Monday, September 27, 2010

Exercise Program for Cancer Survivors

As the director of an exercise program for breast cancer survivors at a cancer center, I need to be able to understand how to organize activities that will promote optimal health benefits, both physically and mentally. 
According to the Journal of American Medical Association, women with breast cancer should follow the U.S. physical activity recommendations (Holmes, Chen, Feskanich, Kroenke, & Colditz, 2005).  Physical activity guidelines for adults (age 18-64) state that 2 and a half hours of moderate activity or 75 minutes of vigorous activity is required per week in order to maintain and achieve health benefits.  The activity should be performed in 10+ minute bouts spread evenly throughout the week.  Also, muscle strengthening activities that involve all major muscle groups are required on 2 or more days of the week (US Department of Health and Human Services, 2008). 
It must be taken into consideration that this is not the average population we are working with.  These are survivors of a fatal disease and health guidelines may need to be altered in order for them to be as physically active as their abilities allow.  It has been supported that physical activity improves quality of life, reduces fatigue, and assists with energy balance in cancer patients and survivors (U.S. National Institutes of Health, 2009).  The Journal of American Medical Association also supports physical activity after a breast cancer diagnosis may reduce the risk of death from the fatal disease.  Researchers found the greatest benefit to be walking 3 to 5 hours per week at an average pace (Holmes, Chen, Feskanich, Kroenke, & Colditz, 2005).
These participants are not only concerned with the physical activity aspect, but with quality of life as well.  According to Gill & Williams (2008), quality of life consists of the person’s perceived physical, social, and psychological well-being.  This being said, it is my focus to improve each category for the participants.  Using the QoL model, I will concentrate on specific aspects of quality of life in order to enhance the exercise program.
The participants will receive pre and post assessments of physical and mental states where goal setting will take place, and a personal exercise program.  The classes will warm up and cool down together; however each participant has their own individualized program to run through each time they come.  Certified trainers will provide one on one time throughout the class.  Each person’s program will consist of cardiovascular, strength, and flexibility exercises that fit the needs of each individual, as well as lead towards their personal goals. 
The exercise program provided for cancer survivors will allow for camaraderie and encouragement from being with other survivors.  They will be able to relate and turn to each other and share similar experiences.  The program will aid in attaining healthy lifestyles physically and emotionally.  The physical activity guidelines for American’s will be enforced, as well as concentrating on the particular needs of the different situations each participant will have. 
Gill, D., & Williams, L. . (2008). Psychological dynamics of sport and exercise. pp. 175-177. Champaign, IL: Human Kinetics.
Holmes, M.D., Chen, W.Y., Feskanich, D., Kroenke, C.H., & Colditz, G.A. (2005). Physical activity and survival after breast cancer diagnosis. The Journal of the American Medical Association, 293(20), 2479-2486. Retrieved from doi: N/A
U.S. Department of Health and Human Services. (2008). 2008 physical activity guidelines for Americans. Retrieved from
U.S. National Institutes of Health. (2009, July 22). Physical activity and cancer. Retrieved from

Monday, September 20, 2010

Applying Cognitive Skills to Rehabilitation

As an athletic trainer, I have 6-8 weeks to work with an intercollegiate level volleyball athlete in order to get her back out on the court.  She has gone through extensive surgery on her knee in order to repair her anterior cruciate ligament (ACL). 
Many athletes go through a phase of depression, anger, and/or tension after suffering the consequences from an injury during intercollegiate athletics (Freedman, Glasgow, Glasgow, & Bernstein, 1998).  Not only does this injury have the potential for comprising detrimental effects on her volleyball career, but also her career as a student.  Freedman and colleagues (1998) studied the effects these types of injuries have on the academic career of intercollegiate athletes.  Results show lower grades correlating with the injuries of university student athletes. 
First things first, we need to set short term goals together.  For example, how many times a week she wants to work with me, how long she wants to meet for, how hard she is willing to work in order to get back to playing again.  I need to be able to find out where she is at physically and mentally before working with her through rehabilitation.  Getting to know her through the first couple of sessions together, I will be able to determine what sort of psychological skills I will need to provide her with in order to get her back to where she was before her injury, if not even more mentally stable. 
It is my job to keep her highly motivated, concentrated, relaxed, and focused on meeting her goal of returning to the game healthy and ready to pick up where she left off, as well as keeping her up on her academic career.  Not only do I need to plan out the exercises that will help to strengthen her body during this recovery phase, but I also need to schedule activities that will benefit her mentally, as well as be sure she is keeping up in school.
There are many factors that can play into the role of the rehabilitation process.  Does she have social support from loved ones, her coaches, and her other teammates? What sort of sport confidence and self confidence does she have? Has she been injured before? Where does she stand in her career? Has she had any sort of experience with psychological skills previously?  Through the answers of these questions, activities can be applied in aiding in her recovery phase.  It has been shown that the use of relaxation and imagery activities will help to improve psychological skills during rehabilitation (Handegard, Joyner, Burke, & Reimann, 2006).
According to Gill & Williams 2008, imagery is one of the most effective ways of coping with pain and staying highly motivated during the rehabilitation process.  We will incorporate imagery sessions every other time we meet.  I want to be sure to keep her relaxed and focused on getting healthier and stronger each session.  These sessions will concentrate on her goals she has set for returning to play after 6-8 weeks.  Towards the beginning we will just focus on the simple skills, whereas towards the end of the whole process we will gear more towards where she left off in terms of her sport specific skills. We will focus on her believing and seeing herself playing again over and over in her head. 
Through rehabilitation, imagery, attention skills, and cognitive control skills will allow this volleyball athlete to get back out there on the court and meet our goal of 6-8 weeks (Gill, & Williams, 2008).  Throughout the 6-8 week process, this athlete will have developed strong psychological skills, and will be mentally prepared for rejoining her team and being able to play competitively again.  She will be able to continue her skills of imagery, attention, and cognitive control in order to aid in her process of becoming a better volleyball athlete. 
Freedman, K.B., Glasgow, M.T., Glasgow, S.G., & Bernstein, J. (1998). Anterior cruciate ligament injury and reconstruction among university students. Clinical Orthopaedics & Related Research, 356. pp. 208-212. Retrieved from doi: N/A
Gill, D., & Williams, L. . (2008). Psychological dynamics of sport and exercise. pp. 71-78. Champaign, IL: Human Kinetics.
Handegard, Initials, Joyner, Initials, Burke, Initials, & Reimann, Initials. (2006), Relaxation and guided imagery in the sports rehabilitation context. Journal of Excellence, (10), pp. 146-164. Retrieved from doi: N/A

