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Fixed Seat Rowing versus Sliding Seat Rowing: Effects on Physical Fitness in Breast Cancer Survivors

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17 May 2024

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20 May 2024

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Abstract
This longitudinal study aimed to analyze the effects of a team rowing-based training program on physical fitness and anthropometric parameters in female breast cancer survivors (n=40; 56.78±6.38 years). Participants were divided into two groups: one rowed in fixed seat rowing (FSR) boats (n=20; 56.35±4.89 years) and the other in sliding seat rowing (SSR) boats (n=20; 57.20±7.7 years). Both groups engaged in two 75-minute sessions per week for 24 weeks. Significant improvements were observed in both groups in terms of weight (FSR: -1.93 kg, SSR: -1.75 kg), body mass index (FSR: -0.73 kg/m², SSR: -0.67 kg/m²), waist circumference (FSR: -2.83 cm, SSR: -3.66 cm), and hip circumference (FSR: -2.02 cm, SSR: -2.88 cm). Muscle strength improved in lower extremities (jump test: FSR: 2.99 cm, SSR: 3.11 cm) and upper extremities (dominant: FSR: 4.13 kgf, SSR: 4.34 kgf; non-dominant: FSR: 3.67 kgf, SSR: 3.32 kgf). Aerobic capacity also improved, with the SSR group showing a greater increase (FSR: 63.05 m, SSR: 93.65 m). Flexibility tests revealed better results in the SSR group for both dominant (SSR: 1.75 cm vs. FSR: -5.55 cm) and non-dominant limbs (SSR: 1.72 cm vs. FSR: -3.81 cm). These findings suggest that the type of rowing modality can influence physical fitness outcomes, with the SSR group showing superior improvements compared to the FSR group.
Keywords: 
Subject: Public Health and Healthcare  -   Physical Therapy, Sports Therapy and Rehabilitation

1. Introduction

Among the different types of cancer, breast cancer is the most commonly diagnosed cancer in women worldwide, accounting for 2.3 million new cases and about 700,000 deaths in 2020 [1]. Nevertheless, advances in cancer research have effectively improved early detection of the disease, as well as treatment and relapse prevention, resulting in improved survival rates after surgery [2] and what previously was a fatal disease has become chronic.
The most common cancer treatments such as chemotherapy, radiotherapy and surgery have side effects in the short and long term that compromise the physical condition of the affected women [2]. Some of these negative effects are associated with the different current treatments including loss of muscle mass and strength, reduced mobility in the upper extremities, worsening of aerobic capacity and other symptoms such as the onset of lymphedema, fatigue, depression and cardiac toxicity, contributing to a decline in quality of life [1,3,4].
Recognizing the need to find therapies that help alleviate the symptoms associated with treatment in women with breast cancer, recent studies have shown that maintaining adequate levels of physical activity is associated with improved functionality and mobility in breast cancer survivors [5,6,7,8,9,10], thereby improving the side effects of treatment such as cancer-related fatigue or symptoms of depression [10,11,12,13]. Accordingly, we believe that a training program led by professionals could improve quality of life [8,10] as well as decrease tumor recurrence, increasing the overall breast cancer survival rate [14]. As a result of the preceding research, the American College of Sports Medicine recommends that cancer survivors should perform at least 150 minutes of moderate physical activity or 75 minutes of vigorous exercise and incorporate strength training twice a week [15].
In contrast, despite the widely demonstrated benefits of physical activity and exercise on physical function and associated symptomatology in breast cancer survivors [13,16,17,18], most women significantly reduce their physical activity during cancer treatment [19,20], even below their pre-diagnosis levels [16]. Because of this, it is important to promote strategies and activities that encourage adherence to physical activity [21].
Rowing, in its FSR and SSR modalities, has been shown to provide both physical and emotional benefits as a complementary non-drug therapy for women with breast cancer [8,9,10,22]. The inclusion of this sport for promoting complementary therapies aimed at this population stems from its very characteristics, since the action of rowing involves both the muscles of the upper and lower extremities as well as most of the muscles of the body [23]. However, the main difference with other sports lies in the cyclic and alternative action of the flexion-extension movement of the upper and lower limbs, while the muscles of the back and abdomen act to stabilize the technique [24].
Examining the technique in both modalities, FSR uses a stroke characterized by asymmetrical action of the musculature, requiring compensatory effort [25]. In contrast, SSR involves comprehensive movements, engaging the musculature in almost identical proportions, as the movement is symmetrical in all planes. The position of the body segments a priori may be more suitable for women who have had cancer and undergone upper limb surgeries, since rowing does not require forced movements [9]. The relationship between physical activity and breast cancer has been widely studied in the existing literature [5,18,26,27], but in the case of rowing, it is virtually nonexistent [9,22]. Therefore, the importance of our study is to determine which form of exercise and which boat is most effective for women breast cancer survivors in order to recommend a specific type of physical therapy.
The aim of this study was to analyze the impact of an FSR- and SSR-based training program on physical fitness and body composition in female breast cancer survivors.

