User:Kellie Toohey/Learning Outcomes/1. Recognise and validate research problems

Validating and formulating data from the research will be a major part of this study and a basis for the research question. Cardiometabolic disease (CMD) is a significant health and economic burden and is the leading cause of death in Australia. As a result of breast cancer related therapy and changes in lifestyle patterns, it has been proposed that breast cancer survivors may be at an increased risk for CMD. This phenomenon has been labelled the “Multiple-Hit” hypothesis and essentially puts forward that breast cancer survivors may be at risk of premature cardiovascular disease related mortality. The underlying pathogenesis resulting in an increased risk of CMD may be associated with the development and perhaps acceleration of coronary artery damage (endothelial damage) and atherosclerosis. Atherosclerosis is widely accepted as an inflammatory disease. Manifestations of this chronic inflammatory disorder include systemic elevations of inflammatory biomarkers and a reduction in vessel compliance i.e. an increases in vessel stiffness.

In the general population, research has shown an inverse association between physical activity and cardiovascular disease exists. Thus physical activity may reduce mortality and morbidity associated with CMD. It is unclear if cancer survivors would experience the same beneficial effects. In other words, would cardiovascular disease risk factors be favourably modified in cancer survivors who exercise? A gap in the literature exists in relation to optimising outcomes for cancer survivors, specifically looking at optimal exercise prescription such as mode, intensity, duration and beginners versus intermediate participants. This research will look at the differences achieved with altering the time and type of exercise. Much research has been carried out on low to moderate intensity exercise, but limited studies have been carried out on high intensity exercise.

Strengths:
 * Communication skills
 * Organised
 * Understanding of exercise physiology

Study Weaknesses:
 * Understanding of statistical data
 * Broad exercise interventions
 * Broad measures
 * Limited controlled studies
 * Limited studies on high-intensity exercise interventions with Cancer survivors
 * Sedentary population doing high intensity exercise

Personal Weaknesses:
 * Under-developed reading background
 * Limited knowledge of cancer drugs
 * Statistical knowledge is immature
 * Limited research background

Addressing weaknesses:

The participants recruited for this study will have been sedentary and therefore all participants will undertake low to moderate exercise for the first two weeks to ensure they are safely introduced to exercise and the changes that will take place. This regulated introduction to the exercise will also ensure that patients become compliant to the exercise protocol increasing the reliability of the results.

After the initial period of two weeks, half of the participants will be randomly assigned into the high intensity group for the remainder of the study and the other half will continue in the low-moderate group. A control group will also be recruited for the study and they will remain sedentary for the intervention period. Participants will undertake supervised exercise sessions three times per week. All participants will be referred from the Canberra Hospital, clients will not be known to me or my supervisors, therefore there will be no external variable that could disrupt results. Measures for this study have been chosen due to their high validation in the research for the mechanisms. This will help to limit broad measures.

Attendence to presentations on cancer physiology will be carried out this year to build level of knowledge in this area. A meeting had been arranged with Nicole Beard (Assistant Professor in cardiac physiology) to build level of knowledge. Weekly meetings with Stuart Semple (main supervisor) also has assisted in deveoping level of knowledge in research. Courses have been accessed at acspri, booking will be made into the course that runs Monday February 10, 2014 to Friday February 14, 2014.