Motivation and quality of life in breast cancer survivors A self-determination theory perspective for physical activity promotion
Main Article Content
Abstract
Despite the well-established benefits of physical activity for breast cancer survivors (BCS), adherence to exercise guidelines remains strikingly low (5–30%), highlighting the urgent need to identify limitations and employ motivational frameworks to increase intervention effectiveness. This cross-sectional study examined the associations among exercise motivation, physical activity levels, quality of life (QoL), and healthy lifestyle behaviours in BCS, using Self-Determination Theory (SDT) as the theoretical foundation. Thirty-five BCS participated, with a mean age of 59.97 ± 10.80 years. The results showed that the highest scores were recorded in identified regulation, social well-being, sleep habits, and dietary habits, while the lowest were found for physical activity participation and additional concerns. Significant correlations emerged among self-determined motivation, basic psychological needs, lifestyle habits, and QoL, providing valuable insights into their interrelationships. These findings highlight the importance of designing and implementing motivational programs that promote adherence to physical exercise and improve the QoL in this population.
Downloads
Article Details
Section

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Each author warrants that his or her submission to the Work is original and that he or she has full power to enter into this agreement. Neither this Work nor a similar work has been published elsewhere in any language nor shall be submitted for publication elsewhere while under consideration by Journal of Human Sport and Exercise (JHSE). Each author also accepts that the JHSE will not be held legally responsible for any claims of compensation.
Authors wishing to include figures or text passages that have already been published elsewhere are required to obtain permission from the copyright holder(s) and to include evidence that such permission has been granted when submitting their papers. Any material received without such evidence will be assumed to originate from the authors.
Please include at the end of the acknowledgements a declaration that the experiments comply with the current laws of the country in which they were performed. The editors reserve the right to reject manuscripts that do not comply with the abovementioned requirements. The author(s) will be held responsible for false statements or failure to fulfill the above-mentioned requirements.
This title is licensed under a Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0).
You are free to:
Share — copy and redistribute the material in any medium or format.
Adapt — remix, transform, and build upon the material.
The licensor cannot revoke these freedoms as long as you follow the license terms.
Under the following terms:
-
Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
-
NonCommercial — You may not use the material for commercial purposes.
-
ShareAlike — If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
Notices:
- You do not have to comply with the license for elements of the material in the public domain or where your use is permitted by an applicable exception or limitation.
- No warranties are given. The license may not give you all of the permissions necessary for your intended use. For example, other rights such as publicity, privacy, or moral rights may limit how you use the material.
How to Cite
Funding data
-
Junta de Extremadura
-
European Commission
Grant numbers GR24002
References
Abrahams, H. J. G., Gielissen, M. F. M., Verhagen, C., & Knoop, H. (2018). The relationship of fatigue in breast cancer survivors with quality of life and factors to address in psychological interventions: A systematic review. Clin Psychol Rev, 63, 1-11. https://doi.org/10.1016/j.cpr.2018.05.004
Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human. Dec Proc, 50(2), 179-211. https://doi.org/10.1016/0749-5978(91)90020-T
Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Prentice-hall.
Behzadnia, B., Kiani, A., & Babaei, S. (2020). Autonomy-supportive exercise behaviors promote breast cancer survivors'well-being. Health Promot Perspect, 10(4), 409-417. https://doi.org/10.34172/hpp.2020.60
Bjerkeset, E., Röhrl, K., & Schou-Bredal, I. (2020). Symptom cluster of pain, fatigue, and psychological distress in breast cancer survivors: Prevalence and characteristics. Breast Cancer Res Treat, 180(1), 63-71. https://doi.org/10.1007/s10549-020-05522-8
Brady, M. J., Cella, D. F., Mo, F., Bonomi, A. E., Tulsky, D. S., Lloyd, S. R., Deasy, S., Cobleigh, M., & Shiomoto, G. (1997). Reliability and validity of the Functional Assessment of Cancer Therapy-Breast quality-of-life instrument. J Clin Oncol, 15(3), 974-986. https://doi.org/10.1200/JCO.1997.15.3.974
Bray, F., Laversanne, M., Sung, H., Ferlay, J., Siegel, R. L., Soerjomataram, I., & Jemal, A. (2024). Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer J Clin, 74(3), 229-263. https://doi.org/10.3322/caac.21834
Cella, D. F., Tulsky, D. S., Gray, G., Sarafian, B., Linn, E., Bonomi, A., Silberman, M., Yellen, S. B., Winicour, P., & Brannon, J. (1993). The Functional Assessment of Cancer Therapy scale: Development and validation of the general measure. J Clin Oncol, 11(3), 570-579. https://doi.org/10.1200/JCO.1993.11.3.570
Céspedes-Aleixandre, P. (2024). Intervención comunitaria de ejercicio físico y educación para la salud en mujeres mayores después de un cáncer de mama. Tesis Doctoral. Universidad de Valencia. España.
