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Older breast cancer survivors’ exercise and support group program experiences and recommendations from the IMPROVE trial: a qualitative study

Jasmin Hundal,Dionne Williams,N. Nock,Kristina Austin,Elizabeth Bennet,Stephen Cerne,Halle C F Moore,Jean Petkac,Kathryn H. Schmitz,Nathan A. Berger,Cynthia Owusu

Published 2026 in BMC Cancer

ABSTRACT

Physical activity is critical for older breast cancer survivors. We explored the experiences and recommendations of older breast cancer survivors from the IMPROVE trial, including a sizable number of older African American and socioeconomically disadvantaged survivors, to inform future implementation and dissemination of sustainable programs. Participants included women, ≥ 65 years, within five years of treatment completion for stage I-III breast cancer who were enrolled into a randomized controlled trial of supervised group moderate-intensity exercise for 20-weeks followed by 32 weeks of unsupervised exercise versus support group (SG) plus Fitbit intervention. Semi-structured exit interviews were conducted at study completion. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis with constant comparison. Two researchers independently coded transcripts, discussing discrepancies to enrich interpretation. The Social Cognitive Theory and the Transtheoretical Model guided interpretation of results. Between 2016 and 2020, 213 older breast cancer survivors were randomized into the exercise arm, (n = 108) or a SG + Fitbit arm, (n = 105). At study completion, 145 (68%) opted to participate in exit interviews. This included 75 Exercise and 70 Support Group participants. Participants described a range of experiences and recommendations that clustered into five broad themes: program experiences, transition challenges, Fitbit experiences, program impact, and recommendations. Survivors consistently highlighted camaraderie, peer bonding, and accountability as central benefits of participation, with enjoyment of activities and staff support further enriching their experience. Many described difficulties sustaining activity after program completion, underscoring the need for ongoing group-based support. Experiences with Fitbit were mixed: some found it motivating, while others reported technical barriers. Survivors also noted increased energy, health awareness, and reduced isolation. Recommendations included extending program duration, adding nutrition content, reducing survey burden, and addressing transportation challenges. Older breast cancer survivors, including those underrepresented in survivorship research, emphasized the importance of social support, structured exercise, and wearable technology in sustaining physical activity. Their recommendations highlight strategies for tailoring future interventions to enhance accessibility, sustainability, and long-term impact. ClinicalTrials.gov Identifier: NCT02763228.

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