Curr Geri Rep (2016) 5:226–232
DOI 10.1007/s13670-016-0185-6
HEMATOLOGY AND ONCOLOGY (T WILDES, SECTION EDITOR)
Upper Extremity Exercise in Older Breast Cancer Survivors:
Benefits of Dragon Boat Paddling
Mary H. Parker 1 & S. Campbell 1,2 & A. A. Weinstein 1,2
Published online: 5 July 2016
# Springer Science+Business Media New York 2016
Abstract This review presents research on exercise, particu-
larly upper extremity exercise, by breast cancer survivors,
including participants in survivor dragon boat paddling and
racing. While previous dogma held that women who had un-
dergone breast cancer treatment needed to minimize upper
extremity use, several studies have demonstrated that upper
body exercise does not cause or exacerbate lymphedema,
maintains muscle strength, and prevents bone loss. Two
papers encourage survivors to reduce sedentary behavior and
engage in 150 min or more of moderate to vigorous physical
activity per week. Other studies have examined the effects of
cancer treatments on lymphedema, use of compression gar-
ments when exercising to prevent lymphedema, and effects of
exercise on side effects of breast cancer treatment. Three arti-
cles present research on effects and benefits of dragon boat
paddling and racing after breast cancer treatment: cardiac
function improvement, paddling using the skeletal muscles
producing a beneficial factor, myokines, effects on lymphede-
ma, and other cancer aftereffects. The review includes data
This article is part of the Topical Collection on Hematology and Oncology
* Mary H. Parker
ipht@comcast.net
S. Campbell
scampb16@masonlive.gmu.edu
A. A. Weinstein
aweinst2@gmu.edu
1
Institute for Palliative & Hospice Training, Inc., Box 16,
Oakpark, VA 22730, USA
2
Department of Global and Community Health, College of Health and
Human Services, George Mason University, 4400 University Dr.,
MS5B7 Fairfax, VA, USA
from an Internet survey of women aged 60 and over who
dragon boat paddle.
Keywords Older breast cancer survivors . Whole body
exercise . Lymphedema . Myokines . Cancer treatment
aftereffects . Dragon boat paddling
Introduction
As cancer treatments became more effective, the number of
survivors who lead active lives with normal expectancy for all
cancers has increased. Among breast cancer survivors, the 20-
year relative survival is now 65 % [1]. Women who have
undergone breast cancer treatment are at increased risk for
lymphedema, and avoidance of trauma to the ipsilateral arm
(including venipuncture, blood pressure measurement, and
repetitive arm movement) was commonly recommended.
However, a number of studies challenge this dogma and
support the benefits of exercise after cancer. The PAL
Trial conducted a randomized study of 144 breast cancer
survivors with or without lymphedema. It showed that
slowly progressive weight lifting had no significant effect
on limb swelling and decreased incidence of exacerba-
tions of lymphedema, reduced symptoms, and increased
strength [2]. The American College of Sports Medicine
Guidelines recommended 150 min of exercise per week
for cancer survivors [3]. Even so, until recently, breast
cancer survivors were warned not to do certain activities:
Bavoid vigorous, repeated activities; avoid heavy lifting or
pulling^ (Cancer.org 2012 and removed in 2013).
The goal of this paper is to review the evidence regarding
the benefits of active upper body exercise, including dragon
boat paddling (see Highlight box), for women after breast
cancer treatment. Major areas of research are strength training,
Curr Geri Rep (2016) 5:226–232
increase in muscle strength and bone density, production of
myokines from skeletal muscle exercise, lymphedema, and
other aftereffects of cancer treatment and quality of life.
Studies of breast cancer survivor (BCS) dragon boat paddling
concern cardiac function, lymphedema, and the physical and
psychosocial benefits of paddling and racing with other survi-
vors in a team.
Highlight: what is dragon boat paddling?