2. Materials and Methods

The aim of this study was to analyze the impact of an FSR- and SSR-based training pro-gram on physical fitness and body composition in female breast cancer survivors.

2.1. Participants

Subjects (N=40) aged 56.78 + 6.38 years were recruited, provided they had survived breast cancer for 6.58 + 5.72 years, with the characteristics shown in Table 1, and had the approval of their oncologist to perform physical activity.
Before initiating the training program, a meeting was held to explain the nature of the study, the objectives and the commitments involved. The participants signed an informed consent form and the project coordinator explained the details of the study, which follows the ethical principles for research with human subjects of the Declaration of Helsinki [28] and the ethical considerations of Sport and Exercise Science Research [29]. This study is registered and approved by the Ethics Committee of the University of Malaga with the number 65-2020-H. All the information collected during the research was performed following the Organic Law 3/2018, of December 5, on Personal Data Protection and guarantee of digital rights, regarding the protection of personal data of Spanish legislation.

2.2. Data Records

Height was measured with a SECA model 213 portable stadiometer, using the Frankfurt plane for head positioning. For weight, a Tanita BC 545N scale was used, following the manufacturer’s protocol for both clothing and previous liquid or food intake.
To measure physical fitness, the tests and procedure described by Gavala et al. (2020) were used [9]. The tests used to measure strength were the counter movement jump (CMJ) for the lower extremities (with the My Jump 2 application; accuracy of ± 1cm) and the handgrip test to measure hand and forearm muscle strength (Takei 5401 dynamometer; accuracy of ± 2 kgf). Cardiac endurance was measured using the 6-minute walk test. For overall flexibility, the Sit-and-Reach test was used (with the Baseline Sit ‘n Reach measuring box; accuracy of ± 1 cm). Finally, a Cescorf tape measure with an accuracy of ± 1 mm was used to measure circumferences.

2.3. Procedure

The sample was divided into two training groups with similar measurements (Table 2):
The SSR group performed a rowing program in sliding seat boats while the FSR group performed the same training in fixed seat boats, with both groups being homogeneous.
During the first week of the study, the different measurements were taken. To carry out the comparative study, a training protocol was implemented for a period of 6 months, where two 75-minute sessions per week were held for two groups of women who had never participated in this sport.
After the measurements were taken, a 24-week program was completed, supervised by trainers who ensured attendance (those participants who did not reach 90% participation were excluded), correct execution of the movements and adequate intensity according to the training cycle. The exercise program was divided into three 8-week phases. These stages are marked by a progressive increase in technical difficulty, distance covered and intensity. For this purpose, the trainers regulated the effort of the rowers by using the subjective perception of effort (Börg scale) [30].

2.4. Statistical Analysis

All analyses were performed with the IBM SPSS Statistics 25 statistical package. The level of significance was set at p<0.05. Frequency analysis was carried out for the variables age, height, weight and body mass index (BMI). The fit of the different variables to the normal distribution was assessed by both graphic procedures and the Shapiro-Wilk test.
To determine the influence of boat type on the anthropometric and physical fitness variables, a comparative analysis of the means (ANOVA) was performed, taking into account the mean values and the standard deviation of the boat factor with respect to the variables in the measurements obtained in the pre-test. To analyze whether there were differences according to the rowing training performed by the participants, the data from the pre-test and post-test measurements were compared through the different tests. The estimated between-subject marginal means (Boat*Measurement) and the standard deviation were considered when quantifying the interaction between the variables and their longitudinal evolution through a repeated measures ANOVA, applying the post hoc Bonferroni test. In addition, the graphic analysis of the different variables was carried out using box and whiskers plots.