Cho, D., & Park, C. L. (2018). Barriers to physical activity and healthy diet among breast cancer survivors: A multilevel perspective. Eur J Cancer Care, 27(1), e12772. https://doi.org/10.1111/ecc.12772
Coughlin, S. S., Caplan, L. S., & Williams, V. (2019). Home-based physical activity interventions for breast cancer patients receiving primary therapy: A systemic review. Breast Cancer Res Treat, 178, 513-522. https://doi.org/10.1007/s10549-019-05424-4
Craig, C. L., Marshall, A. L., Sjöström, M., Bauman, A. E., Booth, M. L., Ainsworth, B. E., Pratt, M., Ekelund, U. L. F., Yngve, A., & Sallis, J. F. (2003). International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc, 35(8), 1381-1395. https://doi.org/10.1249/01.MSS.0000078924.61453.FB
Deci, E. L., & Ryan, R. M. (2000). The" what" and" why" of goal pursuits: Human needs and the self-determination of behavior. Psychol Inq, 11(4), 227-268. https://doi.org/10.1207/S15327965PLI1104_01
Díaz, S. C., Benavides, J. D. D., & Meneses, M. A. F. (2020). Estilos de vida de las mujeres diagnosticadas con cáncer de mama en el año 2020. Trabajo fin de Grado. Universidad de Popayán. Colombia.
Dieli-Conwright, C. M., Courneya, K. S., Demark-Wahnefried, W., Sami, N., Lee, K., Buchanan, T. A., Spicer, D. V., Tripathy, D., Bernstein, L., & Mortimer, J. (2018). Effects of Aerobic and Resistance Exercise on Metabolic Syndrome, Sarcopenic Obesity, and Circulating Biomarkers in Overweight or Obese Survivors of Breast Cancer: A Randomized Controlled Trial. J Clin Oncol, 36, 875-883. https://doi.org/10.1200/JCO.2017.75.7526
Fernández-Lázaro, D., Mielgo-Ayuso, J., Caballero-García, A., Martínez, A. C., Asensio, M. P. L., & Fernández-Lázaro, C. I. (2020). Actividad física en pacientes oncológicos de cáncer de mama: ¿Terapia médica deportiva no farmacológica? Revisión sistemática. Arch Med Deporte, 37, 266-274. https://doi.org/10.18176/archmeddeporte.00017
Fernandes, V., Rodrigues, F., Jacinto, M., Teixeira, D., Cid, L., Antunes, R., Matos, R., Reigal, R., Hernández-Mendo, A., Morales-Sánchez, V., & Monteiro, D. (2023). How does the level of physical activity influence eating behavior? A self-determination theory approach. Life, 13(2), 298. https://doi.org/10.3390/life13020298
George, D., & Mallery, P. (2010). SPSS for Windows Step by Step: A Simple Guide and Reference, 17.0 update (10ª ed.). Boston: Pearson.
González-Cutre, D., Sicilia, Á., & Fernández, A. (2010). Hacia una mayor comprensión de la motivación en el ejercicio físico: Medición de la regulación integrada en el contexto español. Psicothema, 22(4), 841-847.
Jang, D. J., Oh, C. Y., Jun, M. G., Oh, K. R., Lee, J. H., Jang, J., & Park, S. U. (2023). The Structural Relationship between Basic Psychological Needs, Grit, and the Quality of Life of Individuals with Disabilities. Int J Environ Res Public Health,, 20(3), 1758. https://doi.org/10.3390/ijerph20031758
Kim, S., Han, J., Lee, M. Y., & Jang, M. K. (2020). The experience of cancer‐related fatigue, exercise and exercise adherence among women breast cancer survivors: Insights from focus group interviews. J Clin Nurs, 29(5-6), 758-769. https://doi.org/10.1111/jocn.15114
Leyton, M., Lobato, S., Batista, M., Aspano, M. I., & Jiménez, R. (2018). Validación del cuestionario de estilo de vida saludable (EVS) en una población española. Rev Iberoam Psicol, 13(1), 23-31.