Dragon boats are large canoes, 40 ft. or more in length, constructed of
wood or fiberglass, seating 20 paddlers side by side on ten benches. A
steering person stands on the stern and a coach, or when racing, a
drummer sits in the prow; everyone wears a floatation vest. In the
stroke, each paddler reaches forward over their side of the boat
engaging the upper body and core to place the paddle in the water, then
pushing with the feet and legs, engaging the core to keep the back
straight, propelling the paddle backwards in a driving stroke. Dragon
boat racing is an intense sprint of 250–300 m. Typically, teams practice
one or two times weekly for two or more hours. Originating in China as
a traditional spring festival, the sport spread to Canada, Australia, and
the USA. Dragon boat paddling as a sport for breast cancer survivors
began in Vancouver, BC, with BAbreast in a Boat^ organized in 1996
by Donald McKenzie, MD, a sports medicine specialist and exercise
physiologist, University of British Columbia. His goals were to test
active whole body exercise by women after breast cancer treatment as a
source of lymphedema and to train a BCS team for the annual festival
in Vancouver [4, 5]. Subsequently, women organized BCS paddling
teams across Canada and in the USA and elsewhere. Mary H. Parker is
a 14-year breast cancer survivor. She learned of BCS dragon boating in
2003, while attending a lymphedema conference in Montreal, Quebec,
CA. In 2006, she joined BCS team GoPinkDC when it was organized
in Washington, DC, USA. In 2009, she raced with a New Zealand
BCS team in Auckland, NZ. The International Breast Cancer
Paddler’s Commission (IBCPC) has 163 member teams and
sponsors international festivals. In 2014, a BCPC Festival in Sarasota,
Florida, USA included 102 BCS teams from seven countries.
Search Strategy and Methodology
The search was challenged by the requirement that articles be
no more than 3 years old and the paucity of published research
specifically on exercise by older breast cancer survivors.
Initially, a general search using the keywords: Older Breast
Cancer Survivors; women 60 and over; dragon boat paddling;
exercise after breast cancer; lymphedema; quality of life after
breast cancer or cancer, without limitation on date of publica-
tion. Search was conducted of: CINAHL, Cochrane,
EBSCOhost, MEDLINE, PubMed, ProQuest Health and
Medical Complete, ProQuest Nursing and AlliedHealth
Source, ScienceDirect, and SPORTDiscus databases searched
for trials published before January 1, 2016. The George
Mason University (Fairfax, VA) database search tool was
used. No articles were found specific to dragon boating and
breast cancer survivors. The Web of Science yielded the
best access to multiple databases at once. Articles not
specific to dragon boat paddling, older women, and breast
cancer survivors aged 60 and over were included in the
227
selection if they provided information on exercise by
older cancer survivors, older women, and breast cancer
survivors and provided data on the same data topics col-
lected in the 2011–2013 Internet survey.
Results
The search yielded 237 papers, of which 113 were within
the 2012–early 2016 range, papers published in early
2016 were included in the selection. The conditions spe-
cifically targeted were the following: breast cancer,
lymphedema, aftereffects of cancer treatment, exercise
producing myokines, and quality of life benefits of partic-
ipating in BCS dragon boat teams after cancer.
Physical Activity in Breast Cancer Survivors
Clinical concerns have focused on weight gain and sedentary
life style by women after cancer treatment. Between 50–80 %
of survivors are estimated to not meet the recommended
150 min of Bmoderate to vigorous physical activity^
(MVPA) per week or 75 min of vigorous activity or some
combination. Two Canadian papers report different assess-
ments of data from a 1-year study of 199 women, who recent-
ly completed breast cancer treatment, to understand patterns of
sedentary behavior and MVPA [6, 7]. Volunteers wore accel-
erometers during waking hours for 7 days, to provide baseline
data on minutes of MVPA and sedentary time. In a cohort of
177 women, the mean age was 55 years (range 28–79 years).
Over three quarters (78 %) spent their day sedentary across all
time points compared with less than 2 % of their day engaged
in MVPA. Sedentary time remains high in the first year fol-
lowing treatment and MVPA decreased; the trends were more
pronounced for overweight women. In another study,
semiparametric group-based modeling procedures were used
to identify five MVPA exercise trajectories, ranging from con-
sistently inactive (N = 11) to consistently sufficiently active
(N = 98). Those who reported depressive symptoms were less
likely to remain consistently sufficiently active. Women who
reported higher levels of cancer worry were more likely to
remain consistently sufficiently active. In this study, about half
(49 %) of women in the study met MVPA guidelines through-
out the study.