3. Results

Table 4 displays the means of the study variables, as well as the differences before and after the 6-month FSR and SSR training program. In most cases, we found improvements in the values after the training program in the study subjects. Moreover, these improvements were statistically significant virtually in their entirety, both for the variables associated with body composition and those related to physical condition, except for the non-dominant back scratch test (p=.258).
The following figures compare the changes produced according to the different training protocols. Focusing on body composition, Figure 1 shows a slight improvement in both groups (FSR: Δpre-post BMI=-0.73/ SSR: Δpre-post BMI=-0.67; p=.000), although slightly higher in the SSR group.
In Figure 2, statistically significant improvements were detected in both waist circumference (FSR: Δpre-post Waist Circumference=-2.83/ SSR: Δpre-post Waist Circumference=-3.66; p=.000) and hip circumference (FSR: Δpre-post Hip Circumference=-2.2/ SSR: Δpre-post Hip Circumference=-2.88; p=.000), although slightly higher in the SSR group.
Regarding the parameters associated with flexibility, Figure 3 shows significant improvements in both groups for the general flexibility variable with the Sit-and-Reach test (FSR: Δpre-post Sit-and-Reach=+3.53; p=.027 / SSR: Δpre-post Sit-and-Reach=+4.4/ p=.027). Analysis of the values obtained in the back scratch test (BST) shows a significant worsening in upper extremity flexibility in the FSR rowers in both the dominant arm (FSR: Δpre-post Dominant BST=-5.55; p=.02) and the non-dominant arm, although this was not significant (FSR: Δpre-post Non-Dominant BST=-3.81; p=.258). Conversely, data from subjects participating in the SSR training showed improvements in both the dominant arm (SSR: Δpre-post Dominant BST=+1.75; p=.02), and the non-dominant arm (SSR: Δpre-post Non-Dominant BST=+1.72; p=.258).
In the muscle strength tests, Figure 4 shows a significant improvement in women who trained in both fixed seat (FSR: Δpre-post CMJ=+2.99; p=.000) and sliding seat boats (SSR: Δpre-post CMJ=+3.11; p=.000), although slightly higher in the latter group.
Figure 5 illustrates the results of the handgrip test with significant improvements in both training groups, both for the dominant arm (FSR: Δpre-post Dominant Handgrip=+4.13/ SSR: Δpre-post Dominant Handgrip=+4.34; p=.000) and the non-dominant arm (FSR: Δpre-post Non-Dominant Handgrip=+3.67/ SSR: Δpre-post Non-Dominant Handgrip=+3.32; p=.000).
Finally, regarding endurance, Figure 6 shows a significant improvement in the SSR training group (SSR: Δpre-post 6-min walk test= +93.65; p=.000) and also in the FSR group but somewhat lower (FSR: Δpre-post 6-min walk test=+63.05; p=.000).

4. Discussion

Several studies [18,31] have concluded that the regular practice of physical activity and its relationship with cancer has multiple benefits at the cellular level, as well as improving the quality of life of patients undergoing multiple drug treatments, reducing the side effects of anti-cancer therapies and improving the prognosis and survival after cancer [10,13,17]. It is therefore important to be aware of the potential benefits for the body of maintaining a healthy lifestyle and to encourage maintenance of physical activity and exercise levels in a controlled and professionally supervised manner, as a complementary non-pharmacological therapy for the treatment of cancer patients [31].
In our study, we found that after the intervention program, both the FSR and SSR training groups showed a positive and significant change in the anthropometric and physical fitness variables measured, including muscle strength, aerobic capacity and general flexibility. We can consequently report that 6 months of rowing training in female breast cancer survivors had positive effects on physical fitness and anthropometric measures. These results coincide with those of previous studies [8,9,10] showing that rowing can be a safe and effective sport to improve not only the fitness of patients but also their quality of life.
With this in mind, there are now associations and clubs that promote rowing as a sport that can benefit breast cancer survivors [10]. However, the most suitable type of boat must be determined since, to date, there is no scientific evidence in this regard. By examining the type of boat used in the research on this topic, the first studies involving group rowing in women breast cancer survivors were undertaken using FSR as part of the training protocol [8,9,10,22]. In these studies, the potential effects of rowing training on physical fitness, body composition and even cardiac function in groups of women breast cancer survivors were explored using FSR boat programs combining sports therapy [8,9,10] and strength and endurance training. These studies have shown us that a 12-week intervention program in SSR boats is capable of producing cardiac adaptations [8] and positively influencing the subjects’ aerobic capacity, muscle strength and body composition [11,20]. Nevertheless, the literature is still scarce and more studies are needed to draw conclusions on which type of boat and training produce more beneficial effects in this specific population.
The results of our study show statistically significant differences between the FSR training group and the SSR group. Although in both groups, most variables improved. The SSR group showed a greater increase in the variables associated with physical fitness (muscle strength, aerobic capacity and flexibility), as well as a more marked decrease in the anthropometric measurements (weight, BMI, waist and hip circumference), compared to the FSR group. It should also be noted that, while flexibility in the dominant arm increased significantly in the SSR group (also in the non-dominant upper extremity, although not significantly), in the FSR group the results worsened in both cases after the training period. This may be due to the asymmetrical involvement of the arm muscles in the FSR rowing technique, resulting in an imbalance in upper extremity development.
Based on this evidence, the SSR boat appears to be a better type of vessel for delivering this form of therapy. However, further research is needed to study upper extremity muscle involvement during rowing and its relationship to mobility and functionality in breast cancer survivors who have undergone treatment to manage breast cancer and who are highly affected in this body area.
This study has had some limitations, mainly caused by the limitations established for participating in the study. The predefined inclusion criteria and the inherent characteristics of the sport, carried out outdoors and conditioned by weather circumstances, caused a certain experimental attrition among the subjects who participated in the intervention program.

