns and self-esteem can impact a woman's willingness to engage in PA after mastectomy 4 . Positive body image and high self-esteem are associated with a higher likelihood of participating in exercise and PA 8 . Fourth, physical limitations and side effects: physical limitations and side effects resulting from the mastectomy, such as pain, fatigue, lymphedema, and range of motion issues, can affect a woman's ability and willingness to engage in PA 8, 21 . These factors need to be considered and managed appropriately to ensure safe and effective participation in exercise. Finally, access to resources and programs: availability and accessibility of resources, such as exercise facilities, specialized programs, and knowledgeable, patient centred, healthcare professionals, can greatly influence a woman's ability to engage in PA postmastectomy 23, 24 . Access to suitable exercise options and guidance is crucial for a successful recovery. It is important to note that each woman's experience and circumstances may vary, so it is essential to consult with healthcare professionals who can provide personalized guidance based on the needs and preferences of individuals. This study sought to explore the level of PA most suited to women with breast cancer postmastectomy in Siriraj Hospital, which is the largest university hospital in Thailand. On the basis of the review of pertinent literature, we investigated the idea that perceived factors are more predictive of PA and exercise behaviour than perceived motivators in women with breast cancer postmastectomy. We also aimed to determine factors which are important to consider in women with breast cancer postmastectomy in Siriraj Hospital. We hypothesised that the results achieved, including the knowledge of modifiable, perceived factors influencing the PA could help physiotherapists develop strategies to promote both short-term and long-term adherence to increase PA and exercise in Thai women with breast cancer postmastectomy. The focus of this study was on a previously underexplored group, Thai women with breast cancer postmastectomy aged over 30—thereby addressing a significant gap in the literature and proposing new theoretical frameworks for understanding PA in this population. Methods Study design and setting of the study This study was cross-sectional in design with an aim of exploring the level of PA of women with breast cancer postmastectomy in outpatients from Siriraj Breast Clinic, Division of Head-Neck and Breast Surgery, Siriraj Hospital, Thailand from September 2023 to March 2024. Data collection was performed at a single session during patients' follow-up period with the doctor (DS and VL). Participants Previous studies have suggested that for exploratory factor analysis, a minimum of 50 samples is necessary, with around 100 samples being typically recommended 25, 26 . Therefore, we have provided a sample size of about 100 participants to the Ethical committee. However, there were only 93 participants who met the criteria. The inclusion criteria were: 1) women age ≥ 30 years with a diagnosis of breast cancer and had undergone surgery due to the statistics from the previous study that the incidence rate among Thai women was diagnosed aged between 40 to 60 years old 3 . However, we have decreased the age from 30 due to the medical expert of breast cancer suggestion (DS and VL), 2) all types of mastectomy e.g. total mastectomy with sentinel node biopsy, modified radical mastectomy, and total mastectomy; 3) both with and without reconstruction carried out more than 1 year prior, and 4) able to follow commands and instructions. The exclusion criteria were: 1) a cognitive impairment score ≤ 24/30 assessed using the Thai Mental State Examination 27 , 2) any use of medication for anxiety and/or dizziness; 3) self-reported neurological, musculoskeletal, or other problem which could influence the questionnaires, and, 4) any problems involving completion of the questionnaire resulted in stopping the interviews and exclusion from the study. Medical records relating to the primary diagnosis were used to provide details regarding tumor characteristics and treatment. Baseline questionnaires included information regarding adjuvant therapies. The Ethical Committee of Mahidol University Institutional Review Board, Mahidol University, Thailand gave approval for the study and written informed consent was obtained from each participant (COA No. MU-MOU 2023/127.2808) which was carried out fully in accordance with International Guidelines for Human Research Protection and the ethical standard guidelines of the Declaration of Helsinki. Procedure and outcome measures All participants self-administered the questionnaires on the same occasion. The questionnaires included: 1. Physical activity (PA) levels were assessed using the original English “Global Physical Activity Questionnaire” 28, 29 which was translated into Thai 30 . Participants indicated how often and for how long they engaged in moderate and vigorous physical activities as part of their work, transportation, or recreational activities during a typical week. This questionnaire was selected due to its satisfactory level of convergent validity (Spearman’s rho = 0.33, p < 0.01) when compared with physical activity measurements obtained from accelerometers, and its strong seven-day test-retest reliability (Spearman’s rho = 0.77, p < 0.01) among adults in Thailand [30]. In addition, a previous study considered perceptions regarding benefits and barriers to regular exercise behaviorus, which demonstrated good test-retest reliability (0.97, p < 0.0001) and internal consistency (Cronbach's alpha = 0.88), and had been confirmed as appropriate Thai working age people 31 for providing comprehensive insights into PA behaviour. The questionnaire consists of mixed types of questions, including both open-ended and closed-ended formats. The details of the questionnaires are: Part 1: Collection of demographic data including gender, age, education level and occupation. The history of breast cancer was recorded from medical records. Part 2: Assessment of PA, specifically 4 main sections: activities at work, transport, recreational activities and sedentary behaviour, 16 questions in total. The total PA and sub-domains of PA from moderate to vigorous PA and the sufficient level of PA were calculated in accordance with the World Health Organization's recommendations (WHO) 29 , 600 metabolic equivalent (MET)-minutes/week, including the following steps: Calculation of the energy from PA in each activity group (MET-minutes/week) = Intensity of PA (MET) x Duration used each day (minutes) x Number of days per week. Calculation of the total energy from all PA groups (work group + travel group + recreational group). Determination of the sufficient level of PA by dividing the total energy from all PA groups by 600 MET-minutes/week (according to the recommended sufficient level of PA by the WHO). If the value obtained was greater than or equal to 1, the participant is considered to have a sufficient level of PA. Part 3: Assessment of each domain of PA by the perceived benefits, specifically 12 items, perceived barriers 10 items, perceived self-efficacy 8 items, interpersonal influence 10 items and situational influence 8 items. The scores were used to calculate each domain with scoring criteria as follows 31 : Score 3.1-4 = High, indicating a strong feeling of each domain Score 2.1-3 = Moderately high, indicating a moderate feeling of each domain Score 1.1-2 = Low, indicating a slight feeling of each domain Score 0–1 = Very low, indicating a very slight feeling of each domain 2. The Body Image Index score was used, by permission 32 , and translated into Thai to evaluate a self-perception about physical appearance 33 . The Body Image Index score shows high internal consistency (Cronbach's alpha = 0.93) and has demonstrated good clinical validity based on the prevalence of responses, discriminant validity (p < 0.0001, Mann–Whitney test), sensitivity to change (p < 0.001, Wilcoxon signed ranks test), and consistency of scores across different breast cancer treatment centres 32 . The Body Image Index questionnaire consists of 10 questions about satisfaction with body parts and overall appearance, often using a Likert scale. Responses can evaluate body image concerns and self-perception. These tools are commonly used in psychological and medical research to understand body image issues, in this case in women with breast cancer postmastectomy 32 . 3. The Thai Hospital Anxiety and Depression Scale (Thai HADS) was used to assess depression or anxiety in participants. Thai HADS included a 7-item anxiety sub-scale (HADS-A) and a 7-item depression sub-scale (HADS-D). Thai HADS has been translated into Thai 34 . The sensitivity for the anxiety and depression subscales of Thai HADS is 100% and 85.71%, respectively, while specificity is 86.0% for anxiety and 91.3% for depression 34 . Thai HADS also shows a good internal consistency, with Cronbach’s alpha for the anxiety subscale and 0.8259 for the depression subscale, indicating it is a dependable and valid tool for screening anxiety and depression in Thai patients, especially those who are patients with cancer 34 . All questionnaires in this study were used after being granted permission by the relevant authors and organisations. Statistical Analysis SPSS version 29.0 (IBM Corporation, Armonk, NY) was used for statistical analysis. Descriptive statistics were used to describe the characteristics of the participants. The Chi-square test using Odds-Ratio (OR) and 95% Confidence Interval (CI) was applied to investigate the association between the factors, including demographic data (e.g., age, gender, education level, occupation, income, and underlying disease), and aspects of medical records pertinent to breast cancer and mastectomy, Thai Body Image Index, Thai HADS, perceived benefits, perceived barriers, perceived self-efficacy, interpersonal influence, situational influence, and PA characteristics (activities at work, transportations, recreational activities, and total physical activities). An OR exceeding 1 indicates a higher probability of the factor being associated among the independent variables, while an OR below 1 indicates a reduced likelihood of such an association. The statistical significance was set at p < 0.05. Results Demographic data and medical records of women with breast cancer postmastectomy The average age of participants was 60.5 ± 10.5 years and time from mastectomy surgery was 6.0 ± 5.1 years. Most patients presented as breast cancer stage 1 (n = 38, 40.9%), had undergone the total mastectomy (n = 48, 51.6%), and had breast cancer on the left side (n = 54, 58%). All had received adjuvant therapies and were independently ambulant without using an assistive device (n = 93, 100%). The majority reported no lymphedema (n =79, 84.9%) and no complications after mastectomy (n = 52, 55.9%). The most common comorbidities were hypertension (n = 38; 40.9%). Most of the participants graduated at Bachelor degree level (n = 36; 37.8%) and continued working in their usual employment (n = 54, 58.1%) with a salary income of more than 30,000 Thai baht per month (about $857). Other demographic data and details of medical records of participants are shown in Table 1. [Table 1 Here] Reporting of engagement in physical activity (PA) of women with breast cancer postmastectomy Seventy-two percent of participants travelled to and from activities either on foot or by using a bicycle (pedal cycle), 64% were engaged in recreational activities, and 51% performed work-based activities (Table 2). With regards subgroup domains of PA, 54.8% of participants performed moderate activity at work over 7 days for 55 minutes per day, whereas only 10.8% of participants performed vigorous activity at work in 1 day for 74 minutes per day. In the recreational domain 14% of participants performed vigorous-intensity recreational activities and 62% of participants performed moderate-intensity recreational activities. For those that travelled to and from places, the activity on foot or using a bicycle (pedal cycle), 73.1% walked for at least 10 minutes continuously. Finally, sedentary behaviour was reported as an average of 224.9 minutes a day. Total PA averaged 1680 MET-minutes/week, and an adequate PA level of 2.8 METs. [Table 2 Here] Reporting of Body Image Index and Thai Hospital Anxiety and Depression Scale of women with breast cancer postmastectomy Seventy-six percent of participants were very satisfied with the Body Image Index, 15% were moderately satisfied, and 2% were slightly satisfied with the Thai Body Image Index (Table 3). With regards to Thai HAD, no one was reported to have depression or anxiety, considering the scores of our results and the previous reports [34] (Table 3). [Table 3 Here] Perceived benefits, perceived barriers, perceived self-efficacy, interpersonal influence, and situational influence with the physical activity (PA) of women with mastectomy Figure 1 demonstrates the outcomes regarding the impact of perceived benefits, perceived barriers, perceived self-efficacy, interpersonal influence, and situational influence on the PA of women with mastectomy for the 93 participants. The perceived benefits were notably high, indicating a strong belief in the benefits and capabilities (mean ± SD = 3.54 ± 0.46). Perceived self-efficacy, interpersonal influence, and situational influence scored relatively high (mean ± SD = 2.82 ± 0.72, 2.33 ± 0.76 and 2.68 ± 0.8, respectively), while perceived barriers were low (mean ± SD = 1.57 ± 0.44), indicating minimal barriers for Thai women with mastectomy in this study. Factors association with physical activity (PA) in Thai women with breast cancer after mastectomy In this cohort of 93 women with breast cancer postmastectomy (Table 4), the factors associated with an appropriate level of PA included recreational and overall PA levels specifically: those engaging in activity at work (OR = 3.2, 95% CI = 1.357 - 7.548), an income of more than 30,000 Thai baht (OR = 4.5, 95% CI = 4.500 (1.549 - 13.070), moderate satisfaction on Body Image Index score (OR = 4, 95% CI = 1.045 - 15.317) and a higher score of Thai Hospital Anxiety and Depression Scale (OR = 2.969, 95% CI = 1.103 - 7.992). In addition, the findings indicate that individuals engaging in recreational activities recorded older age (OR = 0.245, 95% CI = 0.088 - 0.682), significantly high scores of perceived self-efficacies (OR = 3.284, 95% CI = 11.110 - 9.719), and significantly high scores of interpersonal influences (OR = 3.382, 95% CI = 1.215 - 9.416). However, no significant associations were found between the factors and travelling to and from the activity on foot or using a bicycle (pedal cycle) (Table 4). [Table 4 Here] Discussion Our study aimed to investigate the adequate physical activity (PA) level and the factors associated with PA among Thai women who had undergone mastectomy due to breast cancer at Siriraj Hospital, Thailand. The findings provide valuable insights into the levels of PA engagement and the influences affecting participation in PA in this population. The demographic data shows that most participants in this study were pre-elderly to elderly with a mean age of 60.5 ± 10.5 years, 37.8% graduated at Bachelor degree level and 58.1% had high salary income for Thailand (more than 30,000 Thai baht). Data pertinent to the breast cancer and surgery shows that participants had a mean duration post-mastectomy of 6.0 ± 5.1 years, covering all stages of breast cancer (the majority being at stage 1 of breast cancer). Just over half, 51.6%, of participants had received total mastectomy, removal of the whole breast, including the nipple, areola, and the majority of the overlying skin. Previous research by Mason et al. in 2013 studied 631 women for a decade, examining their PA levels before and after a diagnosis of breast cancer 35 . They discovered that only a minority consistently met PA guidelines over the 10-year period, with participation declining over time. The meeting of guidelines initially was linked to continued adherence at 5- and 10-years post-diagnosis. However, no demographic factors predicted long-term changes in PA levels 35 . A notable observation from our study that is the level of engagement of PA and the adequate PA level among 93 participants were similar, despite the challenges posed by mastectomy. Seventy-two percent of participants reported engaging in walking or cycling for transportation, while 64% participated in recreational activities, and 51% were active in their work setting. Importantly, in this cohort average total PA = 1680 MET-minutes/week and PA level of 2.8 METs, indicating an adequate level of PA according to the WHO guidelines 28, 29 . These findings suggest a willingness among Thai women with breast cancer postmastectomy to engage in various forms of PA, highlighting the importance of promoting and supporting such behaviours in this population. In contrast to our findings, a previous study using tools such as the International Physical Activity Questionnaire (IPAQ), Stanford Health Assessment Questionnaire (HAQ-20), and Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), reported postmastectomy women or those who had undergone breast-saving surgery exhibited lower levels of PA and quality of life compared to those who underwent breast reconstruction 36 . In addition, De Groef et al. in 2018 found that a 2-year follow-up study of 267 consecutive breast cancer patients in Belgium into PA levels showed that they remained significantly lower two years after breast cancer surgery compared to preoperative levels 37 . There are several possible reasons that Thai women who have undergone mastectomy maintain their PA levels. Firstly, the perceived benefits of PA, Thai women may perceive numerous benefits associated with PA, such as improved physical fitness, mental well-being, and overall quality of life. These perceived benefits may motivate them to continue engaging in PA 14 . Secondly, engaging in PA and health benefits postmastectomy can instill a sense of empowerment and control over one's health. It allows women to regain a sense of agency and resilience, demonstrating their ability to overcome physical challenges and maintain an active lifestyle 38 . It was evident that highly intelligent, high-earning women and the majority of those employed, are more likely to engage with the positive aspects of PA compared to lower-earning, potentially less well-educated women with lower expectations. Our findings also indicate that the majority of participants graduated with a Bachelor's degree and work as a government employee. Higher educational attainment with a good job may be associated with greater health awareness, which could encourage these individuals to pursue physical activity outside of work hours to balance their typically sedentary jobs 39 . Thirdly, social support from family, friends, healthcare professionals, and support groups can play a crucial role in encouraging women to remain physically active after mastectomy. Positive social interactions and encouragement from peers can provide motivation and accountability for maintaining PA levels 40 . Finally, the perceived benefits of PA among participants were notably high, indicating a strong belief in the positive outcomes associated with PA. Similarly, perceived self-efficacy, interpersonal influence, and situational influence were relatively high, suggesting that participants felt confident in their ability to engage in PA and were influenced by social and environmental factors. These findings are supported by Mishra and colleagues in 2023 who reported that the underscoring of the importance of addressing psychosocial factors in promoting PA among women with breast cancer postmastectomy 41 . Our analysis of factors associated with PA revealed several noteworthy findings. Engagement in PA at work was associated with occupation, higher income, moderate satisfaction with Thai Body Image Index score, and higher levels of anxiety and depression. Additionally, participation in recreational activities was associated with older age, higher perceived self-efficacy, and greater interpersonal influence. These findings highlight the complex interplay of individual, social, and environmental factors influencing PA engagement among women postmastectomy. However, the findings are summarized and discussed in each point below. The significant association between PA at work and occupation, and higher incomes among Thai women with breast cancer postmastectomy breast cancer is significant. No study has directly investigated these association. One possible explanation for this association is the impact of PA on productivity, job performance, and financial status in older adults 42 , which may be relevant to our sample. Before a diagnosis of breast cancer, individuals who engage in regular PA may experience improvements in energy levels, concentration, and overall well-being, which can positively influence their work performance and career advancement opportunities. Further research should explore these associations and evaluate interventions to promote PA in the workplace for this population. An association was found between engagement in PA at work and moderate satisfaction with the Body Image Index score which highlights the potential psychological affects in Thai women with breast cancer postmastectomy. This idea is supported by the findings of Türk & Yılmaz in 2018, when they reported that this association suggests that incorporating PA into the workday may contribute positively to body image perceptions, particularly in the moderate satisfaction range 43 . PA can enhance self-esteem, promote a sense of accomplishment, and foster body appreciation, which may contribute to improved body image. Janowski and colleagues in 2020 suggested that the workplace environment, with its opportunities for social support and positive reinforcement, may serve as a conducive setting for individuals to develop a more positive perception of their bodies [40]. However, it's important to acknowledge that individual differences and contextual factors can influence the relationship between PA at work and body image satisfaction. Further research is needed to explore these dynamics and to develop targeted interventions that promote positive body image through workplace PA initiatives. The research indicated a link between engagement in PA at work and higher levels of anxiety and depression which raises important considerations. While PA is typically associated with improved mental health, this association suggests a more complex relationship in the workplace 44 . Several factors may contribute to this finding, including individuals using PA as a coping mechanism for anxiety or depression, workplace-related stressors influencing both PA engagement and mental health, and variations in exercise intensity and preferences in Thai women with breast cancer postmastectomy 41 . Further research is needed to better understand these dynamics and develop strategies to support the mental well-being of employees alongside workplace PA initiatives. The significant association between individuals aged over 60 and recreational activity is increasingly recognized for its positive impact on overall well-being in Thai women with breast cancer postmastectomy. Studies consistently reveal a notable correlation between increasing age and heightened engagement in leisure pursuits 45, 46 . In 2023, Tripathi & Samanta found that such activities, ranging from social gatherings to outdoor excursions, serve as avenues for maintaining physical health, cognitive function, and emotional resilience among older adults 46 . Moreover, recreational endeavors provide opportunities for meaningful social interactions, contributing to a sense of purpose and belonging in later life 46 . Recognition of this association underscores the importance of promoting and facilitating recreational activities tailored to the needs and interests of older individuals. Ultimately, fostering an active lifestyle in this demographic may enhance the quality of life and promote healthy aging. Higher perceived self-efficacy and greater interpersonal influence are significantly associated with recreational activities in Thai women with breast cancer post- mastectomy. Through the setting and achieving of goals in activities like sports or fitness classes, individuals build confidence in their abilities, creating a positive feedback loop of increased engagement and self-belief. These findings are supported by previous studies which demonstrated that social interactions inherent in these activities provide opportunities for social learning, where observing and learning from others enhances skills and confidence after those who have been diagnosed with breast cancer and undergone a mastectomy 16, 21 . As early as 2006 McNeely et al. reported that social support networks in recreational settings offer encouragement and motivation, reinforcing one's belief in their abilities 14 . These experiences can transfer to other areas of life, improving overall well-being and resilience. Understanding these connections can inform interventions and programs aimed at promoting personal development and well-being through recreational engagement in this population. Contrary to expectations, our study found no significant association between breast cancer stages and mastectomy, and PA levels. Despite the well-established benefits of PA for overall health, other factors beyond exercise may predominantly influence cancer progression 14 . The findings between mastectomy and PA suggests that the psychological and emotional impact of surgery may outweigh its physical effects on activity levels 30 . Individuals may find motivation in PA as a coping mechanism, or they may adjust their routines to accommodate post-surgical changes. In addition, our study has shown that Thai women with breast cancer postmastectomy had a reliance on self-reported data and potential oversight of other influential variables including socioeconomic status and access to healthcare which was data collected at the biggest medical school at Siriraj Hospital. Our research has several limitations. Firstly, the sample size is relatively small compared to the previous studies 13, 21 . Due to practical constraints, including limited access to participants and resource restrictions, we were unable to increase the sample size. This limitation may affect the generalizability of our findings, as a larger sample would provide more robust data and potentially reveal additional trends and correlations. We acknowledge that the small sample size could introduce a degree of bias and reduce the statistical power of the study. Future research should aim to include a larger, more diverse cohort to validate our results and enhance the reliability of the conclusions drawn. Secondly, the sample may not be representative; participants were recruited from a single breast cancer clinic at Siriraj Hospital. However, this study is a good beginning with several avenues opened for exploration in the future