Exercise Interventions for Breast Cancer Survivors
Since the PAL Study, there have been a number of exercise
intervention studies in breast cancer survivors, mostly of
weight and resistance exercise. Few have focused on older
women, who are the majority of women receiving breast can-
cer diagnoses each year. A 1-year study of supervised resis-
tance and impact training with 67 older breast cancer
228
survivors stopped bone loss and increased muscle strength. It
was followed up 1 year later with assessments of 44 of the
original participants [8]. The results suggested that bone den-
sity of the spine was preserved after 1 year but muscle strength
was not maintained. This suggested that maintenance of mus-
cle strength may require continued participation in a super-
vised exercise program.
A 4-year study of cardiac function followed 55 breast can-
cer survivors who participated in competitive dragon boat
training in Florence, Italy, and 36 healthy women as con-
trols [9••]. All 91 women received annual ergometric test-
ing and 2D echocardiography to Bevaluate hemodynamic,
morphological, and functional cardiac parameters.^ When
the study began, none had hypertension, diabetes, or evi-
dent arm edema but cardiac tests showed Ba slight trend^
toward diastolic dysfunction in the breast cancer survi-
vors. In the exercise intervention, twice a week the pad-
dlers had a10-min aerobic warm-up, a 90-min practice in
the boat, and a 20-min stretching cool down. The control
group chose other exercises, e.g., swimming, tennis, ca-
noeing, or running, three times a week for 2 h. When the
study ended, cardiac tests showed diastolic function in the
breast cancer women had Bincreased significantly^ with
the regular physical activity, and dragon boat training
Bdid not impact negatively^ on cardiac function. This
study demonstrated that breast cancer survivors can safely
practice dragon boat paddling.
Lymphedema as a Result of Breast Cancer Treatment
and Effects of Exercise
As indicated earlier, lymphedema is a primary concern after
breast cancer treatment. Lymphedema is the swelling of tis-
sues due to accumulation of fluids and plasma proteins,
resulting from treatments that impair lymph drainage and cir-
culation. It can occur in any area of the body where lymph
nodes have been removed or damaged, although a primary
focus is the arm on the treatment side of the body.
Lymphedema risk increases with the extent of treatment,
e.g., mastectomy rather than lumpectomy, removal of more
than the sentinel lymph nodes, radiation which scars the
lymph nodes and channels located just below the skin, and
post-surgical infections. Mild swelling may have pitting of the
swollen area when pressed. More severe swelling causes pain,
heaviness of the affected area, and even cellulitis and infec-
tion. Severe lymphedema swelling may become permanent,
requiring bandaging and other continuous treatments.
Clinicians recommend that women at risk of arm lymphedema
wear a special compression sleeve fitted to arm measurement
and even a glove, when engaged in exercise activating the
affected arm and when flying at high altitudes.
The Review and Survey Group of the Breast Cancer
Network of Australia (BCNA) recruited 760 volunteers with
Curr Geri Rep (2016) 5:226–232
a prior diagnosis of breast cancer who accepted an informed
consent online with BCNA and 440 answered the survey on-
line, 4 by mail, a 58 % response rate [10•]. One hundred forty-
nine (43 %) reported having lymphedema and 40 (9 %) were
unsure. About one third (31 %) reported treatment for lymph-
edema in the previous 5 years. Survivors experienced lymph-
edema in different locations: 77 % reported arm lymphedema,
52 % the hand, 35 % the chest wall or the breast, and 40 %
swelling in more than one location. A comparison of women
with and without lymphedema found no significant difference
between their types of breast surgery. Those without lymph-
edema were more likely to have sentinel node biopsy, rather
than axillary dissection. More women with radiation to the
axilla (69 %) had lymphedema. To treat lymphedema symp-
toms, 89 % of women reported doing self-administered man-
ual lymphatic massage, 80 % wore compression garments,
64 % received therapist-administered manual lymphatic drain-
age (MLD), and 62 % exercise. Two thirds (69 %) tried four or
more types of treatment and 9 % tried seven or more treat-
ments. There was a Bweak association^ between the numbers
of treatments tried and the severity of lymphedema reported.
The types of therapies reported to be effective were complex
lymphatic therapy (several modalities combined). Some wom-
en reported laser treatments to be helpful.
