Could e-cycling assist individuals who have had a breast cancer diagnosis to be more physically active? 

This study aimed to explore the potential role of e-cycling for individuals with a breast cancer diagnosis. It looked at physical activity engagement levels amongst those undergoing treatment, their perception of e-bikes after a taster session and if there is an optimal time to introduce e-cycling during treatment.
The project initially began as a dissertation topic for one of the postgraduate students on the MSc Nutrition, Physical Activity and Public Health programme, in collaboration with academic and research staff, and has subsequantally been published in The International Journal for Environmental Research and Public Health.
by Jessica Bourne, Miranda Armstrong and Kirsty Way. 

The importance of physical activity in tackling breast cancer

Breast cancer is the most common cancer in the UK, generating substantial financial burdens through healthcare and lost productivity. Public Health interventions are crucial in addressing these issues.

Several risk factors contribute to developing breast cancer and survival rates. Being physically active is one lifestyle behaviour that has been shown to help aid recovery and lower your risk of cancer coming back. Exercise also helps alleviate many of the common side effects of cancer treatment, including fatigue, low mood, and lack of energy.

Physical activity guidelines for individuals with a breast cancer diagnosis are the same as for the adult population. That is, to accumulate 150 minutes of moderate-intensity activity per week (like brisk walking) or 75 minutes of vigorous activity (like jogging), plus strength training twice a week. Meeting these recommendations before and after a breast cancer diagnosis can cut the risk of breast cancer recurrence by almost half, and your risk of dying from breast cancer by nearly one-third.

However, despite the known benefits, physical activity engagement decreases following a breast cancer diagnosis, with around 50% of women not meeting guidelines. There are several reasons why women might not be physically active during treatment. These include physical limitations like shoulder problems from surgery, feeling tired and lacking energy, and not having a good space or time to exercise. Gentle exercise can help alleviate many of these symptoms so, finding activities that make getting moving easier is important.

The Potential of E-bikes

Female on e-bikeElectrically assisted bicycle (e-bikes; also known as pedelecs), provide electrical assistance to the user only when they pedal. They have become increasingly popular recently and help users to ride further with less effort. E-cycling may increase physical activity levels due to users riding them more often and for longer distances than conventional bicycles. This is despite the reduced physical effort associated with riding an e-bike in comparison to a conventional bicycle. Researchers have also found that engaging in e-cycling has a favourable impact on fitness and mental health. Given the reduced physical exertion of e-cycling in comparison to regular cycling and the promising health outcomes, e-cycling maybe an acceptable physical activity for individuals diagnosed and or being treated for breast cancer. However, no research to date has examined the perception of e-cycling among these individuals.

We conducted one-on-one interviews with 24 women who had been diagnosed with breast cancer (mean age = 57 years). On average individuals were approximately 3-years since diagnosis. We held two interviews with each individual: one before trialling an e-bike and one after. E-bike taster sessions lasted 1-hour and were conducted by qualified cycling instructors in the community. All equipment required for the taster session was provided. We looked for themes across the interviews that captured the thoughts and feelings of these individuals.

Overcoming the side-effects of treatment

The cancer treatment individuals received had a large impact on their activity levels. This was due to reduced energy, feelings of weakness, fatigue and a general lack of motivation to be active. For women who were previous cyclists, e-bikes were seen as a way of helping them to get back on the road due to the extra help provided. Women commented that the prospect of e-cycling provided a sense of independence. It was also a chance to regain their identity which they had lost due to the breast cancer diagnosis. Often women were anxious about how much effort e-cycling would need. Following the taster session women commented on the ease of e-cycling and felt it would not lead to feelings of exhaustion. While some participants saw e-bikes as a way to stay active even on low-energy days, others were cautious. They worried about pushing themselves too hard and compromising their health. Women felt it was important to listen to their bodies and prioritise rest on days when fatigue was high. For those individuals e-bikes could be a great option on good days, but sometimes taking it easy was the best choice.

A boost for the body

After the taster session many participants felt that e-cycling had raised their heart rate, and they were able to have a ‘good workout.’ They said that they worked harder than expected despite the assistance of the e-bike. Individuals felt e-cycling played a type of ‘psychological trick’ on them and their willingness to cycle. The ability to change the level of assistance was extremely important to this group. It meant they could alter their exertion level based on how they were feeling. This assistance meant that tackling hills was not a concern.

Not just about the workout

Participants said e-cycling could help with fitness, strength, and boosting their circulation. Improved circulation can help treatment drugs work better. However, they felt the biggest advantage of e-bikes was psychological. Being outdoors and breathing in the fresh air made people want to keep e-cycling. Many who first thought e-bikes weren’t for them, changed their minds after completing the taster session. They found e-cycling to be an enjoyable way to exercise, making them more likely to give it another go in the future. For some women, who often felt out of control during treatment, riding the e-bike was empowering. Feelings of achievement motivate people to sticking with exercise, especially during cancer treatment. It is also good for keeping active in the long term.

Social Interaction

A key reported benefit of e-cycling was the social opportunities that e-cycling provides. Many had not been able to cycle with others since their diagnosis, but e-bikes made it possible to join in again. The shared experience of cycling with others created a sense of encouragement and made it even more enjoyable. The electrical assistance evened out everyone’s speed. This reduced users’ anxiety about being too slow or comparing themselves to others.

This social connection is more than just having fun with friends. It can also be a powerful motivator to keep exercising. Studies show that we are more likely to stick with something if we do it with others who are cheering us on. E-bikes provide a perfect opportunity for that social support system, making physical activity less like a chore.

The downsides of e-cycling

The biggest barrier that participants mention about e-cycling was the potential financial investment. For many this would stop them from considering engaging in e-cycling in the future. Related to this were concerns around theft. Discussions arose around fear and anxiety associated with parking an e-bike in a public space for fear it would not be there on return. Several other e-bike perception studies have also reported this. Environmental changes to the availability of parking facilities for bicycle users may therefore need to change for them to become more popular.

Towards an individualised approach

Despite the challenges, e-bikes emerged as a promising option for boosting physical activity among individuals being treated for and recovering from breast cancer. E-bikes can help to overcome many barriers associated with regular cycling. They also offer both physical and mental benefits. Participants responded positively to e-bike taster sessions. This suggests that they could be a valuable tool for encouraging exercise in this group. Yet, the best time to introduce an e-bike intervention in this population is hard to pinpoint. Different patients have different experiences of breast cancer and receive different treatments. Therefore, an individual approach might be best.

Read the published study here.