as regards PA levels in this field. The high levels of motivation of this cohort facilitated extensive completion of the questionnaires, offering a unique opportunity to explore various aspects of Thai women with breast cancer postmastectomy and the level of PA within the group. However, a third limitation, or rather showing a potential extension for the future, our study included only women who had undergone a surgical mastectomy, limiting the exploration of an association between PA and multidimensional surgical techniques. Finally, our data did not show significant results when multiple regression was applied, therefore, we have excluded of multiple regression analysis, which could have provided a more comprehensive understanding of the interactions between various factors influencing physical activity. Future research could address this by employing multiple regression to capture the combined effects and potential interactions of multiple predictors. Conclusion This study provides valuable insights into the perceptions around an adequate level of PA among Thai women who have undergone mastectomy. Our study into the factors associated to PA revealed several notable findings, specifically that participation in PA at work was associated with occupation, higher incomes, moderate satisfaction with the Thai Body Image Index, and elevated levels of anxiety and depression. Furthermore, engagement in recreational activities was associated with older age, increased perceived self-efficacy, and greater interpersonal influence. Promotion and supporting PA engagement in this population is essential for enhancing overall health and well-being. Future research should focus on developing tailored interventions to address barriers to PA and promote a more active lifestyle among Thai women with breast cancer postmastectomy. Declarations Competing interests The authors declare no competing interests. Author Contribution All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by F.K, P.W., D.S, S.P., S.P., V.L. and W.K.. The first draft of the manuscript was written by F.K and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Acknowledgement The authors would like to thank all members from Faculty of Physical Therapy, Mahidol University and Siriraj Breast Clinic, Division of Head-Neck and Breast Surgery, Siriraj Hospital. The authors would also like to thank to all participants who participated in this study. Data Availability The data presented in this study are available from the corresponding author upon reasonable request. References Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al . Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA. Cancer. J. 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Characteristics n = 93 Age (years): mean ± SD (range) 60.5 ± 10.5 (38, 85) Thai Mental State Examination: mean ± SD (range) 27.9 ± 3.82 (26, 30) Time from mastectomy surgery (years): mean ± SD (range) 6.0 ± 5.1 (1, 31.6) Stage of breast cancer - 0 (n, %) - 1 (n, %) - 2 (n, %) - 3 (n, %) - 4 (n, %) 8 (8.6%) 38 (40.9%) 27 (29.0%) 19 (20.4%) 1 (1.1%) Side of breast cancer - Right (n, %) - Left (n, %) - Both (n, %) 30 (32.3%) 54 (58.0%) 9 (9.7%) Type of mastectomy - Total mastectomy (n, %) - Modified radical mastectomy (n, %) - Nipple sparing mastectomy (n, %) 48 (51.6%) 38 (40.9%) 7 (7.5%) Adjuvant therapies Yes 93 (100%) Lymphedema phenomenon - Yes - No 14 (15.1%) 79 (84.9%) Complication of mastectomy - Yes - No 41 (44.1%) 52 (55.9%) Ambulation (n, %) - Independent without assistive device 93 (100%) Number of comorbidities (n, %) - Hypertension - Diabetes mellitus - Dyslipidemia - Heart disease - Others 38 (40.9%) 17 (18.3%) 25 (26.9%) 11 (11.8%) 9 (9.7%) Marital status (n, %) - Single - Married - Divorce/Widow 25 (26.9%) 53 (57.0%) 15 (16.1%) Education levels (n, %) - Uneducated - Primary school - Secondary school - Diploma degree - Bachelor degree - Master/Doctoral degree - 18 (19.4%) 15 (16.1%) 11 (11.8%) 36 (38.7%) 13 (14.0%) Occupation (n, %) - Unemployed - Employed · Government employee · Self-employed · Employees of the company · Farmers 39 (41.9%) 54 (58.1%) 26 (48.1%) 15 (27.7%) 7 (12.9%) 4 (7.4%) Income per month (n, %) - None - ≤ 10,000 - >10,000 – 20,000 - >20,000 - 30,000 - >30,000 - No data 1 (1.1%) 25 (26.9%) 16 (17.2%) 8 (8.6%) 39 (41.9%) 4 (4.3%) n – number of participants, % - percent, SD – standard deviation Table 2 . Physical activity characteristics of women with breast cancer postmastectomy. Physical activity characteristics n = 93 Physical activity (n, %) - Activity at work - Transportation - Recreational 51 (54.8%) 67 (72.0%) 64 (68.8%) Sub-domain of Physical activity (n, %) - Vigorous work (n, %) - Moderate work (n, %) - Transportation (n, %) - Vigorous recreation (n, %) - Moderate recreation (n, %) - Sitting (mean ± SD (range)) 12 (10.8%) 51 (54.8%) 68 (73.1%) 13 (14.0%) 62 (66.7%) 224.9 ± 171.9 (10, 840) Total Physical Activity MET-minutes/week: median (range) 1680 (80, 13440) The adequate physical activity level (MET) 2.8 (0.13, 22.40) MET: metabolic equivalent of task n – number of participants, % - percent Table 3 . Body Image Index score and Thai Hospital Anxiety and Depression Scale of women with breast cancer postmastectomy. Score n = 93 Body Image Index score: mean ± SD (range) Very satisfied Moderate satisfied Little satisfied 14.0 ± 5.8 (10, 36) 76 (81.7%) 15 (16.1%) 2 (2.2%) Thai Hospital Anxiety and Depression Scale Total: mean ± SD (range) Score 0-7 Score 8-10 Score 11-21 Anxiety: mean ± SD (range) Depression: mean ± SD (range) 5.6 ± 4.8 (0, 19) 67 (72.1%) 11 (11.8%) 15 (16.1%) 3.4 ± 2.9 (0, 10) 2.2 ± 2.3 (0, 9) n – number of participants, % - percent, SD – standard deviation Table 4. Factors associated with physical activity of women with breast cancer postmastectomy. Factors Activity at work Transportation Recreational activities Total Odds ratio ( 95 % CI ) Odds ratio ( 95 % CI ) Odds ratio ( 95 % CI ) Odds ratio ( 95 % CI ) Age (years) - <60 - ≥60 1.000 0.431 (0.183, 1.013) 1.00 2.443 (0.969, 6.158) 1.000 0.245 (0.088, 0.682) * 1.000 0.676 (0.117, 3.887) Status - Single/widowed/divorced/separate - Married 1.000 1.180 (0.517, 2.692) 1.000 0.615 (0.240, 1.574) 1.000 1.113 (0.460, 2.695) 1.000 0.645 (0.112, 3.708) Education - Non-Primary school - Secondary school – Vocational - Bachelor-higher than bachelor 1.000 0.781 (0.231, 2.646) 2.578 (0.854, 7.783) 1.000 2.171 (0.609, 7.739) 02.764 (0.878, 8.698) 1.000 1.091 (0.325, 3.667) 3.120 (0.977, 9.958) 1.000 0.958 (0.143, 6.404) 6.000 (0.509, 70.668) Occupation - No - Yes 1.000 3.200 (1.357, 7.548) * 1.000 0.403 (0.150, 1.085) 1.000 2.194 (0.899, 5.355) 1.000 2.971 (0.516, 17.110) Incomes - ≤10,000 - >10,000 – 30,000 - >30,000 1.000 3.750 (1.160, 12.122) 4.500 (1.549, 13.070) * 1.000 0.476 (0.131, 1.735) 0.536 (0.163, 1.759) 1.000 1.875 (0.556, 6.324) 1.591 (0.555, 4.564) 1.000 0.200 (0.021, 1.934) 1.520 (0.091, 25.434) Body Image Index score - Very satisfied - Moderate satisfied - Little satisfied 1.000 4.000 (1.045, 15.317) * 1.000 (0.060, 16.577) 1.000 0.381 (0.122, 1.191) N/A 1.000 0.923 (0.284, 2.996) N/A 1.000 0.361 (0.060, 2.178) N/A Thai Hospital Anxiety and Depression Scale - No (<8) - Yes (≥8) 1.000 2.969 (1.103, 7.992) 1.000 1.418 (0.496, 4.060) 1.000 1.742 (0.614, 4.942) 1.000 N/A Underlying disease - Hypertension - Diabetes mellitus - Dyslipidemia - Heart disease 0.600 (0.260, 1.382) 0.376 (0.126, 1.123) 0.686 (0.274, 1.723) 0.652 (0.184, 2.309) 1.149 (0.454, 2.904) 1.324 (0.389, 4.509) 1.319 (0.459, 3.792) 1.040 (0.253, 4.265) 0.426 (0.174, 1.042) 0.582 (0.197, 1.724) 0.741 (0.281, 1.952) 1.238 (0.303, 5.051) 0.673 (0.128, 3.528) N/A 0.338 (0.064, 1.801) 0.649 (0.069, 6.135) Duration since surgery (years) 0.963 (0.886, 1.047) 1.025 (0.929, 1.130) 1.098 (0.969, 1.243) 1.031 (0.848, 1.253) Stage of breast cancer - 0 - 1 - 2 - 3 1.000 2.292 (0.477, 11.010) 2.424 (0.478, 12.302) 1.667 (0.311, 8.928) 1.000 2.455 (0.519, 11.601) 3.500 (0.668, 18.343) 3.000 (0.539, 16.689) 1.000 1.473 (0.299, 7.250) 1.425 (0.273, 7.439) 1.114 (0.203, 6.105) N/A Side of breast cancer - Right - Left - Both 0.613 (0.148, 2.544) 2.300 (0.492, 10.743) 1.000 0.605 (0.113, 3.227) 0.980 (0.165, 5.825) 1.000 1.267 (0.280, 5.730) 0.909 (0.189, 4.366) 1.000 1.200 (0.124, 11.659) N/A 1.000 Type of mastectomy - Total mastectomy - Modified radical mastectomy - Nipple sparing mastectomy 1.000 1.451 (0.608, 3.462) 0.141 (0.016, 1.262) 1.000 1.040 (0.397, 2.723) 0.495 (0.097, 2.519) 1.000 0.714 (0.283, 1.800) 0.495 (0.097, 2.519) 1.000 3.364 (0.360, 31.422) 0.545 (0.052, 5.728) Complications - No - Yes 1.000 1.872 (0.811, 4.321) 1.000 1.379 (0.547, 3.473) 1.000 0.424 (0.173, 1.037) 1.000 1.625 (0.283, 9.344) Perceived benefits Low (1.00 – 3.46) High (3.47 – 4.00) 1.000 0.811 (0.352, 1.867) 1.000 1.086 (0.434, 2.722) 1.000 1.032 (0.423, 2.516) 1.000 0.708 (0.123, 4.077) Perceived barriers Low (1.00 – 1.45) High (1.46 – 4.00) 1.000 0.625 (0.271, 1.444) 1.000 0.819 (0.324, 2.068) 1.000 0.635 (0.256, 1.578) 1.000 1.417 (0.270, 7.422) Perceived self-efficacy Low (1.00 – 3.12) High (3.13 – 4.00) 1.000 1.818 (0.748, 4.420) 1.000 0.923 (0.355, 2.401) 1.000 3.284 (1.110, 9.719) * 1.000 N/A Interpersonal influence Low (1.00 – 2.78) High (2.79 – 4.00) 1.000 1.832 (0.779, 4.312) 1.000 2.071 (0.768, 5.587) 1.000 3.382 (1.215, 9.416) * 1.000 N/A Situational influence Low (1.00 – 3.00) High (3.01 – 4.00) 1.000 1.069 (0.457, 2.498) 1.000 1.427 (0.543, 3.753) 1.000 1.425 (0.560, 3.622) 1.000 3.056 (0.342, 27.309) * statistical significantp<0.05 N/A – Not applicable CI – Confident interval Additional Declarations No competing interests reported. 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When compared to Asian populations, Western populations, including those in Australia and New Zealand, North America, and Western Europe, have a significantly higher incidence of breast cancer\u003csup\u003e1\u003c/sup\u003e. However, due to the early detection and advancements in treatment, the fatality rate for breast cancer has significantly decreased in Western populations. However, the prevalence of breast cancer in Thailand is increasing at an alarming rate. In Thailand the annual incidence of breast cancer is showing an increasing trend, from 17.8 per 100,000 in 1998 to 26.6 per 100,000 in 2012 to 31.4 per 100,000 in 2015. The condition is most prevalent in the 40 to 60-year age group\u003csup\u003e2\u0026ndash;3\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eCancer diagnosis and treatment have a significant impact on the psychological health of patients, especially when surgery is involved\u003csup\u003e4\u0026ndash;6\u003c/sup\u003e. There are several types of mastectomy procedures involved in the treatment of breast cancer specifically: total (simple) mastectomy, modified radical mastectomy, radical mastectomy, skin-sparing mastectomy, and nipple-sparing mastectomy\u003csup\u003e5, 6\u003c/sup\u003e. The choice of mastectomy type depends on a range of factors, the reason for the procedure, the size and location of any tumors, and the overall health of the patient\u003csup\u003e5, 6\u003c/sup\u003e. After a mastectomy, breast reconstruction surgery can be performed to restore the appearance of the breast\u003csup\u003e5, 6\u003c/sup\u003e. Every year, more than 10,000 women in Thailand undergo a mastectomy\u003csup\u003e7\u003c/sup\u003e; the psychological impact on patients, affecting various aspects of quality of life including self-image, self-esteem, and sexual relationships. The procedure is also associated with high rates of depression\u003csup\u003e8\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePhysical activity (PA) has been well-documented for its substantial health benefits\u003csup\u003e9, 10\u003c/sup\u003e. PA is \u0026ldquo;any bodily movement produced by skeletal muscles that requires energy expenditure\u0026rdquo;\u003csup\u003e10\u003c/sup\u003e. It includes all forms of movement, from light activities like walking and gardening to vigorous activities like running and swimming. According to epidemiological studies inactivity and the underlying diseases which presence of cardiovascular risk factors including hypertension, insulin resistance, non-insulin dependent diabetes, dyslipidemia, and obesity are strongly linked\u003csup\u003e9, 11\u003c/sup\u003e. It has also been suggested that consistent PA is effective for the prevention and treatment of the aforementioned illnesses as well as chronic conditions like osteoporosis, also helping to reduce stress and improve self-esteem\u003csup\u003e12, 13\u003c/sup\u003e. PA has been shown to be effective in ensuring the reduction in sequelae of the complication from mastectomy, decreased need for both hospitalization and use of drugs, lowering hospital medical expenses. It has been suggested that PA is a possible intervention to enhance the quality of life of women with breast cancer both pre- and post- diagnosis, and after surgery\u003csup\u003e14\u003c/sup\u003e. Furthermore, exercise is \u0026ldquo;a subset of physical activity that is planned, structured, and repetitive\u0026rdquo;\u003csup\u003e10\u003c/sup\u003e. Exercise has been shown to help women with breast cancer and survivors improve their quality of life, cardiorespiratory fitness, physical functioning, and reduce tiredness\u003csup\u003e10, 14\u003c/sup\u003e. It may also increase overall and disease-free recovery in women with breast cancer, reduce breast cancer recurrence and improve quality of life in women with breast cancer postmastectomy\u003csup\u003e14, 15\u003c/sup\u003e. Women who have undergone mastectomy to treat breast cancer may have barriers to exercise in terms of biological mechanisms such as inflammation, immune function, and insulin sensitivity, body weight changes, other comorbidities, treatment effects, mental health, and quality of life\u003csup\u003e16\u003c/sup\u003e. In addition, given the nature of the breast cancer and the associated decline in physical function, women with breast cancer postmastectomy may not expect to derive benefit from exercise programs and struggle with outcome expectations despite exercise being routinely recommended for these women\u003csup\u003e16, 17\u003c/sup\u003e. Social support from family, friends, and healthcare professionals can encourage individuals to engage in regular PA by providing motivation and companionship\u003csup\u003e18, 19\u003c/sup\u003e. Cultural norms and values also play a critical role, with certain cultures placing a higher emphasis on PA than others\u003csup\u003e18, 19\u003c/sup\u003e. Additionally, studies in modern lifestyles, characterized by sedentary behaviour and increased screen time, underscore the importance of promoting PA to counteract these trends\u003csup\u003e20\u003c/sup\u003e. A lack of a patient-centred approach to prescribing PA may further limit motivation and outcome expectations in this population in Thailand.