A 2016 meta-analysis concerned the effects of exercise on
cancer-related lymphedema and sought to determine the need
to wear compression during exercise [11•]. The first literature
review evaluated studies on the effects of exercise for people
with diagnosed upper or lower body lymphedema. A second
reviewed studies evaluating the effect of compression use dur-
ing exercise, mostly resistance training, on lymphedema.
Assessments of lymphedema were included, with no exclu-
sion criteria on the methods used for assessment. A fault of
many studies was limited follow-up after exercise. Only one
assessed lymphedema beyond 24 h post-exercise. No sig-
nificant overall effect was observed in 12 studies evaluat-
ing longer term effects of exercise. Studies involving re-
sistance exercise consistently demonstrated that resistance
does not exacerbate lymphedema and reported favorable
outcomes on lymphedema symptoms. The meta-analysis
concluded that exercise after cancer results in improve-
ments in function, health, quality of life, and potentially
survival. The reviews and meta-analysis suggest that
physical activity guidelines for cancer survivors are rele-
vant for survivors with lymphedema. Regarding compres-
sion use during exercise, there appears to be no consistent
benefit of wearing compression for lymphedema and
associated symptoms. Performing exercise without
compression does not exacerbate lymphedema, and there
seem to exist positive and negative effects of wearing
compression during exercise. The review found insuffi-
cient scientific evidence to support or refute clinical rec-
ommendation for the use of compression during exercise.
Curr Geri Rep (2016) 5:226–232
Paddling Exercise Uses Skeletal Muscles, Produces
Myokines
Research from Europe reports skeletal muscle activity has
been shown to produce a factor, Bmyokines,^ which reduces
inflammation and may contribute to exercise-induced protec-
tion against some chronic diseases [12]. Recent research with
dragon boat paddlers tested the hypothesis that whole body
exercise and dragon boat paddling would produce these fac-
tors [13••]. Over 16 weeks, 20 breast cancer survivors who
dragon boat paddled were trained in resistance and aerobic
exercise, with dragon boat paddling added for the next
8 weeks; 14 sedentary breast cancer survivors were controls.
The exercise program Binduced changes in myokines
levels in breast cancer patients.^ The study confirmed that
skeletal muscle may be considered as an endocrine organ
that produces and releases myokines in response to exer-
cise training and dragon boat paddling, and the health
beneficial effects are emphasized by a decrease in the
oxidative status.
Quality of Life for BCS Survivors After Cancer
Canadian Universities have been a rich source of research on
the benefits of exercise and dragon boat paddling after breast
cancer. Another study from British Columbia explores health-
related quality of life (HRQOL), [14•]. A survey enrolled 116
breast cancer survivors from 14 British Columbia dragon boat
teams, who were at least 6 months post-treatment and active
paddling participants in 2010. The phase I survey question-
naire was sent by e-mail or postal mail. All but four partici-
pants completed the questionnaire online. The questionnaire
incorporated qualitative assessment tools: (1) Functional
Assessment of Cancer Therapy-Breast (FACT-B), (2)
Functional Assessment of Chronic Illness Therapy-Spiritual
Well-Being Scale (FACIT-SP12), and (3) Functional
Assessment of Cancer Therapy-Fatigue Scale (FACIT-
Fatigue). One hundred participants completed the question-
naire again post-season. Phase II was a 30–60-min recorded
telephone interview with 15 participants from nine teams
using open-ended questions. Data analysis focused on
eight themes: physical fitness and lifestyle, emotional
strength and reduced stress, social support network, ob-
stacles and deterrents, spiritual health, and the new nor-
mal. Most of participants (54.9 %) were 60 years or older.
Over half (52 %) were 5 years or more past diagnosis;
21 % were in their first season of paddling, 56.6 % had
paddled four or more seasons, 90 % of women paddled
two or more times weekly in on-the-water training ses-
sions, 74.3 % paddled in two or more races during the
season, and 75 % attended three or more team social
events. Physical and functional well-being scores were
higher for women who had participated more than one
229
season, compared to those in their first season. All the
women reported positive physical benefits: cardiovascular
endurance; more strength in the arms, shoulders, legs, and
core; improved strength; stamina; and energy levels.
Participation in dragon boat racing was perceived to in-
spire women to be conscious of living a well-rounded and
healthy lifestyle. Participation in a season of dragon
boating was associated with improved HRQOL physical,
functional, emotional, and spiritual well-being.