Majeed, Z., van Wijngaarden, E., Dolan, J. G., & Shah, K. N. (2017). Depression partially mediated the relationship between basic psychological needs and quality of life among people living with HIV. AIDS care, 29(11), 1399-1403. https://doi.org/10.1080/09540121.2017.1300627
Mateo-Orcajada, A., Vaquero-Cristóbal, R., Rey-López, J. P., Martín-Campoy, R., & Abenza-Cano, L. (2023). The role of basic psychological needs in the adoption of healthy habits by adolescents. Behav Sci, 13(7), 592. https://doi.org/10.3390/bs13070592
Michael, M., Goble, J., Hawk, M., & Kujawa, D. J. (2021). Reported barriers impeding adherence to a physical exercise program in patients with breast cancer: A systematic review. Rehab Oncol, 39(2), 88-102. https://doi.org/10.1097/01.REO.0000000000000220
Miller, K. D., Nogueira, L., Devasia, T., Mariotto, A. B., Yabroff, K. R., Jemal, A., Kramer, J., & Siegel, R. L. (2022). Cancer treatment and survivorship statistics, 2022. CA Cancer J Clin, 72(5), 409-436. https://doi.org/10.3322/caac.21731
Moreno-Murcia, J. A., Marzo, J. C., Martinez-Galindo, C., & Conte Marin, L. (2011). Validation of psychological need satisfaction in exercise scale and the behavioural regulation in sport questionnaire to the Spanish context. RICIDE-Rev Int Cienc, 7(26), 355-369. https://doi.org/10.5232/ricyde2011.02602
Nontakhod, K., Ratchakit, K., Krobtong, P., Ketthaisog, S., Sremsiri, C., & Intanoo, K. (2025). Exercise selection for health to elderly after the COVID-19 outbreak. J Hum Sport Exerc, 20(2), 596-605. https://doi.org/10.55860/27ncq749
Park, J., Rodriguez, J. L., O'Brien, K. M., Nichols, H. B., Hodgson, M. E., Weinberg, C. R., & Sandler, D. P. (2021). Health‐related quality of life outcomes among breast cancer survivors. Cancer, 127(7), 1114-1125. https://doi.org/10.1002/cncr.33348
Pérez-Cerezo, B. (2023). Motivación y actividad física en pacientes oncológicos bajo la teoría de la autodeterminación: Una Revisión Sistemática. Trabajo fin de Grado. Universidad Miguel Hernández de Elche. España.
Pimentel-Parra, G. A., García-Vivar, C., Escalada-Hernández, P., San Martín-Rodríguez, L., & Soto-Ruiz, N. (2025). Systematic review of clinical practice guidelines for long-term breast cancer survivorship: Assessment of quality and evidence-based recommendations. Br J Cancer, 1-16. https://doi.org/10.1038/s41416-025-03059-5
Price, J., & Brunet, J. (2022). Understanding rural-living young adult cancer survivors' motivation during a telehealth behavior change intervention within a single-arm feasibility trial. Health Inform J, 28(1), 14604582221075560. https://doi.org/10.1177/14604582221075560
Pudkasam, S., Feehan, J., Talevski, J., Vingrys, K., Polman, R., Chinlumprasert, N., Stojanovska, L., & Apostolopoulos, V. (2021). Motivational strategies to improve adherence to physical activity in breast cancer survivors: A systematic review and meta-analysis. Maturitas, 152, 32-47. https://doi.org/10.1016/j.maturitas.2021.06.008
Pudkasam, S., Polman, R., Pitcher, M., Fisher, M., Chinlumprasert, N., Stojanovska, L., & Apostolopoulos, V. (2018). Physical activity and breast cancer survivors: Importance of adherence, motivational interviewing and psychological health. Maturitas, 116, 66-72. https://doi.org/10.1016/j.maturitas.2018.07.010
Renzi, G. M., Vanyay, M. E., Almada, C. E., Basavilbaso, M. A., & Bengohechea, M. F. (2022). La motivación de los adultos mayores hacia la práctica de actividad física en Avellaneda. Perspectivas de Investigación en Educación Física, 1(1), e006.
