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Abstract

This descriptive qualitative study explores breast cancer survivors’ lived experiences with exercise and body image following diagnosis and treatment. Ten women, aged 48 to 80, participated in individual Zoom interviews, sharing personal reflections on how breast cancer impacted their perception of their bodies and overall appearance. Through reflexive thematic analysis, three key themes emerged: exercise as a means of physical rehabilitation, emotional coping, and social connection. Participants commonly described walking and other forms of movement as helpful in improving both their physical well-being and self-image. Notably, many survivors reported feeling unprepared for the visible changes to their bodies, expressing shock and emotional distress when confronting these transformations. The study highlights the importance of incorporating anticipatory guidance and supportive interventions into survivorship care, particularly around appearance-related concerns. These insights underscore the value of patient-centered approaches that recognize exercise as a multidimensional tool for healing and adaptation, ultimately contributing to improved quality of life among breast cancer survivors.

Keywords

breast cancer body image appearance physical activity

Introduction

Breast cancer patients go through various changes after diagnosis and during treatment, including physical, mental, emotional, and financial challenges. One challenge that many breast cancer patients and survivors face is changes in their physical appearance after undergoing oncological treatment.^1–3 While several factors contribute to coping with cancer, exercise plays a significant role in improving people's mood, body image, and overall health.^4,5 The significance of these factors expands to treatment considerations: weight gain, weight loss, exercise, and other bodily changes are closely associated with cancer diagnosis, treatment, and recovery.

Research indicates that physical changes resulting from cancer diagnosis and treatment are often a source of concern, especially for younger women; in fact, 33% of young breast cancer survivors reported significant worries about weight changes post-treatment.² If these concerns are neglected, a patient's physical and mental well-being may decline, potentially increasing feelings of anxiety or depression. Therefore, understanding the impact of body image and physical approaches on recovery for these patients can assist in holistic-centered care by implementing exercise and psychological support to enhance the quality of life and recovery. The goal of this study is to describe breast cancer survivors’ experiences of exercise as it pertains to their body image. This study focuses on how exercise affects breast cancer survivors, with a focus on changes in body image from the time of diagnosis through treatments and post-treatment. More precisely, this study examines how exercise and weight management may assist breast cancer survivors with negative body image.

Breast cancer survivors often struggle with body image due to physical changes from treatments, such as mastectomy scars, hair loss, and weight fluctuations.^4,6 These changes can lead to body dissatisfaction and emotional distress, influenced by societal beauty standards and perceptions of femininity.^1,7,8 Budden et al⁹ found that these concerns may cause survivors to avoid social interactions, worsening their emotional well-being. Emotional distress due to changes in the body can lead to social isolation and altered behavior due to the perceived or actual reactions of others.^10–12 A study of 23 Danish cancer survivors by Rasmussen et al¹³ found that people tend to focus on the altered appearance of cancer survivors and avoid public contact with them, regardless of whether the changes in appearance are readily visible. Invasive surgery may lead to dissatisfaction with appearance and bodily functions, which then leads to stress, psychological distress, and body image dysmorphia.¹⁴

Exercise has been implicated as a means by which cancer survivors can soften the physical toll associated with cancer treatment. A study of the effect of exercise on cancer-related fatigue found that aerobic exercise, unlike resistance training, positions survivors to diminish treatment-related fatigue.¹⁵ Being able to manage and maintain a healthy weight also contributes to reducing the risk of cancer recurrence. Furthermore, exercise has demonstrated itself to improve mood, expand social involvement, and improve body image. Self-efficacy plays an important role in survivors’ quality of life. Those with higher self-efficacy are more likely to engage in positive health behaviors, like exercise, which can improve body image and reduce distress.^3,16 Exercise has also been shown to help survivors regain a sense of control over their bodies.² Interventions such as cognitive-behavioral therapy and lifestyle changes, including exercise and mindfulness, have been shown to improve body image and quality of life.^3,17 Integrating these approaches into survivorship care can support a more holistic recovery, addressing both the physical and psychological needs of patients.