5. Conclusions

Through this pioneering study, we confirmed that rowing, in both its variants: FSR and SSR, is a safe activity to consider when prescribing physical exercise to women breast cancer survivors. Although both the FSR and SSR training groups showed improvements in anthropometric measurements and physical fitness variables after a 6-month intervention program, the SSR group made greater progress. Nevertheless, future research is needed to test the relationship between rowing technique and boat type and aspects of physical fitness such as upper extremity flexibility in people who have upper limb impairment, such as female breast cancer survivors.

Author Contributions

All authors contributed equally to the writing of the manuscript.

Funding

This research received no external funding.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Ethical Committee of the University of Malaga, which authorized this study, precludes ceding, showing or disclosing to third parties by any means the database of this research (personal data, medical history, interviews, physical condition tests and others) because it is considered confidential and sensitive information.

Conflicts of Interest

The authors declare no conflicts of interest.

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Figure 1. Comparison of BMI (kg/m2) pre- and post-rowing training. BMI=Body Mass Index; FSR= Fixed Seat Rowing; SSR=Sliding Seat Rowing. *p<.05; **p<.001.
Figure 1. Comparison of BMI (kg/m2) pre- and post-rowing training. BMI=Body Mass Index; FSR= Fixed Seat Rowing; SSR=Sliding Seat Rowing. *p<.05; **p<.001.
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Figure 2. Comparison of circumferences (cm) pre- and post-rowing training. WC=Waist Circumference; HC=Hip Circumference; FSR= Fixed Seat Rowing; SSR=Sliding Seat Rowing. *p<.05; **p<.001.
Figure 2. Comparison of circumferences (cm) pre- and post-rowing training. WC=Waist Circumference; HC=Hip Circumference; FSR= Fixed Seat Rowing; SSR=Sliding Seat Rowing. *p<.05; **p<.001.
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Figure 3. Back Scratch Test (BST) (cm) pre- and post-rowing training. SR=Sit and Reach; NDBST=Non-dominant Back Scratch Test; DBST=Dominant Back Scratch Test; FSR=Fixed Seat Rowing; SSR=Sliding Seat Rowing. *p<.05; **p<.001.
Figure 3. Back Scratch Test (BST) (cm) pre- and post-rowing training. SR=Sit and Reach; NDBST=Non-dominant Back Scratch Test; DBST=Dominant Back Scratch Test; FSR=Fixed Seat Rowing; SSR=Sliding Seat Rowing. *p<.05; **p<.001.
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Figure 4. Counter Movement Jump (CMJ) (cm) pre- and post- rowing training. FSR=Fixed Seat Rowing; SSR=Sliding Seat Rowing. *p<.05; **p<.001.
Figure 4. Counter Movement Jump (CMJ) (cm) pre- and post- rowing training. FSR=Fixed Seat Rowing; SSR=Sliding Seat Rowing. *p<.05; **p<.001.
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Figure 5. Handgrip (kgf) comparison pre- and post-rowing training. DHG=Dominant Handgrip; NDHG=Non-dominant Handgrip; FSR=Fixed Seat Rowing; SSR=Sliding Seat Rowing. *p<.05; **p<.001.
Figure 5. Handgrip (kgf) comparison pre- and post-rowing training. DHG=Dominant Handgrip; NDHG=Non-dominant Handgrip; FSR=Fixed Seat Rowing; SSR=Sliding Seat Rowing. *p<.05; **p<.001.
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Figure 6. Comparison of the distance in 6-minute walk test (m) pre- and post-rowing training. 6MWT=6-minutes walk test; FSR=Fixed Seat Rowing; SSR=Sliding Seat Rowing. *p<.05; **p<.001.