\u003c/p\u003e \u003cp\u003eUnderstanding the adequate and appropriate level of PA and the factors that influence PA participation in women postmastectomy is essential for developing targeted interventions and support strategies to promote an active lifestyle in this population\u003csup\u003e21\u003c/sup\u003e. There are some key factors that are often associated with PA in post mastectomy women. First, personal motivation: women who are personally motivated and have a positive attitude towards PA are more likely to engage in regular exercise after mastectomy\u003csup\u003e8, 22\u003c/sup\u003e. Motivation could stem from a desire to regain strength, maintain a healthy lifestyle, or improve overall quality of life. Second, social support: having a strong support system, including friends, family, and healthcare professionals, can greatly influence a woman's decision to engage in PA after mastectomy\u003csup\u003e22\u003c/sup\u003e. Support from others can provide encouragement, guidance, and accountability. Third, body image and self-esteem: body image concerns and self-esteem can impact a woman's willingness to engage in PA after mastectomy\u003csup\u003e4\u003c/sup\u003e. Positive body image and high self-esteem are associated with a higher likelihood of participating in exercise and PA\u003csup\u003e8\u003c/sup\u003e. Fourth, physical limitations and side effects: physical limitations and side effects resulting from the mastectomy, such as pain, fatigue, lymphedema, and range of motion issues, can affect a woman's ability and willingness to engage in PA\u003csup\u003e8, 21\u003c/sup\u003e. These factors need to be considered and managed appropriately to ensure safe and effective participation in exercise. Finally, access to resources and programs: availability and accessibility of resources, such as exercise facilities, specialized programs, and knowledgeable, patient centred, healthcare professionals, can greatly influence a woman's ability to engage in PA postmastectomy\u003csup\u003e23, 24\u003c/sup\u003e. Access to suitable exercise options and guidance is crucial for a successful recovery. It is important to note that each woman's experience and circumstances may vary, so it is essential to consult with healthcare professionals who can provide personalized guidance based on the needs and preferences of individuals.\u003c/p\u003e \u003cp\u003eThis study sought to explore the level of PA most suited to women with breast cancer postmastectomy in Siriraj Hospital, which is the largest university hospital in Thailand. On the basis of the review of pertinent literature, we investigated the idea that perceived factors are more predictive of PA and exercise behaviour than perceived motivators in women with breast cancer postmastectomy. We also aimed to determine factors which are important to consider in women with breast cancer postmastectomy in Siriraj Hospital. We hypothesised that the results achieved, including the knowledge of modifiable, perceived factors influencing the PA could help physiotherapists develop strategies to promote both short-term and long-term adherence to increase PA and exercise in Thai women with breast cancer postmastectomy. The focus of this study was on a previously underexplored group, Thai women with breast cancer postmastectomy aged over 30\u0026mdash;thereby addressing a significant gap in the literature and proposing new theoretical frameworks for understanding PA in this population.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and setting of the study\u003c/h2\u003e \u003cp\u003eThis study was cross-sectional in design with an aim of exploring the level of PA of women with breast cancer postmastectomy in outpatients from Siriraj Breast Clinic, Division of Head-Neck and Breast Surgery, Siriraj Hospital, Thailand from September 2023 to March 2024. Data collection was performed at a single session during patients' follow-up period with the doctor (DS and VL).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003ePrevious studies have suggested that for exploratory factor analysis, a minimum of 50 samples is necessary, with around 100 samples being typically recommended\u003csup\u003e25, 26\u003c/sup\u003e. Therefore, we have provided a sample size of about 100 participants to the Ethical committee. However, there were only 93 participants who met the criteria. The inclusion criteria were: 1) women age\u0026thinsp;\u0026ge;\u0026thinsp;30 years with a diagnosis of breast cancer and had undergone surgery due to the statistics from the previous study that the incidence rate among Thai women was diagnosed aged between 40 to 60 years old\u003csup\u003e3\u003c/sup\u003e. However, we have decreased the age from 30 due to the medical expert of breast cancer suggestion (DS and VL), 2) all types of mastectomy e.g. total mastectomy with sentinel node biopsy, modified radical mastectomy, and total mastectomy; 3) both with and without reconstruction carried out more than 1 year prior, and 4) able to follow commands and instructions. The exclusion criteria were: 1) a cognitive impairment score\u0026thinsp;\u0026le;\u0026thinsp;24/30 assessed using the Thai Mental State Examination\u003csup\u003e27\u003c/sup\u003e, 2) any use of medication for anxiety and/or dizziness; 3) self-reported neurological, musculoskeletal, or other problem which could influence the questionnaires, and, 4) any problems involving completion of the questionnaire resulted in stopping the interviews and exclusion from the study. Medical records relating to the primary diagnosis were used to provide details regarding tumor characteristics and treatment. Baseline questionnaires included information regarding adjuvant therapies. The Ethical Committee of Mahidol University Institutional Review Board, Mahidol University, Thailand gave approval for the study and written informed consent was obtained from each participant (COA No. MU-MOU 2023/127.2808) which was carried out fully in accordance with International Guidelines for Human Research Protection and the ethical standard guidelines of the Declaration of Helsinki.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eProcedure and outcome measures\u003c/h2\u003e \u003cp\u003eAll participants self-administered the questionnaires on the same occasion. The questionnaires included:\u003c/p\u003e \u003cp\u003e1. Physical activity (PA) levels were assessed using the original English \u0026ldquo;Global Physical Activity Questionnaire\u0026rdquo;\u003csup\u003e28, 29\u003c/sup\u003e which was translated into Thai\u003csup\u003e30\u003c/sup\u003e. Participants indicated how often and for how long they engaged in moderate and vigorous physical activities as part of their work, transportation, or recreational activities during a typical week. This questionnaire was selected due to its satisfactory level of convergent validity (Spearman\u0026rsquo;s rho\u0026thinsp;=\u0026thinsp;0.33, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) when compared with physical activity measurements obtained from accelerometers, and its strong seven-day test-retest reliability (Spearman\u0026rsquo;s rho\u0026thinsp;=\u0026thinsp;0.77, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) among adults in Thailand [30]. In addition, a previous study considered perceptions regarding benefits and barriers to regular exercise behaviorus, which demonstrated good test-retest reliability (0.97, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) and internal consistency (Cronbach's alpha\u0026thinsp;=\u0026thinsp;0.88), and had been confirmed as appropriate Thai working age people\u003csup\u003e31\u003c/sup\u003e for providing comprehensive insights into PA behaviour. The questionnaire consists of mixed types of questions, including both open-ended and closed-ended formats. The details of the questionnaires are:\u003c/p\u003e \u003cp\u003ePart 1: Collection of demographic data including gender, age, education level and occupation. The history of breast cancer was recorded from medical records.\u003c/p\u003e \u003cp\u003ePart 2: Assessment of PA, specifically 4 main sections: activities at work, transport, recreational activities and sedentary behaviour, 16 questions in total. The total PA and sub-domains of PA from moderate to vigorous PA and the sufficient level of PA were calculated in accordance with the World Health Organization's recommendations (WHO)\u003csup\u003e29\u003c/sup\u003e, 600 metabolic equivalent (MET)-minutes/week, including the following steps:\u003c/p\u003e \u003cp\u003e \u003col style=\"list-style-type:lower-alpha;\"\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eCalculation of the energy from PA in each activity group (MET-minutes/week)\u0026thinsp;=\u0026thinsp;Intensity of PA (MET) x Duration used each day (minutes) x Number of days per week.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eCalculation of the total energy from all PA groups (work group\u0026thinsp;+\u0026thinsp;travel group\u0026thinsp;+\u0026thinsp;recreational group).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eDetermination of the sufficient level of PA by dividing the total energy from all PA groups by 600 MET-minutes/week (according to the recommended sufficient level of PA by the WHO).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eIf the value obtained was greater than or equal to 1, the participant is considered to have a sufficient level of PA.\u003c/p\u003e \u003cp\u003ePart 3: Assessment of each domain of PA by the perceived benefits, specifically 12 items, perceived barriers 10 items, perceived self-efficacy 8 items, interpersonal influence 10 items and situational influence 8 items. The scores were used to calculate each domain with scoring criteria as follows\u003csup\u003e31\u003c/sup\u003e:\u003c/p\u003e \u003cp\u003eScore 3.1-4\u0026thinsp;=\u0026thinsp;High, indicating a strong feeling of each domain\u003c/p\u003e \u003cp\u003eScore 2.1-3\u0026thinsp;=\u0026thinsp;Moderately high, indicating a moderate feeling of each domain\u003c/p\u003e \u003cp\u003eScore 1.1-2\u0026thinsp;=\u0026thinsp;Low, indicating a slight feeling of each domain\u003c/p\u003e \u003cp\u003eScore 0\u0026ndash;1\u0026thinsp;=\u0026thinsp;Very low, indicating a very slight feeling of each domain\u003c/p\u003e \u003cp\u003e2. The Body Image Index score was used, by permission\u003csup\u003e32\u003c/sup\u003e, and translated into Thai to evaluate a self-perception about physical appearance\u003csup\u003e33\u003c/sup\u003e. The Body Image Index score shows high internal consistency (Cronbach's alpha\u0026thinsp;=\u0026thinsp;0.93) and has demonstrated good clinical validity based on the prevalence of responses, discriminant validity (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001, Mann\u0026ndash;Whitney test), sensitivity to change (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Wilcoxon signed ranks test), and consistency of scores across different breast cancer treatment centres\u003csup\u003e32\u003c/sup\u003e. The Body Image Index questionnaire consists of 10 questions about satisfaction with body parts and overall appearance, often using a Likert scale. Responses can evaluate body image concerns and self-perception. These tools are commonly used in psychological and medical research to understand body image issues, in this case in women with breast cancer postmastectomy\u003csup\u003e32\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e3. The Thai Hospital Anxiety and Depression Scale (Thai HADS) was used to assess depression or anxiety in participants. Thai HADS included a 7-item anxiety sub-scale (HADS-A) and a 7-item depression sub-scale (HADS-D). Thai HADS has been translated into Thai\u003csup\u003e34\u003c/sup\u003e. The sensitivity for the anxiety and depression subscales of Thai HADS is 100% and 85.71%, respectively, while specificity is 86.0% for anxiety and 91.3% for depression\u003csup\u003e34\u003c/sup\u003e. Thai HADS also shows a good internal consistency, with Cronbach\u0026rsquo;s alpha for the anxiety subscale and 0.8259 for the depression subscale, indicating it is a dependable and valid tool for screening anxiety and depression in Thai patients, especially those who are patients with cancer\u003csup\u003e34\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eAll