Objectification theory suggests that internalizing societal standards can increase body dissatisfaction, especially for younger women.^2,7,18 As a result, women may develop negative attitudes towards physical changes in their bodies, particularly if these changes affect their perceived sexual desirability. Cultural norms further exacerbate these concerns, as cancer survivors may feel pressure to conform to unrealistic beauty ideals.^1,19 Some sociocultural values associate a woman's worth with the appearance of her body and sexual function, which may lead women to feel increasingly unsatisfied with their bodily changes. Understanding the sociocultural factors that contribute to the development and maintenance of body image disturbance are crucial in understanding how cancer survivors perceive their bodies.²⁰ Additionally, understanding forms of sexual objectification of women can better provide an overview of the body image concerns in female cancer survivors.^21,22

Women influenced by objectification may opt for riskier breast-conserving surgeries instead of a total mastectomy. A study assessed the body image of breast cancer patients 8 weeks before and after surgery; those who had undergone surgery reported a decrease in their body satisfaction while women who did not undergo surgery reported no change. Notably, about 94% of women who chose to receive treatment did so based on what type of surgery could offer them optimal “survival.”²³ This study emphasized that women must be aware of their treatment methods and be involved in the decision-making process to ensure moderate satisfaction with their appearance post-treatment. To better facilitate a positive body image, effective interventions and guidance from medical professionals may be necessary in helping patients decide on having surgery or not.

Previous research has explored the benefits of exercise in addressing body image concerns among cancer patients. However, few studies have qualitatively examined how survivors perceive their own bodies during the post-treatment recovery period, particularly in connection with physical activity. This study addresses that gap by focusing on the lived experiences of breast cancer survivors. The findings aim to inform public health professionals and healthcare providers about the role of exercise in shaping patient identity and self-perception. To achieve this, qualitative data were collected to explore how exercise influences body image during survivorship. The study was guided by the following research question:

Research question: How do breast cancer survivors describe the role of exercise regarding their body image?

Methods

Ethical Approval

The research protocol was reviewed and approved by the Institutional Review Board (1845542-1). Written informed consent was obtained electronically from all participants before participation. Participants were reminded that they could skip any question or withdraw from the study at any time without consequence. There was no compensation for their participation in this study.

Study Design and Approach

This qualitative study employed a descriptive design applying reflexive thematic analysis, consistent with Braun and Clarke's framework.²⁴ This approach allowed for a rich exploration of breast cancer survivors’ lived experiences related to exercise and body image. This approach was best suited for this study given the focus on the description of participants’ experiences. Other approaches, such as grounded theory, narrative inquiry, and phenomenology, did not align with this study, as the focus of this study was not theoretical, nor were lived experiences or participant stories collected to address the research question. The goal of descriptive designs is to be able to describe a phenomenon using rich qualitative data, which aligns with Braun and Clarke.²⁴

Participants and Recruitment

Participants were recruited through advertisements placed in a local newspaper and magazine in the United States. The study invitation briefly described the project as seeking breast cancer survivors’ experiences with exercise and body image and provided the primary investigator's email for interested individuals. Eligibility criteria included being 18 or older and a self-identified survivor of breast cancer. Those who were interested emailed a member of the research team to schedule an interview over Zoom. Before the interview began, participants were emailed a copy of the consent form to sign and send back to the research team before the interview was conducted. Participants were informed of the goal of the study and allowed to refrain from answering any questions that made them feel uncomfortable or withdraw from participation at any time.

Participant Characteristics

The study consisted of 10 female participants ranging in age from 48 to 80 years (M = 64). Nine participants identified as White, and one as Black. Demographic information was collected on age, race/ethnicity, and gender identity. Clinical details such as cancer stage, treatment type, and time since diagnosis were not systematically collected to minimize potential discomfort. However, some participants voluntarily shared aspects of their treatment experiences during the interviews, which were incorporated into the analysis where relevant.