Rock, C. L., Thomson, C. A., Sullivan, K. R., Howe, C. L., Kushi, L. H., Caan, B. J., Neuhouser, M. L., Bandera, E. V., Wang, Y., Robien, K., Basen‐Engquist, K. M., Brown, J. C., Courneya, K. S., Crane, T. E., Garcia, D. O., Grant, B. L., Hamilton, K. K., Hartman, S. J., Kenfield, S. A., … McCullough, M. L. (2022). American Cancer Society nutrition and physical activity guideline for cancer survivors. CA Cancer J Clin, 72(3), 230-262. https://doi.org/10.3322/caac.21719
Roman‐Viñas, B., Serra‐Majem, L., Hagströmer, M., Ribas‐Barba, L., Sjöström, M., & Segura‐Cardona, R. (2010). International Physical Activity Questionnaire: Reliability and validity in a Spanish population. Eur J Sport Sci, 10(5), 297-304. https://doi.org/10.1080/17461390903426667
Ryan, R. M., & Deci, E. L. (2017). Self-determination theory: Basic psychological needs in motivation, development, and wellness. Guilford publications. https://doi.org/10.1521/978.14625/28806
Ryan, R. M., Deci, E. L., Vansteenkiste, M., & Soenens, B. (2021). Building a science of motivated persons: Self-determination theory's empirical approach to human experience and the regulation of behavior. Motiv Sci, 7(2), 97. https://doi.org/10.1037/mot0000194
Toloza, S. M., & Gómez-Conesa, A. (2007). El Cuestionario Internacional de Actividad Física. Un instrumento adecuado en el seguimiento de la actividad física poblacional. Rev Iberoam Fisioterapia Kinesiología, 10(1), 48-52. https://doi.org/10.1016/S1138-6045(07)73665-1
Triberti, S., Savioni, L., Sebri, V., & Pravettoni, G. (2019). eHealth for improving quality of life in breast cancer patients: A systematic review. Cancer Treat Rev, 74, 1-14. https://doi.org/10.1016/j.ctrv.2019.01.003
Vallerand, R. J. (2007). A hierarchical model of intrinsic and extrinsic motivation for sport and physical activity. In M. S. Hagger & N. L. D. Chatzisarantis (Eds.), Intrinsic motivation and self-determination in exercise and sport (pp. Human Kinetics. https://doi.org/10.5040/9781718206632.ch-017
Viveiros, B., Jacinto, M., Antunes, R., Matos, R., Amaro, N., Cid, L., Couto, N., & Monteiro, D. (2025). Application of the hierarchical model of intrinsic and extrinsic motivation in the context of exercise: a systematic review. Front Psychol, 16, 1512270. https://doi.org/10.3389/fpsyg.2025.1512270
Wilson, P. M., Rodgers, W. M., Loitz, C. C., & Scime, G. (2006). "It's Who I Am … Really!' The Importance of Integrated Regulation in Exercise Contexts1. J Appl Biobehav Res, 11(2), 79-104. https://doi.org/10.1111/j.1751-9861.2006.tb00021.x
Wilson, P. M., Rogers, W. T., Rodgers, W. M., & Wild, T. C. (2006). The psychological need satisfaction in exercise scale. J Sport Exerc Psychol, 28(3), 231-251. https://doi.org/10.1123/jsep.28.3.231
Wurz, A., St-Aubin, A., & Brunet, J. (2015). Breast cancer survivors' barriers and motives for participating in a group-based physical activity program offered in the community. Support Care Cancer, 23(8), 2407-2416. https://doi.org/10.1007/s00520-014-2596-2
Zhang, S., Huang, J., & Wang, H. (2024). Influencing Factors of Women's Sports Participation Based on Self-Determination Theory: A Systematic Review and Meta-Analysis. Psychol Res Behav Manag, 17, 2953-2969. https://doi.org/10.2147/PRBM.S465903
Zhang, Y., Li, G., Zhang, S., Zhou, Y., Lv, Y., Feng, L., & Yu, L. (2025). Effects of Exercise on Depression and Anxiety in Breast Cancer Survivors: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials. Cancer Med, 14(5), e70671. https://doi.org/10.1002/cam4.70671