questionnaires in this study were used after being granted permission by the relevant authors and organisations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eSPSS version 29.0 (IBM Corporation, Armonk, NY) was used for statistical analysis. Descriptive statistics were used to describe the characteristics of the participants. The Chi-square test using Odds-Ratio (OR) and 95% Confidence Interval (CI) was applied to investigate the association between the factors, including demographic data (e.g., age, gender, education level, occupation, income, and underlying disease), and aspects of medical records pertinent to breast cancer and mastectomy, Thai Body Image Index, Thai HADS, perceived benefits, perceived barriers, perceived self-efficacy, interpersonal influence, situational influence, and PA characteristics (activities at work, transportations, recreational activities, and total physical activities). An OR exceeding 1 indicates a higher probability of the factor being associated among the independent variables, while an OR below 1 indicates a reduced likelihood of such an association. The statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDemographic data and medical records of women with breast cancer postmastectomy\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe average age of participants was 60.5 \u0026plusmn; 10.5 years and time from mastectomy surgery was 6.0 \u0026plusmn; 5.1 years. Most patients presented as breast cancer stage 1 (n = 38, 40.9%), had undergone the total mastectomy (n = 48, 51.6%), and had breast cancer on the left side (n = 54, 58%). All had received adjuvant therapies and were independently ambulant without using an assistive device (n = 93, 100%). The majority reported no lymphedema (n =79, 84.9%) and no complications after mastectomy (n = 52, 55.9%). The most common comorbidities were hypertension (n = 38; 40.9%). Most of the participants graduated at Bachelor degree level (n = 36; 37.8%) and continued working in their usual employment (n = 54, 58.1%) with a salary income of more than 30,000 Thai baht per month (about $857). Other demographic data and details of medical records of participants are shown in Table 1.\u003c/p\u003e\n\u003cp\u003e[Table 1 Here]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReporting of engagement in physical activity (PA) of women with breast cancer\u0026nbsp;postmastectomy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeventy-two percent of participants travelled to and from activities either on foot or by using a bicycle (pedal cycle), 64% were engaged in recreational activities, and 51% performed work-based activities (Table 2). With regards subgroup domains of PA, 54.8% of participants performed moderate activity at work over 7 days for 55 minutes per day, whereas only 10.8% of participants performed vigorous activity at work in 1 day for 74 minutes per day. In the recreational domain 14% of participants performed vigorous-intensity recreational activities and 62% of participants performed moderate-intensity recreational activities. For those that travelled to and from places, the activity on foot or using a bicycle (pedal cycle), 73.1% walked for at least 10 minutes continuously. Finally, sedentary behaviour was reported as an average of 224.9 minutes a day. Total PA averaged 1680 MET-minutes/week, and an adequate PA level of 2.8 METs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[Table 2 Here]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReporting of Body Image Index and Thai Hospital Anxiety and Depression Scale of women with breast cancer postmastectomy\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeventy-six percent of participants were very satisfied with the Body Image Index, 15% were moderately satisfied, and 2% were slightly satisfied with the Thai Body Image Index (Table 3). With regards to Thai HAD, no one was reported to have depression or anxiety, considering the scores of our results and the previous reports [34] (Table 3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[Table 3 Here]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerceived benefits, perceived barriers, perceived self-efficacy, interpersonal influence, and situational influence with the physical activity (PA) of women with mastectomy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFigure 1 demonstrates the outcomes regarding the impact of perceived benefits, perceived barriers, perceived self-efficacy, interpersonal influence, and situational influence on the PA of women with mastectomy for the 93 participants. The perceived benefits were notably high, indicating a strong belief in the benefits and capabilities (mean \u0026plusmn; SD = 3.54 \u0026plusmn; 0.46). Perceived self-efficacy, interpersonal influence, and situational influence scored relatively high (mean \u0026plusmn; SD = 2.82 \u0026plusmn; 0.72, 2.33 \u0026plusmn; 0.76 and 2.68 \u0026plusmn; 0.8, respectively), while perceived barriers were low (mean \u0026plusmn; SD = 1.57 \u0026plusmn; 0.44), indicating minimal barriers for Thai women with mastectomy in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors association with physical activity (PA) in Thai women with breast cancer after mastectomy\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this cohort of 93 women with breast cancer postmastectomy (Table 4), the factors associated with an appropriate level of PA included recreational and overall PA levels specifically: those engaging in activity at work (OR = 3.2, 95% CI = 1.357 - 7.548), an income of more than 30,000 Thai baht (OR = 4.5, 95% CI = 4.500 (1.549 - 13.070), moderate satisfaction on Body Image Index score (OR = 4, 95% CI = 1.045 - 15.317) and a higher score of Thai Hospital Anxiety and Depression Scale (OR = 2.969, 95% CI = 1.103 - 7.992). In addition, the findings indicate that individuals engaging in recreational activities recorded older age (OR = 0.245, 95% CI = 0.088 - 0.682), significantly high scores of perceived self-efficacies (OR = 3.284, 95% CI = 11.110 - 9.719), and significantly high scores of interpersonal influences (OR = 3.382, 95% CI = 1.215 - 9.416). However, no significant associations were found between the factors and travelling to and from the activity on foot or using a bicycle (pedal cycle) (Table 4).\u003c/p\u003e\n\u003cp\u003e[Table 4 Here]\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study aimed to investigate the adequate physical activity (PA) level and the factors associated with PA among Thai women who had undergone mastectomy due to breast cancer at Siriraj Hospital, Thailand. The findings provide valuable insights into the levels of PA engagement and the influences affecting participation in PA in this population.\u003c/p\u003e \u003cp\u003eThe demographic data shows that most participants in this study were pre-elderly to elderly with a mean age of 60.5\u0026thinsp;\u0026plusmn;\u0026thinsp;10.5 years, 37.8% graduated at Bachelor degree level and 58.1% had high salary income for Thailand (more than 30,000 Thai baht). Data pertinent to the breast cancer and surgery shows that participants had a mean duration post-mastectomy of 6.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1 years, covering all stages of breast cancer (the majority being at stage 1 of breast cancer). Just over half, 51.6%, of participants had received total mastectomy, removal of the whole breast, including the nipple, areola, and the majority of the overlying skin. Previous research by Mason et al. in 2013 studied 631 women for a decade, examining their PA levels before and after a diagnosis of breast cancer\u003csup\u003e35\u003c/sup\u003e. They discovered that only a minority consistently met PA guidelines over the 10-year period, with participation declining over time. The meeting of guidelines initially was linked to continued adherence at 5- and 10-years post-diagnosis. However, no demographic factors predicted long-term changes in PA levels\u003csup\u003e35\u003c/sup\u003e. A notable observation from our study that is the level of engagement of PA and the adequate PA level among 93 participants were similar, despite the challenges posed by mastectomy. Seventy-two percent of participants reported engaging in walking or cycling for transportation, while 64% participated in recreational activities, and 51% were active in their work setting. Importantly, in this cohort average total PA\u0026thinsp;=\u0026thinsp;1680 MET-minutes/week and PA level of 2.8 METs, indicating an adequate level of PA according to the WHO guidelines\u003csup\u003e28, 29\u003c/sup\u003e. These findings suggest a willingness among Thai women with breast cancer postmastectomy to engage in various forms of PA, highlighting the importance of promoting and supporting such behaviours in this population. In contrast to our findings, a previous study using tools such as the International Physical Activity Questionnaire (IPAQ), Stanford Health Assessment Questionnaire (HAQ-20), and Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), reported postmastectomy women or those who had undergone breast-saving surgery exhibited lower levels of PA and quality of life compared to those who underwent breast reconstruction\u003csup\u003e36\u003c/sup\u003e. In addition, De Groef et al. in 2018 found that a 2-year follow-up study of 267 consecutive breast cancer patients in Belgium into PA levels showed that they remained significantly lower two years after breast cancer surgery compared to preoperative levels\u003csup\u003e37\u003c/sup\u003e. There are several possible reasons that Thai women who have undergone mastectomy maintain their PA levels. Firstly, the perceived benefits of PA, Thai women may perceive numerous benefits associated with PA, such as improved physical fitness, mental well-being, and overall quality of life. These perceived benefits may motivate them to continue engaging in PA\u003csup\u003e14\u003c/sup\u003e. Secondly, engaging in PA and health benefits postmastectomy can instill a sense of empowerment and control over one's health. It allows women to regain a sense of agency and resilience, demonstrating their ability to overcome physical challenges and maintain an active lifestyle\u003csup\u003e38\u003c/sup\u003e. It was evident that highly intelligent, high-earning women and the majority of those employed, are more likely to engage with the positive aspects of PA compared to lower-earning, potentially less well-educated women with lower expectations. Our findings also indicate that the majority of participants graduated with a Bachelor's degree and work as a government employee. Higher educational attainment with a good job may be associated with greater health awareness, which could encourage these individuals to pursue physical activity outside of work hours to balance their typically sedentary jobs\u003csup\u003e39\u003c/sup\u003e. Thirdly, social support from family, friends, healthcare professionals, and support groups can play a crucial role in encouraging women to remain physically active after mastectomy. Positive social interactions and encouragement from peers can provide motivation and accountability for maintaining PA levels\u003csup\u003e40\u003c/sup\u003e. Finally, the perceived benefits of PA among participants were notably high, indicating a strong belief in the positive outcomes associated with PA. Similarly, perceived self-efficacy, interpersonal influence, and situational influence were relatively high, suggesting that participants felt confident in their ability to engage in PA and were influenced by social and environmental factors. These findings are supported by Mishra and colleagues in 2023 who reported that the underscoring of the importance of addressing psychosocial factors in promoting PA among women with breast cancer postmastectomy\u003csup\u003e41\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOur analysis of factors associated with PA revealed several noteworthy findings. Engagement in PA at work was associated with occupation, higher income, moderate satisfaction with Thai Body Image Index score, and higher levels of anxiety and depression. Additionally, participation in recreational activities was associated with older age, higher perceived self-efficacy, and greater interpersonal influence. These findings highlight the complex interplay of individual, social, and environmental factors influencing PA engagement among women postmastectomy. However, the findings are summarized and discussed in each point below.\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe significant association between PA at work and occupation, and higher incomes among Thai women with breast cancer postmastectomy breast cancer is significant. No study has directly investigated these association. One possible explanation for this association is the impact of PA on productivity, job performance, and financial status in older adults\u003csup\u003e42\u003c/sup\u003e, which may be relevant to our sample. Before a diagnosis of breast cancer, individuals who engage in regular PA may experience improvements in energy levels, concentration, and overall well-being, which can positively influence their work performance and career advancement opportunities. Further research should explore these associations and evaluate interventions to promote PA in the workplace for this population.