Aftereffects of Cancer Treatment and Exercise
The aftereffects of cancer treatment may be immediate, such
as pain or numbness from surgery or widespread radiation scar
tissue, or the symptoms of adjuvant therapies, hot flashes,
joint pain, or weight gain. Some aftereffects surface when
the survivor begins normal activities of daily living, limita-
tions on reach, lack of shoulder range of motion, difficulty
lifting and carrying groceries, and lymphedema. Other after-
effects may surface many years after treatment, heart problems
from chemotherapy or radiation, a cancer recurrence, or nerve
damage from impinging scar tissue. Unlike the therapies to
destroy the cancer, many of these conditions have been poorly
studied and may not have therapies. The Breast Cancer
Network Australia (BCNA) targeted an Internet survey to
women with a prior breast cancer diagnosis, who had regis-
tered e-mail addresses with BCNA. Four hundred thirty-two
women completed the survey (68 close-ended and 11 open-
ended items) [15•]. The study investigated associations be-
tween personal characteristics (age, type of surgery, and cur-
rent treatment status), exercise levels, and a comprehensive
list of symptoms experienced in the 2 weeks prior to taking
the survey. Participants were aged 23–77, mean 53.3 years.
They were classified in high (9 %), moderate (28 %), and low
(37.4 %) levels of physical activity and 62.6 % Bnot meeting
any classified levels of physical activity.^ Independent vari-
ables were the following: age, surgery, current treatment, and
exercise participation. The most common side effects were hot
flashes, sleep disorders, aching muscles, and fatigue re-
ported by two thirds. Women who had lumpectomy were
less likely to report fatigue. Women receiving adjuvant
treatment were more likely to report weight gain, shoulder
limitations, breathlessness, muscular chest wall pain, and
arm lymphedema. Age was not strongly associated with
side effects. Women who had mastectomy were more like-
ly to report weight gain. Overall, exercise was associated
with a lesser symptom experience for shoulder limitations,
muscular chest wall pain, weight gain, lymphedema, and
breathlessness. The study suggested that targeting women
who are at high risk of developing breast cancer treatment
side effects could direct resources to those patients most
likely to benefit.
230 Curr Geri Rep (2016) 5:226–232

Dragon Boat Paddling in Older Breast Cancer Survivors Table 1 Participant responses regarding the impact of paddling on
physical and psychosocial symptoms and well-being.

The Institute for Palliative & Hospice Training, Inc. How does paddling benefit you? (Check all that apply) Lymphedema
conducted the Internet survey by recruiting breast cancer
survivors through e-mail letters to BCS teams containing N = 356 Percent N = 79 22 %
the survey site URL. After logging on and acknowledging Increased fitness 345 97 % 76 96 %
an informed consent, 750 women accessed the survey in-
Feel better 322 90 % 68 86 %
strument. A birth date was the only personal identifier
Have fun 351 98 % 77 97 %
recorded. Data from the 356 women (47 %) aged 60 to
Challenge 322 90 % 62 64 %
86 years of age are included in this paper.
Less stress 184 52 % 39 49 %
Survey responses were received from the following: the
Learn a skill 234 66 % 58 73 %
USA 48 %, Canada 28 %, Australia 17 %, New Zealand
Sense of accomplishment 306 86 % 65 82 %
5 %, England 1 %, and South Africa 1 %. Ninety-nine
Team activity 322 90 % 70 89 %
percent of respondents had not dragon boat paddled before
Racing/competition 297 83 % 55 70 %
their breast cancer. The median age of respondents was
Friendship/companionship 310 87 % 75 95 %
65, mean 66. Ethnicity was 94 % Caucasian and 6 % other
Sleep better 245 69 % 35 44 %
ethnicities. Length of paddling ranged 1 to 15 years, median 5,
Energized 310 87 % 61 77 %
and mean 6.6 years. Length of time since cancer diagnosis was
Healthier 313 88 % 66 83 %
1 to 35 years, median 11 years, and mean 11.52 years.