Monday, September 13, 2010

Chris the Superstar

Chris shows signs of low self-confidence and has an overall unhappy attitude towards soccer. She has the potential for being a great athlete, yet gives up easily during practice and games. Her parents are worried that soccer will never do anything to help improve their daughter’s self-esteem.

As Chris’ coach, I need to find a way to enhance her experience as a talented soccer athlete. She must enjoy the sport to an extent, otherwise why would she continue to volunteer to play? It is my job to improve her attitude and self-esteem towards the sport itself as well as the team on and off the field.

Chris has low self-efficacy which means she tends to avoid challenges and gives up easily. According to Bandura, there are six key elements that play a role in affecting one’s self-efficacy, they are performance accomplishments, vicarious experiences, emotional and physiological states, verbal persuasion, and imaginal experiences (Gill, & Williams, 2008). As a coach, I am able to influence some of these key elements in hopes of improving how Chris views her capabilities to successfully perform at soccer. One of the most influential determinants of self-efficacy is past performance (Williams, 2006). By videotaping a practice or a game, I would be able to sit down and have a one on one meeting with Chris and show her what she does well and what she is capable of. By doing so, she will feel more confident as she will be able to see that she has the potential to perform well at particular tasks.

Vicarious experience also can facilitate self-efficacy. By taking the team to watch another team play, Chris will be able to relate to an athlete playing in her position and will be able to see that a girl of the same athletic ability and age is able to do it, so she is capable of performing the task as well.

Verbal persuasion will be given throughout practice and games. Chris will be given feedback on things she is doing as well as motivational statements for encouragement. Hopefully, this will allow her to employ verbal persuasion of her own as a way of encouragement through positive self-talk to help increase her self-efficacy too. Her own encouragement would improve her performance knowing there is a tendency to act according to how we think (Williams, 2006).

At the conclusion of practice on the evenings before game days, I will do an imagery activity with the team. They will each independently mentally see themselves performing at their best and seeing each play run through their minds smoothly. If they can imagine themselves performing successfully it will increase their self-efficacy (Gill, & Williams, 2008).

Other than focusing on these determinants to help increase Chris’ self-efficacy, I would make Chris team captain. As captain, she will feel more involved having a leadership role on the team. This in turn may make her work harder, feeling an obligation towards the team performing successfully.

Chris continues to play soccer, yet doesn’t try hard even though she has the potential to be a great athlete. She gives up easily and seems unhappy while she is playing, especially during games. Having been part of the team for the past two years, Chris being labeled as team captain will allow her to have more dedication towards the team. She will work harder in order to impress the team as she now has a leadership role and is looked up to. She wants to gain respect from everyone, so she will prove to them, and herself, that she can be a great addition to the team. In conclusion, by showing Chris what she is capable of through past experiences, showing her another player of the same ability and age, verbally encouraging her during practice and game environments, performing imagery activities before game days, and making her team captain will increase her self-efficacy which will improve her performance as well as her self-esteem.


Gill, D.L., & Williams, L. (2008). Psychological dynamics of sport and exercise (pp. 91-94). United States of America: Human Kinetics.

Williams, J.M. (2006). Applied sport psychology: Personal growth to peak performance (pp. ). New York: McGraw-Hill.