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAn association was found between engagement in PA at work and moderate satisfaction with the Body Image Index score which highlights the potential psychological affects in Thai women with breast cancer postmastectomy. This idea is supported by the findings of T\u0026uuml;rk \u0026amp; Yılmaz in 2018, when they reported that this association suggests that incorporating PA into the workday may contribute positively to body image perceptions, particularly in the moderate satisfaction range\u003csup\u003e43\u003c/sup\u003e. PA can enhance self-esteem, promote a sense of accomplishment, and foster body appreciation, which may contribute to improved body image. Janowski and colleagues in 2020 suggested that the workplace environment, with its opportunities for social support and positive reinforcement, may serve as a conducive setting for individuals to develop a more positive perception of their bodies [40]. However, it's important to acknowledge that individual differences and contextual factors can influence the relationship between PA at work and body image satisfaction. Further research is needed to explore these dynamics and to develop targeted interventions that promote positive body image through workplace PA initiatives.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe research indicated a link between engagement in PA at work and higher levels of anxiety and depression which raises important considerations. While PA is typically associated with improved mental health, this association suggests a more complex relationship in the workplace\u003csup\u003e44\u003c/sup\u003e. Several factors may contribute to this finding, including individuals using PA as a coping mechanism for anxiety or depression, workplace-related stressors influencing both PA engagement and mental health, and variations in exercise intensity and preferences in Thai women with breast cancer postmastectomy\u003csup\u003e41\u003c/sup\u003e. Further research is needed to better understand these dynamics and develop strategies to support the mental well-being of employees alongside workplace PA initiatives.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe significant association between individuals aged over 60 and recreational activity is increasingly recognized for its positive impact on overall well-being in Thai women with breast cancer postmastectomy. Studies consistently reveal a notable correlation between increasing age and heightened engagement in leisure pursuits\u003csup\u003e45, 46\u003c/sup\u003e. In 2023, Tripathi \u0026amp; Samanta found that such activities, ranging from social gatherings to outdoor excursions, serve as avenues for maintaining physical health, cognitive function, and emotional resilience among older adults\u003csup\u003e46\u003c/sup\u003e. Moreover, recreational endeavors provide opportunities for meaningful social interactions, contributing to a sense of purpose and belonging in later life\u003csup\u003e46\u003c/sup\u003e. Recognition of this association underscores the importance of promoting and facilitating recreational activities tailored to the needs and interests of older individuals. Ultimately, fostering an active lifestyle in this demographic may enhance the quality of life and promote healthy aging.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHigher perceived self-efficacy and greater interpersonal influence are significantly associated with recreational activities in Thai women with breast cancer post- mastectomy. Through the setting and achieving of goals in activities like sports or fitness classes, individuals build confidence in their abilities, creating a positive feedback loop of increased engagement and self-belief. These findings are supported by previous studies which demonstrated that social interactions inherent in these activities provide opportunities for social learning, where observing and learning from others enhances skills and confidence after those who have been diagnosed with breast cancer and undergone a mastectomy\u003csup\u003e16, 21\u003c/sup\u003e. As early as 2006 McNeely et al. reported that social support networks in recreational settings offer encouragement and motivation, reinforcing one's belief in their abilities\u003csup\u003e14\u003c/sup\u003e. These experiences can transfer to other areas of life, improving overall well-being and resilience. Understanding these connections can inform interventions and programs aimed at promoting personal development and well-being through recreational engagement in this population.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eContrary to expectations, our study found no significant association between breast cancer stages and mastectomy, and PA levels. Despite the well-established benefits of PA for overall health, other factors beyond exercise may predominantly influence cancer progression\u003csup\u003e14\u003c/sup\u003e. The findings between mastectomy and PA suggests that the psychological and emotional impact of surgery may outweigh its physical effects on activity levels\u003csup\u003e30\u003c/sup\u003e. Individuals may find motivation in PA as a coping mechanism, or they may adjust their routines to accommodate post-surgical changes. In addition, our study has shown that Thai women with breast cancer postmastectomy had a reliance on self-reported data and potential oversight of other influential variables including socioeconomic status and access to healthcare which was data collected at the biggest medical school at Siriraj Hospital.\u003c/p\u003e \u003cp\u003eOur research has several limitations. Firstly, the sample size is relatively small compared to the previous studies\u003csup\u003e13, 21\u003c/sup\u003e. Due to practical constraints, including limited access to participants and resource restrictions, we were unable to increase the sample size. This limitation may affect the generalizability of our findings, as a larger sample would provide more robust data and potentially reveal additional trends and correlations. We acknowledge that the small sample size could introduce a degree of bias and reduce the statistical power of the study. Future research should aim to include a larger, more diverse cohort to validate our results and enhance the reliability of the conclusions drawn. Secondly, the sample may not be representative; participants were recruited from a single breast cancer clinic at Siriraj Hospital. However, this study is a good beginning with several avenues opened for exploration in the future as regards PA levels in this field. The high levels of motivation of this cohort facilitated extensive completion of the questionnaires, offering a unique opportunity to explore various aspects of Thai women with breast cancer postmastectomy and the level of PA within the group. However, a third limitation, or rather showing a potential extension for the future, our study included only women who had undergone a surgical mastectomy, limiting the exploration of an association between PA and multidimensional surgical techniques. Finally, our data did not show significant results when multiple regression was applied, therefore, we have excluded of multiple regression analysis, which could have provided a more comprehensive understanding of the interactions between various factors influencing physical activity. Future research could address this by employing multiple regression to capture the combined effects and potential interactions of multiple predictors.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides valuable insights into the perceptions around an adequate level of PA among Thai women who have undergone mastectomy. Our study into the factors associated to PA revealed several notable findings, specifically that participation in PA at work was associated with occupation, higher incomes, moderate satisfaction with the Thai Body Image Index, and elevated levels of anxiety and depression. Furthermore, engagement in recreational activities was associated with older age, increased perceived self-efficacy, and greater interpersonal influence. Promotion and supporting PA engagement in this population is essential for enhancing overall health and well-being. Future research should focus on developing tailored interventions to address barriers to PA and promote a more active lifestyle among Thai women with breast cancer postmastectomy.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by F.K, P.W., D.S, S.P., S.P., V.L. and W.K.. The first draft of the manuscript was written by F.K and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to thank all members from Faculty of Physical Therapy, Mahidol University and Siriraj Breast Clinic, Division of Head-Neck and Breast Surgery, Siriraj Hospital. The authors would also like to thank to all participants who participated in this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data presented in this study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, \u003cem\u003eet al\u003c/em\u003e. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. \u003cem\u003eCA. Cancer. J. 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Sociol. 8, 1185794. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fsoc.2023.1185794\u003c/span\u003e\u003cspan address=\"10.3389/fsoc.2023.1185794\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2023)\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1.\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eDemographic data of women with breast cancer postmastectomy.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.60606060606061%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.39393939393939%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e=\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e93\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.71717171717172%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u0026nbsp;(years): mean \u0026plusmn; SD (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.282828282828284%\" valign=\"top\"\u003e\n \u003cp\u003e60.5 \u0026plusmn; 10.5 (38, 85)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.71717171717172%\" valign=\"top\"\u003e\n \u003cp\u003eThai Mental State Examination: mean \u0026plusmn; SD (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.282828282828284%\" valign=\"top\"\u003e\n \u003cp\u003e27.9 \u0026plusmn; 3.82 (26, 30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.71717171717172%\" valign=\"top\"\u003e\n \u003cp\u003eTime from mastectomy surgery\u0026nbsp;(years): mean \u0026plusmn; SD (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.282828282828284%\" valign=\"top\"\u003e\n \u003cp\u003e6.0 \u0026plusmn; 5.1 (1, 31.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.71717171717172%\" valign=\"top\"\u003e\n \u003cp\u003eStage of breast cancer\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; 0 (n, %)\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; 1 (n, %)\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; 2 (n, %)\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; 3 (n, %)\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; 4 (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.282828282828284%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8 (8.6%)\u003c/p\u003e\n \u003cp\u003e38 (40.9%)\u003c/p\u003e\n \u003cp\u003e27 (29.0%)\u003c/p\u003e\n \u003cp\u003e19 (20.4%)\u003c/p\u003e\n \u003cp\u003e1 (1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.71717171717172%\" valign=\"top\"\u003e\n \u003cp\u003eSide of breast cancer\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Right (n, %)\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Left (n, %)\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Both (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.282828282828284%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e30 (32.3%)\u003c/p\u003e\n \u003cp\u003e54 (58.0%)\u003c/p\u003e\n \u003cp\u003e9 (9.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.71717171717172%\" valign=\"top\"\u003e\n \u003cp\u003eType of mastectomy\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Total mastectomy (n, %)\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Modified radical mastectomy (n, %)\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Nipple sparing mastectomy (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.282828282828284%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e48 (51.6%)\u003c/p\u003e\n \u003cp\u003e38 (40.9%)\u003c/p\u003e\n \u003cp\u003e7 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.71717171717172%\" valign=\"top\"\u003e\n \u003cp\u003eAdjuvant therapies\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.282828282828284%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e93 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.71717171717172%\" valign=\"top\"\u003e\n \u003cp\u003eLymphedema phenomenon\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Yes\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.282828282828284%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e14 (15.1%)\u003c/p\u003e\n \u003cp\u003e79 (84.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.71717171717172%\" valign=\"top\"\u003e\n \u003cp\u003eComplication of mastectomy\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Yes\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.282828282828284%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e41 (44.1%)\u003c/p\u003e\n \u003cp\u003e52 (55.