Figure 6. Comparison of the distance in 6-minute walk test (m) pre- and post-rowing training. 6MWT=6-minutes walk test; FSR=Fixed Seat Rowing; SSR=Sliding Seat Rowing. *p<.05; **p<.001.
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Table 1. Description of the characteristics of the participating subjects (affected breast, diagnosed stage and intervention performed).
Table 1. Description of the characteristics of the participating subjects (affected breast, diagnosed stage and intervention performed).
Breast (%)
Right: 37.5 Left: 57.5 Both: 5.0
Stage (%)
I: 7.5 II: 37.5 III: 40.0 IV: 15.0
Surgery (%)
Preservation: 50.0 Total Mastectomy: 42.5 Double Mastectomy: 7.5
Table 2. Descriptive analysis of the study subjects according to training group.
Table 2. Descriptive analysis of the study subjects according to training group.
Training Group Age (years) (SD) Height (cm) (SD) Weight (kg) (SD) BMI (kg/m2) (SD)
Sliding Seat Rowing (SSR) 57.20 (7.7) 162.20 (6.33) 66.92 (10.85) 25.47 (4.09)
Fixed Seat Rowing (FSR) 56.35 (4.89) 161.90 (4.91) 72.05 (8.11) 27.48 (2.73)
TOTAL (SSR + FSR) 56.78 (6.38) 162.05 (5.59) 69.49 (9.8) 26.48 (3.58)
Table 3. Exercise prescription design for the program.
Table 3. Exercise prescription design for the program.
Stage Content Börg scale
1 Initial phase with mobility exercises, proprioceptive exercises and postural control exercises.
Main phase with rowing training.
Final phase with stretching.		 5-6
2 Initial phase with mobility exercises, proprioceptive exercises and postural control exercises.
Main phase with rowing training.
Final phase with stretching.		 6-7
3 Initial phase with mobility exercises, proprioceptive exercises and postural control exercises.
Main phase with rowing training.
Final phase with stretching.		 7-8
Table 4. Between-subject analysis of study variables according to boat type.
Table 4. Between-subject analysis of study variables according to boat type.
Fixed Seat Rowing (FSR) Sliding Seat Rowing (SSR) Interaction Effect Boat *Measurement
Pre-test (SD) Post-test (SD) ΔPre-Post Pre-test (SD) Post-test (SD) ΔPre-Post MS F p
Body composition
Weight (kg) 72.05 (8.11) 70.12 (7.88) -1.93 66.92 (10.85) 65.17 (10.43) -1.75 263.17 8.87 .000**
BMI (kg/m2) 27.48 (2.73) 26.75 (2.66) -0.73 25.47 (4.09) 24.8 (3.89) -0.67 40.49 3.34 .000**
Waist circumference (cm) 91.1 (7.3) 88.27 (7.28) -2.83 84.53 (11.52) 80.87 (10.35) -3.66 430.99 4.63 .000**
Hip circumference (cm) 106.22 (6.35) 104.2 (6.87) -2.02 104.45 (9.57) 101.57 (8.89) -2.88 31.51 .48 .000**
Strength
CMJ (cm) 12.55 (3.09) 15.54 (2.94) +2.99 11.71 (3.49) 14.82 (3.65) +3.11 7.09 .65 .000**
Dominant handgrip (kgf) 22.69 (3.64) 26.82 (3.87) +4.13 20.49 (6.21) 24.83 (6.03) +4.34 48.16 1.85 .000**
Non-dominant handgrip (kgf) 20.55 (4.53) 24.22 (3.96) +3.67 21.17 (5.61) 24.49 (6.54) +3.32 3.84 .15 .000**
Aerobic capacity
6-minute walk test (m) 817.25 (51.1) 880.3 (69.96) +63.05 752.3 (127.37) 845.95 (132.58) +93.65 42185.02 4.25 .000**
Flexibility
Sit-and-Reach (cm) 1.40 (6.97) 4.93 (6.05) +3.53 1.05 (7.49) 5.45 (6.92) +4.4 1.22 .02 .027*
Dominant back scratch test (cm) -1.75 (6.36) -7.30 (8.03) -5.55 -7.68 (9.13) -5.93 (7.55) +1.75 351.06 5.39 .02*
Non-dominant back scratch test (cm) .32 (6.11) -4.13 (6.76) -3.81 -2.80 (7.18) -1.08 (6.23) +1.72 97.66 2.08 .258
*p<.05; **p<.001
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