Happier 294 82 % 66 83 %
Seventeen women began paddling in the year of their cancer
diagnosis. The data revealed a similarity across the six coun- Stronger 313 88 % 66 83 %
tries of positive and beneficial experiences for women partic- More satisfied with my abilities 253 71 % 55 70 %
ipating in BCS dragon boat teams. Limitations of the survey: In control of my body 243 68 % 54 68 %
The questionnaire collected experiential, self-reported data, Peaceful 170 48 % 33 42 %
including cancer treatment and after effects. It was not Fatigued 56 22 % 14 18 %
intended as a clinical study, only to gather opinions about Frustrated 16 4% 4 5%
the experience of dragon boating from women participating In pain 5 1% 2 2%
in BCS teams in the six countries surveyed. Stressed 1 0.003 % 0 0%
The women who answered the survey selected dragon Inadequate 5 1% 2 2%
boating as a post-cancer exercise activity. Most (89 %) Anxious 8 2% 2 2%
reported paddling two times a week during the season. Weak 0 0% 0 0%
Since practices usually last about 2 h, this would meet
or exceed the 150-min weekly MVPA requirement. As a
result of paddling, 70 % reported exercising more, 33 %
set fitness goals, and 27 % lost weight. Fun is identified as a benefit of paddling, as are team activity
Seventy-nine women (25 %) reported having lymphedema; and racing/competition. Paddling gives them a sense of ac-
58 % reported their lymphedema began after surgery, 33 % complishment. Paddlers feel more satisfied with their abilities
after radiation, 20 % chemotherapy, 11 % reconstruction, and in control of their bodies. Paddling makes them feel
18 % infection, and 43 % other sources, e.g., injury, overuse. healthier, happier, and more satisfied with their abilities and
Of women with lymphedema, 13 (15 %) report wearing com- in control of their bodies. The women with lymphedema had
pression garments. There was no significant difference be- similar responses as those without, including a lack of nega-
tween the women with and without lymphedema in breast tive feelings about paddling. No one felt weak; feelings of
cancer treatments, breast or lymph node surgeries, radiation stress, inadequacy, pain, and anxiety were rare. Table 2
therapy, or chemotherapy. There was no significant differ- presents self-reports of paddlers surveyed about afteref-
ence between women with or without lymphedema in fects of breast cancer treatments. Of interest for compar-
experiencing treatment aftereffects: restricted movement, ison are the reports from the women 1–10 years post-
scar tissue, pain, or hot flashes. No survivors felt that diagnosis and the women 12–35 years post-diagnosis.
paddling made their lymphedema worse, and over half More of the 1–5-year women report no aftereffects, re-
(56 %) reported that it made it better. stricted movement, and scar tissue. In the last survey
Table 1 summarizes participant responses regarding the question, 316 women said that they would continue to
impact of paddling on physical and psychosocial symptoms paddle in order to keep physically active (98 %), to main-
and well-being. The responses to the HRQOL survey and tain a healthy lifestyle (100 %), and to have a supportive
responses to the Women on the Water 2011 survey are similar. group of friends and teammates (95 %).
Curr Geri Rep (2016) 5:226–232 231

Table 2 Aftereffects of cancer treatment

N-356 Mastectomy (%) Lumpectomy (%) Sentinel node biopsy (%) Axillary node removed (%) Chemotherapy (%)

None 43 (12 %) 61 (17 %) 35 (10 %) 33 (9 %) 44 (12 %)

Restricted movement 31 (9 %) 42 (12 %) 34 (10 %) 38 (11 %) 57 (10 %)
Scar tissue 61 (17 %) 76 (21 %) 70 (20 %) 65 (18 %) 77 (22 %)
Pain 26 (7 %) 52 (15 %) 37 (10 %) 33 (9 %) 38 (11 %)
Neuropathy 55 (15 %) 67 (19 %) 63 (18 %) 66 (18 %) 66 (18 %)
(N = 95) hot flashes 10 (11 %) 22 (23 %) 13 (14 %) 18 (19 %) 17 (18 %)
Night sweats 9 (10 %) 15 (16 %) 11 (12 %) 12 (13 %) 12 (13 %)
Memory issues 11 (12 %) 16 (17 %) 12 (13 %) 17 (18 %) 18 (19 %)
Lymphedema N = 78 (%) Diagnosis 1976–1999 Diagnosis 2000–2010 Total
12–35 years 1–10 years N = 335 (%)
N = 168 (%) N = 107 (%)
None 15 (19 %) 47 (28 %) 40 (37 %) 101 (30 %)
Restricted movement 20 (26 %) 26 (15 %) 18 (17 %) 67 (20 %)
Scar tissue 34 (43 %) 64 (38 %) 26 (24 %) 123 (37 %)
Pain 19 (24 %) 40 (24 %) 20 (19 %) 73 (22 %)
Neuropathy 36 (46 %) 55 (33 %) 35 (33 %) 114 (34 %)
Hot flashes 7 (29 %) (N = 24) 20 (12 %) 8 (7 %) 29 (31 %) (N = 95)
Night sweats 6 (25 %) 4 (4 %) (N = 95) 18 (19 %) (N = 95) 22 (23 %)
Memory issues 6 (25 %) 4 (4 %) 21 (22 %) 25 (26 %)

NOTE: This question was check all that apply. So responses will not total 100 %

The following responses give evidence of the physical
health and psychosocial benefits experienced from pad-
dling after breast cancer.