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.71717171717172%\" valign=\"top\"\u003e\n \u003cp\u003eAmbulation\u0026nbsp;(n,\u0026nbsp;%)\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Independent without assistive device\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.282828282828284%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e93\u0026nbsp;(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.71717171717172%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of comorbidities\u0026nbsp;(n,\u0026nbsp;%)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e- \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eHypertension\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e- \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eDiabetes mellitus\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e- \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eDyslipidemia\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e- \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eHeart disease\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e- \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.282828282828284%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e38 (40.9%)\u003c/p\u003e\n \u003cp\u003e17 (18.3%)\u003c/p\u003e\n \u003cp\u003e25 (26.9%)\u003c/p\u003e\n \u003cp\u003e11 (11.8%)\u003c/p\u003e\n \u003cp\u003e9 (9.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.71717171717172%\" valign=\"top\"\u003e\n \u003cp\u003eMarital status\u0026nbsp;(n,\u0026nbsp;%)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e- \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eSingle\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e- \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eMarried\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e- \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eDivorce/Widow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.282828282828284%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e25 (26.9%)\u003c/p\u003e\n \u003cp\u003e53 (57.0%)\u003c/p\u003e\n \u003cp\u003e15 (16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.71717171717172%\" valign=\"top\"\u003e\n \u003cp\u003eEducation levels\u0026nbsp;(n,\u0026nbsp;%)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e- \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eUneducated \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e- \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003ePrimary school\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e- \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eSecondary school\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e- \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eDiploma degree\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e- \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eBachelor degree\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e- \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eMaster/Doctoral degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.282828282828284%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003cp\u003e18 (19.4%)\u003c/p\u003e\n \u003cp\u003e15 (16.1%)\u003c/p\u003e\n \u003cp\u003e11 (11.8%)\u003c/p\u003e\n \u003cp\u003e36 (38.7%)\u003c/p\u003e\n \u003cp\u003e13 (14.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.71717171717172%\" valign=\"top\"\u003e\n \u003cp\u003eOccupation\u0026nbsp;(n,\u0026nbsp;%)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e- \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eUnemployed\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e- \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eEmployed\u003c/p\u003e\n \u003cp\u003e\u0026middot; \u0026nbsp; \u0026nbsp;Government employee\u003c/p\u003e\n \u003cp\u003e\u0026middot; \u0026nbsp; \u0026nbsp;Self-employed\u003c/p\u003e\n \u003cp\u003e\u0026middot; \u0026nbsp; \u0026nbsp;Employees of the company\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026middot; \u0026nbsp; \u0026nbsp;Farmers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.282828282828284%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e39 (41.9%)\u003c/p\u003e\n \u003cp\u003e54 (58.1%)\u003c/p\u003e\n \u003cp\u003e26 (48.1%)\u003c/p\u003e\n \u003cp\u003e15 (27.7%)\u003c/p\u003e\n \u003cp\u003e7 (12.9%)\u003c/p\u003e\n \u003cp\u003e4 (7.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.71717171717172%\" valign=\"top\"\u003e\n \u003cp\u003eIncome per month\u0026nbsp;(n,\u0026nbsp;%)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e- \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eNone\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e- \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u0026le; 10,000\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e- \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u0026gt;10,000 \u0026ndash; 20,000\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e- \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u0026gt;20,000 - 30,000\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e- \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u0026gt;30,000\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e- \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eNo data\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.282828282828284%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 (1.1%)\u003c/p\u003e\n \u003cp\u003e25 (26.9%)\u003c/p\u003e\n \u003cp\u003e16 (17.2%)\u003c/p\u003e\n \u003cp\u003e8 (8.6%)\u003c/p\u003e\n \u003cp\u003e39 (41.9%)\u003c/p\u003e\n \u003cp\u003e4 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003en \u0026ndash; number of participants, % - percent, SD \u0026ndash; standard deviation\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003ePhysical activity characteristics of women with breast cancer postmastectomy.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.60606060606061%\" colspan=\"3\" valign=\"top\" style=\"width: 30.6864%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical activity characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.39393939393939%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e=\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e93\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.71717171717172%\" colspan=\"3\" valign=\"top\" style=\"width: 36.3392%;\"\u003e\n \u003cp\u003ePhysical activity\u0026nbsp;(n,\u0026nbsp;%)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e- \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eActivity at work\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e- \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003cu\u003eTransportation\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e- \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eRecreational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.282828282828284%\" valign=\"top\" style=\"width: 11.2027%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e51 (54.8%)\u003c/p\u003e\n \u003cp\u003e67 (72.0%)\u003c/p\u003e\n \u003cp\u003e64 (68.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.34693877551021%\" colspan=\"3\" valign=\"top\" style=\"width: 33.6229%;\"\u003e\n \u003cp\u003eSub-domain of Physical activity (n, %)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Vigorous work (n, %)\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Moderate work (n, %)\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Transportation (n, %)\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Vigorous recreation (n, %)\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Moderate recreation (n, %)\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Sitting (mean \u0026plusmn; SD (range))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\" style=\"width: 12.994%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12 (10.8%)\u003c/p\u003e\n \u003cp\u003e51 (54.8%)\u003c/p\u003e\n \u003cp\u003e68 (73.1%)\u003c/p\u003e\n \u003cp\u003e13 (14.0%)\u003c/p\u003e\n \u003cp\u003e62 (66.7%)\u003c/p\u003e\n \u003cp\u003e224.9 \u0026plusmn; 171.9 (10, 840)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.71717171717172%\" colspan=\"3\" valign=\"top\" style=\"width: 36.3392%;\"\u003e\n \u003cp\u003eTotal Physical Activity MET-minutes/week: median (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.282828282828284%\" valign=\"top\" style=\"width: 14.242%;\"\u003e\n \u003cp\u003e1680 (80, 13440)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.71717171717172%\" colspan=\"3\" valign=\"top\" style=\"width: 36.3392%;\"\u003e\n \u003cp\u003eThe adequate physical activity level (MET)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.282828282828284%\" valign=\"top\" style=\"width: 14.242%;\"\u003e\n \u003cp\u003e2.8 (0.13, 22.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eMET: metabolic equivalent of task\u0026nbsp;\u003c/p\u003e\n\u003cp\u003en \u0026ndash; number of participants, % - percent\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eBody Image Index score and Thai Hospital Anxiety and Depression Scale of women with breast cancer postmastectomy.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.60606060606061%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eScore\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.39393939393939%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e=\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e93\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.71717171717172%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eBody Image Index score: mean \u0026plusmn; SD (range)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Very satisfied\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Moderate satisfied\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Little satisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.282828282828284%\" valign=\"top\"\u003e\n \u003cp\u003e14.0 \u0026plusmn; 5.8 (10, 36)\u003c/p\u003e\n \u003cp\u003e76 (81.7%)\u003c/p\u003e\n \u003cp\u003e15 (16.1%)\u003c/p\u003e\n \u003cp\u003e2 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.71717171717172%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eThai Hospital Anxiety and Depression Scale\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Total: mean \u0026plusmn; SD (range)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Score 0-7\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Score 8-10\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Score 11-21\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Anxiety: mean \u0026plusmn; SD (range)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Depression: mean \u0026plusmn; SD (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.282828282828284%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5.6 \u0026plusmn; 4.8 (0, 19)\u003c/p\u003e\n \u003cp\u003e67 (72.1%)\u003c/p\u003e\n \u003cp\u003e11 (11.8%)\u003c/p\u003e\n \u003cp\u003e15 (16.1%)\u003c/p\u003e\n \u003cp\u003e3.4 \u0026plusmn; 2.9 (0, 10)\u003c/p\u003e\n \u003cp\u003e2.2 \u0026plusmn; 2.3 (0, 9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003en \u0026ndash; number of participants, % - percent, SD \u0026ndash; standard deviation\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u0026nbsp;\u003c/strong\u003eFactors associated with physical activity of women with breast cancer postmastectomy.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"101%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eFactors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e\u003cstrong\u003eActivity at work\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eTransportation\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRecreational\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eactivities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOdds ratio\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(\u003c/strong\u003e\u003cstrong\u003e95\u003c/strong\u003e\u003cstrong\u003e%\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCI\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOdds ratio\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(\u003c/strong\u003e\u003cstrong\u003e95\u003c/strong\u003e\u003cstrong\u003e%\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCI\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOdds ratio\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(\u003c/strong\u003e\u003cstrong\u003e95\u003c/strong\u003e\u003cstrong\u003e%\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCI\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOdds ratio\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(\u003c/strong\u003e\u003cstrong\u003e95\u003c/strong\u003e\u003cstrong\u003e%\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCI\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u0026nbsp;(years)\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; \u0026lt;60\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; \u0026ge;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e0.431 (0.183, 1.013)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003cp\u003e2.443 (0.969, 6.158)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e0.245 (0.088, 0.682)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e0.676 (0.117, 3.887)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eStatus\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Single/widowed/divorced/separate\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e1.180 (0.517, 2.692)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e0.615 (0.240, 1.574)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e1.113 (0.460, 2.695)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e0.645 (0.112, 3.708)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Non-Primary school\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Secondary school \u0026ndash; Vocational\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Bachelor-higher than bachelor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e0.781 (0.231, 2.646)\u003c/p\u003e\n \u003cp\u003e2.578 (0.854, 7.783)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e2.171 (0.609, 7.739)\u003c/p\u003e\n \u003cp\u003e02.764 (0.878, 8.698)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e1.091 (0.325, 3.667)\u003c/p\u003e\n \u003cp\u003e3.120 (0.977, 9.958)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e0.958 (0.143, 6.404)\u003c/p\u003e\n \u003cp\u003e6.000 (0.509, 70.668)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; No\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e3.200 (1.357, 7.548)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e0.403 (0.150, 1.085)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e2.194 (0.899, 5.355)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e2.971 (0.516, 17.110)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eIncomes\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; \u0026le;10,000\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; \u0026gt;10,000 \u0026ndash; 30,000\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; \u0026gt;30,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e3.750 (1.160, 12.122)\u003c/p\u003e\n \u003cp\u003e4.500 (1.549, 13.070)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e0.476 (0.131, 1.735)\u003c/p\u003e\n \u003cp\u003e0.536 (0.163, 1.759)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e1.875 (0.556, 6.324)\u003c/p\u003e\n \u003cp\u003e1.591 (0.555, 4.564)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e0.200 (0.021, 1.934)\u003c/p\u003e\n \u003cp\u003e1.520 (0.091, 25.434)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eBody Image Index score\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Very satisfied\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Moderate satisfied\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Little satisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e4.000 (1.045, 15.317)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e1.000 (0.060, 16.577)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e0.381 (0.122, 1.191)\u003c/p\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e0.923 (0.284, 2.996)\u003c/p\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e0.361 (0.060, 2.178)\u003c/p\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eThai Hospital Anxiety and Depression Scale\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; No (\u0026lt;8)\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Yes (\u0026ge;8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e2.969 (1.103, 7.992)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e1.418 (0.496, 4.060)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e1.742 (0.614, 4.942)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eUnderlying disease\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Hypertension\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Diabetes mellitus\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Dyslipidemia\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Heart disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.600 (0.260, 1.382)\u003c/p\u003e\n \u003cp\u003e0.376 (0.126, 1.123)\u003c/p\u003e\n \u003cp\u003e0.686 (0.274, 1.723)\u003c/p\u003e\n \u003cp\u003e0.652 (0.184, 2.309)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.149 (0.454, 2.904)\u003c/p\u003e\n \u003cp\u003e1.324 (0.389, 4.509)\u003c/p\u003e\n \u003cp\u003e1.319 (0.459, 3.792)\u003c/p\u003e\n \u003cp\u003e1.040 (0.253, 4.265)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.426 (0.174, 1.042)\u003c/p\u003e\n \u003cp\u003e0.582 (0.197, 1.724)\u003c/p\u003e\n \u003cp\u003e0.741 (0.281, 1.952)\u003c/p\u003e\n \u003cp\u003e1.238 (0.303, 5.051)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.673 (0.128, 3.528)\u003c/p\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003cp\u003e0.338 (0.064, 1.801)\u003c/p\u003e\n \u003cp\u003e0.649 (0.069, 6.135)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eDuration since surgery\u0026nbsp;(years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.963 (0.886, 1.047)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e1.025 (0.929, 1.130)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e1.098 (0.969, 1.243)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e1.031 (0.848, 1.253)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eStage of breast cancer\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; 1\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; 2\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e2.292 (0.477, 11.010)\u003c/p\u003e\n \u003cp\u003e2.424 (0.478, 12.302)\u003c/p\u003e\n \u003cp\u003e1.667 (0.311, 8.928)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e2.455 (0.519, 11.601)\u003c/p\u003e\n \u003cp\u003e3.500 (0.668, 18.343)\u003c/p\u003e\n \u003cp\u003e3.000 (0.539, 16.689)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e1.473 (0.299, 7.250)\u003c/p\u003e\n \u003cp\u003e1.425 (0.273, 7.439)\u003c/p\u003e\n \u003cp\u003e1.114 (0.203, 6.105)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eSide of breast cancer\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Right\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Left\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Both\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.613 (0.148, 2.544)\u003c/p\u003e\n \u003cp\u003e2.300 (0.492, 10.743)\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.605 (0.113, 3.227)\u003c/p\u003e\n \u003cp\u003e0.980 (0.165, 5.825)\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.267 (0.280, 5.730)\u003c/p\u003e\n \u003cp\u003e0.909 (0.189, 4.366)\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.200 (0.124, 11.659)\u003c/p\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eType of mastectomy\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Total mastectomy\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Modified radical mastectomy\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Nipple sparing mastectomy\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e1.451 (0.608, 3.462)\u003c/p\u003e\n \u003cp\u003e0.141 (0.016, 1.262)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e1.040 (0.397, 2.723)\u003c/p\u003e\n \u003cp\u003e0.495 (0.097, 2.519)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e0.714 (0.283, 1.800)\u003c/p\u003e\n \u003cp\u003e0.495 (0.097, 2.519)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e3.364 (0.360, 31.422)\u003c/p\u003e\n \u003cp\u003e0.545 (0.052, 5.728)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eComplications\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; No\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e1.872 (0.811, 4.321)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e1.379 (0.547, 3.473)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e0.424 (0.173, 1.037)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e1.625 (0.283, 9.344)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003ePerceived benefits\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Low (1.00 \u0026ndash; 3.46)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; High (3.47 \u0026ndash; 4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e0.811 (0.352, 1.867)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e1.086 (0.434, 2.722)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e1.032 (0.423, 2.516)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e0.708 (0.123, 4.077)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003ePerceived barriers\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Low (1.00 \u0026ndash; 1.45)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; High (1.46 \u0026ndash; 4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e0.625 (0.271, 1.444)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e0.819 (0.324, 2.068)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e0.635 (0.256, 1.578)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e1.417 (0.270, 7.422)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003ePerceived self-efficacy\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Low (1.00 \u0026ndash; 3.12)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; High (3.13 \u0026ndash; 4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e1.818 (0.748, 4.420)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e0.923 (0.355, 2.401)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e3.284 (1.110, 9.719)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eInterpersonal influence\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Low (1.00 \u0026ndash; 2.78)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; High (2.79 \u0026ndash; 4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e1.832 (0.779, 4.312)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e2.071 (0.768, 5.587)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e3.382 (1.215, 9.416)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eSituational influence\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Low (1.00 \u0026ndash; 3.00)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; High (3.01 \u0026ndash; 4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e1.069 (0.457, 2.498)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e1.427 (0.543, 3.753)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e1.425 (0.560, 3.622)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e3.056 (0.342, 27.309)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*\u0026nbsp;statistical significantp\u0026lt;0.05\u003c/p\u003e\n\u003cp\u003eN/A \u0026ndash; Not applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCI \u0026ndash; Confident interval\u003c/p\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":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Breast cancer, Physical activity, Body Image Index, Perceived self-efficacy, Anxiety, Depression","lastPublishedDoi":"10.21203/rs.3.rs-4854096/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4854096/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e \u003cb\u003eThe primary treatment for breast cancer patients is surgery and it often impacts physical activity (PA). This study aimed to investigate factors associated with the PA level of Thai women with breast cancer after surgical mastectomy at Siriraj Hospital, Thailand. Ninety-three participants were completed the questionnaires included personal information, the Global Physical Activity Questionnaire, perceived benefits, perceived barriers, perceived self-efficacy, interpersonal influence and situational influence, the Thai Body Image Index score, and the Thai Hospital Anxiety and Depression Scale. Data was analyzed using descriptive statistics and Chi-square statistics (Odds-Ratio and 95% Confidence Interval). The study found that after post-mastectomy Thai women had sufficient PA (2.8 metabolic equivalent of tasks (METs)). It was also found that PA at work was associated with occupation, higher incomes, moderate satisfaction as assessed by the Thai Body Image Index score, and higher levels of anxiety and depression. Additionally, participation in recreational activities was associated with older age, higher perceived self-efficacy, and greater interpersonal influence. By exploring these association, we can tailor supportive care strategies that address the PA needs of individuals affected by breast cancer and it is essential for developing comprehensive interventions that optimize patient health and well-being throughout the cancer journey.\u003c/b\u003e \u003c/p\u003e","manuscriptTitle":"Factors associated with physical activity among Thai women with breast cancer postmastectomy at a University Hospital, Thailand","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-08 00:58:33","doi":"10.21203/rs.3.rs-4854096/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-02-21T08:22:35+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-02-04T07:40:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-23T14:41:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"79427205958990330494696598706834108834","date":"2025-01-21T02:44:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"339786551883749210700464276585288083137","date":"2025-01-20T16:34:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-10-23T18:42:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-15T20:34:01+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-08-14T11:37:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-08-12T11:24:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-08-03T15:56:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"26f86a55-3cee-4c73-806f-004ec581381f","owner":[],"postedDate":"October 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":37283986,"name":"Biological sciences/Cancer"},{"id":37283987,"name":"Health sciences/Health care"}],"tags":[],"updatedAt":"2025-05-26T16:03:53+00:00","versionOfRecord":{"articleIdentity":"rs-4854096","link":"https://doi.org/10.1038/s41598-025-02137-1","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-05-19 15:58:17","publishedOnDateReadable":"May 19th, 2025"},"versionCreatedAt":"2024-10-08 00:58:33","video":"","vorDoi":"10.1038/s41598-025-02137-1","vorDoiUrl":"https://doi.org/10.1038/s41598-025-02137-1","workflowStages":[]},"version":"v1","identity":"rs-4854096","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4854096","identity":"rs-4854096","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}