Data Collection

Data were collected through semi-structured individual interviews conducted via Zoom, which allowed for flexibility, accessibility, and participant comfort during the COVID-19 era. The data was collected during the COVID-19 pandemic; thus, remote interviews ensured participant safety. Furthermore, online interviews allowed the team to reach diverse groups of participants regardless of geographic region. Next, remote interviews increased flexibility and convenience for both the team and participants. Finally, the online platform allowed participants to remain in their own homes, and it may have increased their comfort and willingness to discussion sensitive topics that affect their health and quality of life. With permission, interviews were audio-recorded and professionally transcribed verbatim. Conducting virtual interviews allowed participants to participate in a location most comfortable with them, which was particularly important for participants still going through treatment. Each interview lasted approximately 30 min. Interviews followed an open-ended guide (11 questions; see revised Appendix A) designed to elicit experiences related to cancer diagnosis, treatment, body image, exercise, and medical care. Probing questions were used to encourage elaboration.

Research Team and Reflexivity

Interviews were conducted by the Primary Investigator of this study, a researcher with training in qualitative interviewing. The interviewer had no prior clinical or personal relationships with participants, minimizing bias. The academic background and clinical familiarity with cancer survivorship informed the development of the interview guide and sensitivity in addressing body image-related topics. Concurrently, awareness of these professional perspectives prompted efforts to minimize bias by (a) using open-ended, participant-driven questions, (b) maintaining reflexive field notes after each interview to document assumptions, and (c) discussing coding and theme development with colleagues to ensure credibility and trustworthiness. While the researcher's familiarity with psychosocial aspects of cancer survivorship may have directed attention to issues of body image and coping, steps were taken to ensure that interpretations were grounded in participants’ words. All transcripts were coded collaboratively by the research team, and discrepancies were discussed until consensus was reached. The research team consisted of two academic faculty members with expertise in qualitative analytic techniques and one undergraduate student who completed an advanced research methods course.

Data Analysis and Rigor

All interviews were transcribed verbatim and analyzed using reflexive thematic analysis, consistent with a descriptive qualitative design. Following Braun and Clarke's six-step approach,²⁵ the analysis involved: 1) familiarization with the data; 2) generating initial codes; 3) developing preliminary themes; 4) reviewing themes; 5) defining and naming themes; and 6) producing the final report. Two principal investigators independently coded the transcripts, and a third investigator reviewed and refined themes to ensure consistency and rigor.

To enhance credibility, transcripts were shared with participants for member checking, allowing them to confirm the accuracy of their statements. During analysis, we carefully considered how participants’ statements related to body image. Where quotes explicitly addressed body appearance or confidence, they were coded as reflecting body image. For statements where links to body image were indirect (eg, concerns about weight or physical activity), alternative interpretations, such as functional limitations, health considerations, or emotional coping, were acknowledged. This approach ensures that findings are firmly grounded in participants’ perspectives while transparently reflecting the multifaceted motivations behind exercise behaviors. Finally, saturation was achieved when no new themes emerged across interviews, indicating that the dataset provided sufficient depth to capture the range of participant experiences. Recruitment and interviewing continued until data saturation was reached, and saturation was monitored throughout the data collection process by the research team and achieved after 10 interviews.

Results

The results below present themes that emerged from their reflections on exercise during and after treatment. When participants explicitly described their appearance, confidence, or feelings about their bodies, these were interpreted as direct reflections of body image, while participants did not name body image, highlighted broader motivations for exercise such as physical rehabilitation, emotional coping, or social connection. By distinguishing between direct and indirect links to body image, we aim to offer a nuanced interpretation that remains closely grounded in the data while acknowledging the multiple roles exercise plays in survivorship. Thematic analysis identified three overarching themes: (1) Exercise for Physical Rehabilitation, (2) Exercise for Emotional Coping, and (3) Exercise as a Social Catalyst. Illustrative participant quotes are presented in Table 1.

Table 1.

Emergent Themes, Subthemes, and Illustrative Quotes from Breast Cancer Survivors (N = 10).