Qualitative Data: BCS Paddlers Speak for Themselves
BOne of the best things about paddling is being able to
compete in a hard physical competition at an older age
(I’m now over 60)—a sport I can do sitting down! And
seeing other paddlers still hard at it in their 70s and 80s is
very inspiring. It certainly proves that one can survive
this disease. The actual racing is hugely exciting. You’re
in a big team, but the real battle is with yourself—willing
yourself to do your utmost every stroke—all the way
down the course. Plus the training sessions out on the
water on a fine day are brilliant—they lift my spirits and
make me really appreciate being alive. I would have to
say that dragon-boating for me has been the biggest up-
side to breast cancer.^
BPaddling is an extremely positive activity to take part in
after treatment. When I had finished my treatment I was
made to feel that I couldn’t even pick up a heavy shop-
ping bag! Taking part in this sport throws everything out
of the window and it’s a fantastic feeling to win medals
and show people that breast cancer is not the end of your
life—it’s the beginning.^
BOur team pushes us to get fit and stay fit and provides
lots of ways to do that.^
BI am not a very athletic person and joining paddling has
made me feel strong and confident and part of a very
supportive team.^
BFor me the initial draw was to meet some other breast
cancer folks and get out on the water for some exercise. I
did not expect the rigorous level of exercise that dragon
boat paddling entails, but I think it has been good for me
physically. I do not enjoy the ‘paddle ‘til you puck’ attitude
that goes along with racing. I am not a competitive person
by nature and don’t want to be an athlete. I wish there was
less emphasis on the racing and competition and more on
building endurance and getting regular exercise with a
group that understands the limits that cancer can impose.^
BPaddling has been a wonderful experience for me. The
physical exercise I believe helped me to get passed the
extreme tiredness after 25 treatments of radiation. It
certainly got me through and made me feel strong. I
cannot swim and have always been afraid of water.
But this feels sooo right! Paddles Up^
BI recently found a lump which fortunately is not malig-
nant and having my team mates support during this time
has been amazing. I value their friendship and support.^
BI believe that any information about dragonboating that
can help future breast cancer patients is very important. You
can lead a good and healthy life after breast cancer and the
rewards, friends that you make along the way are priceless.
232
Conclusion
The research in this review provides an overview of findings on
exercise for older women after breast cancer treatment and the
beneficial and significant role exercise plays in healthy recovery
and mitigation of after effects of cancer treatment, particularly
lymphedema. The studies introduce recent clinical and psycho-
social research involving women who participate in Breast
Cancer Survivor (BCS) dragon boat teams. Studies demonstrate
the possible cardiac benefits of this exercise and the role of the
paddling process itself in producing beneficial factors,
myokines, which may lead to reduction of symptoms and in-
flammation and perhaps provide protection against disease.
Original research data from 356 women aged 60–86, who par-
ticipate in BCS teams in six countries, provides illustration and
expansion of the findings in the previously published literature.
This body of research supports the physical and psychosocial
palliative benefits of dragon boat paddling and racing by wom-
en aged 60 and over. The benefits of dragon boating as exercise
and sport should be a more widely recognized survivorship
activity deserving of active clinical and recreational support.
Compliance with Ethical Standards
Conflict of Interest The authors declare that they have no conflict of
interest.
Human and Animal Rights and Informed Consent The Institutional
Review Board of the George Mason University approved the question-
naire and informed consent document used in the Internet survey.
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