Theme	Subtheme	Illustrative quotes
Exercise as physical rehabilitation	Restoring function	“When I was getting my radiation treatments, I had the opportunity to walk about 10 blocks … I just needed that time to get the physical exercise.”
Exercise as physical rehabilitation	Managing treatment effects	“There wasn’t a whole lot you could do [about gaining weight] because you physically can’t.”
Exercise for emotional coping	Mental resilience	“Exercise is as much mental as it is physical.”
	Body acceptance	“Just keeping your body fit … try not to gain weight. Keep your body as fit as you can.”
	Stress relief	“Yoga has been a big part of relaxing … walking clears my mind. I like to walk at least 2 miles a day when it's warm enough.”
Exercise as a social catalyst	Maintaining relationships	“I walked around my neighborhood with a friend daily.”
	Peer support	“Being around other survivors … was very helpful for me.”
	Giving back	We had our own breast cancer walk … that one person who had just been diagnosed met a lot of people, and it helped her to see how things are gonna be.”

Exercise for Physical Rehabilitation

Healthcare providers often emphasize the importance of physical activity during breast cancer treatment, though survivors reported that treatment-related limitations, such as fatigue, weight gain, or reduced mobility, made exercise difficult. Participant 9 explained, “there wasn't a whole lot you could do [about gaining weight] because you physically can't,” reflecting the frustration of limited physical capacity during chemotherapy. At face value, this statement refers to the physical restrictions of treatment and their impact on weight control. While weight management may reflect health-related concerns, it also connects to body image, as the inability to exercise represents a loss of control over one's body and appearance. Importantly, the ambiguity here illustrates that body image during treatment cannot be separated from broader concerns of functionality and health. By acknowledging these overlapping interpretations, we recognize that body image distress may arise not only from dissatisfaction with appearance but also from frustration with diminished physical autonomy.

Despite these barriers, participants described exercise as a deliberate strategy for regaining physical functioning and coping with side effects. Walking emerged as the most common and accessible activity. Participant 1 shared, “When I was getting my radiation treatments, I had the opportunity to walk about 10 blocks to work … I just needed that time to get the physical exercise,” emphasizing intentional movement to sustain strength despite fatigue. Similarly, one participant completed two marathons as a way to support her recovery and feel more confident in her body. Others turned to Pilates or yoga to gradually rebuild flexibility and mobility.

Overall, survivors framed exercise as a meaningful avenue for physical rehabilitation. While some participants noted potential secondary benefits for body confidence, their primary motivations centered on restoring function and managing the physical consequences of treatment. This underscores that survivors’ engagement in exercise often reflects a multidimensional interplay between recovery, health, and, in some cases, body image.

Exercise for Emotional Coping

Survivors consistently described exercise as an important emotional coping mechanism during and after treatment. For some, maintaining fitness was tied to preserving confidence in their appearance. As Participant 6 explained, exercise helped her “keep your body fit, try not to gain weight. Keep your body as fit as you can,” reflecting the dual role of physical activity in supporting both health and body image.

Others emphasized the psychological benefits of exercise more broadly. Participant 1 noted that exercise “is as much mental as it is physical,” highlighting its role in managing stress and fostering resilience. Participant 8 described it as transformative: “it truly tones your mental outlook and the way you feel … it becomes your new medicine.” Similarly, Participant 10 identified yoga and walking as key strategies to “clear my mind” and “relax,” underscoring the therapeutic value of movement for mental well-being.

Taken together, these accounts suggest that exercise functioned not only as a means of addressing appearance-related concerns but also as a powerful tool for enhancing emotional health. Survivors used physical activity to reduce stress, improve mood, and cultivate resilience, demonstrating the multifaceted role of exercise in coping with the challenges of survivorship. Importantly, participants also described creative strategies to remain active despite treatment-related fatigue or physical restrictions. Many modified routines or adopted lighter activities, illustrating flexibility and perseverance in sustaining movement. These adaptations reveal that body image was not only about appearance but also about perceptions of bodily functionality and competence. As participant 8 shared, “I couldn’t do what I used to, but I found other ways to keep moving,” suggesting that the ability to maintain activity, even in altered forms, contributed to a sense of bodily control and self-efficacy.

Exercise as a Social Catalyst

Survivors emphasized the social value of exercise, describing how physical activity created opportunities for connection, support, and encouragement. Walking with friends or joining group classes provided motivation and accountability, while survivor programs and community events fostered a sense of belonging. As Participant 9 explained, being active with others who had “done some of the things you’ve done … was very helpful for me.” For some, exercise strengthened existing relationships. Participant 6 recalled walking daily with a friend during treatment, noting that the routine offered both companionship and consistency. Others highlighted survivor-focused programs, such as community yoga or Pilates groups, which provided safe spaces for bonding and mutual encouragement.

Exercise also created opportunities to “give back” and support newly diagnosed patients. Participant 10 described organizing a local breast cancer walk, and shared how the event helped a new survivor feel hopeful and connected: “She met a lot of people, and it helped her to see how things are gonna be, and she's thriving now.” These experiences demonstrate how exercise fostered reassurance and normalization of bodily changes, indirectly supporting body image through shared survivorship.

Beyond formal programs, resuming or maintaining everyday activities, such as walking with friends or participating in group exercise, helped participants reconnect socially and reestablish a sense of normalcy. This illustrates how body image was experienced not only individually but also relationally, as survivors used exercise to reclaim belonging and continuity in their daily lives. Overall, exercise functioned as a social catalyst by strengthening interpersonal ties, building peer-support networks, and fostering community. In doing so, it complemented its physical and emotional benefits and underscored its multidimensional role in recovery and adaptation.

Discussion

This study explored breast cancer survivors’ experiences of exercise in relation to body image, highlighting three interconnected themes: exercise as physical rehabilitation, emotional coping, and social catalyst. These findings contribute to the growing body of qualitative research on survivorship, exercise, and psychosocial well-being by examining how participants described incorporating physical activities, such as walking, yoga, and group programs, into their recovery process. Overall, the results indicate that exercise supports survivors across multiple domains, providing both physical and psychological benefits. Several participants noted that while treatment-related side effects sometimes limited their intensive activity, walking was described as an important aspect that aided in recovery, maintained their well-being, and even increased their confidence in their bodies.

The findings in this study align with prior research, as participants described experiencing emotional distress due to feeling unprepared for physical alterations on their bodies as a side effect of treatment. The distress is linked to a change in their perception of themselves. However, some participants have discussed that he rehabilitative role of exercise in restoring function, managing weight changes, and addressing treatment-related side effects helped them adjust to visible body changes.^26,27 Walking emerged as the most common and accessible activity, reinforcing evidence that flexible, low-cost exercise options are vital for long-term survivorship care. Previous studies have documented that breast cancer survivors often experience changes in body image related to surgical outcomes, treatment side effects, and visible alterations to appearance.^28–30 Our findings align with these reports, as participants described challenges they face, which are impacted by their self-perception and resulting distress.

At the same time, this study extends the literature by illustrating how exercise was valued not only for physical recovery but also as a resource for emotional regulation and social reconnection. Several participants have described in their interviews that exercise is similar to “medicine” since it provides benefits such as stress reduction, mood enhancement, resilience, and body acceptance. This echoes earlier findings^31,32 while underscoring that everyday, non-intensive routines (eg, daily walks, yoga) can meaningfully improve psychological well-being and body image.

A key contribution of this study is the emphasis participants placed on the role of exercise as a social connector. Participants often discussed how exercise created opportunities to meet other patients experiencing the same struggles as them, with whom they could seek social support. While group-based interventions have been examined in survivorship care,³³ participants highlighted informal and community-driven activities, such as neighborhood walks and survivor support groups, equally effective in fostering a sense of belonging, reassurance, and normalization of bodily changes. This underscores the importance of integrating social dimensions into exercise programming and survivorship support.

Various participants described experiencing improvements in their body image directly (eg, feeling stronger, fitter, or more in control) along with indirect benefits (eg, reduced fatigue, enhanced coping, and strengthened social ties). Together, these findings illustrate the multifaceted role of exercise in recovery while remaining grounded in survivors’ own narratives. These findings imply that anticipatory guidance concerning appearance-related changes may be a valuable dimension of patient-centered care.^26,27,34

Despite these contributions, several limitations should be noted. Participants were recruited through self-selection, which may have attracted individuals who were more motivated or comfortable discussing exercise and body image. The sample was small and relatively homogenous (nine of 10 participants were White women aged 48-80), limiting transferability to more diverse survivor groups. Interviews were conducted via Zoom and averaged 30 min, which, while convenient, may have restricted rapport or depth compared to longer, in-person sessions. In addition, clinical details such as cancer stage, treatment type, and time since diagnosis were not systematically collected. Although some participants disclosed these details, the lack of consistency limited the analysis of clinical influences on exercise experiences. Finally, as with all retrospective, self-reported data, responses may have been shaped by recall or social desirability bias. We acknowledge that self-recruitment may have influenced the study sample. Women who actively responded may have been more motivated to engage in exercise or more comfortable discussing body image, which could affect the generalizability of findings.

Taken together, these limitations suggest caution in generalizing the findings but also highlight opportunities for future research. Studies with larger and more diverse samples, systematic inclusion of clinical variables, and extended or longitudinal interviews could provide deeper insight into how exercise supports body image and psychosocial adjustment across different survivor groups.

Implications for Practice

The findings point to several clinical and supportive care implications. Survivors acknowledged both the physical limitations and emotional challenges of treatment, yet emphasized the importance of accessible, patient-centered activity. Walking emerged as a universal strategy for reclaiming control over the body and fostering normalcy during a time of profound change. Survivors also advocated holistic support strategies, including open discussions between medical professionals and patients about body image concerns, treatment impacts, and strategies to cope with appearance-related changes. Additionally, survivors highlighted the role of personal agency, such as using clothing, prosthetics, and cosmetic products, as important tools for regaining confidence and maintaining intimacy. These insights suggest that body image counseling may benefit from incorporating fashion, self-presentation, and everyday coping practices as part of survivorship care.

Conclusion

This study highlights the multidimensional role of exercise in the lives of breast cancer survivors, encompassing physical rehabilitation, emotional coping, and social connection (Figure 1). Exercise not only supports physical recovery but also contributes to body confidence, psychological resilience, and peer-based support. By grounding interpretations in survivors’ own narratives, we demonstrate that exercise influences body image both directly, through perceptions of appearance and function, and indirectly, through mood, coping, and social belonging.

Figure 1

Conceptual model of exercise across breast cancer survivorship.

This study contributes novel insights into the ways breast cancer survivors use exercise to regain control, restore confidence, and foster connection. For clinicians and survivorship programs, the findings underscore the value of integrating structured yet flexible opportunities for physical activity, encouraging open discussions about appearance-related concerns, and promoting peer-based engagement. By addressing both the physical and psychosocial dimensions of survivorship, exercise can serve as a powerful, accessible tool for enhancing quality of life during and beyond cancer treatment.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical Approved

This study was approved as IRB Exempt by Baylor University's Institutional Review Board (IRB Reference #1970966). An ethical statement is not applicable, and patient consent was not required for this research.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by the Centennial Scholars Award from the American Association of Family and Consumer Sciences.

ORCID iDs

Mickey Langlais

Jeong-Ju Yoo

Appendix A

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Breast Cancer Survivors’ Perspectives on Exercise and Body Image: Qualitative Findings for Patient-Centered Care

Abstract

Keywords

Introduction

Methods

Ethical Approval

Study Design and Approach

Participants and Recruitment

Participant Characteristics

Data Collection

Research Team and Reflexivity

Data Analysis and Rigor

Results

Exercise for Physical Rehabilitation

Exercise for Emotional Coping

Exercise as a Social Catalyst

Discussion

Implications for Practice

Conclusion

Footnotes

Declaration of Conflicting Interests

Ethical Approved

Funding

ORCID iDs

Appendix A

References