How do you stick to an exercise routine in spite of the obstacles? Canadian researchers who study motivation and exercise followed a group of 24 breast cancer survivors exercising together toward a common and specific goal — winning a dragon-boat race.

What's a dragon boat? It's a long, thin rowboat, shaped like a dragon's head at one end, and tail at the other. Rowers sit two abreast, 12 on each side. In the last decade, the sport has caught on among breast-cancer survivors in Canada and parts of the US.

Although the women compete with other teams, the major reason they stick to their training schedules is the support of their spouses and doctors, according to the study published in the journal Psycho-Oncolog (Vol. 10: 444-452).

They also need to be tough. "They have to believe that they can exercise even when they are fatigued, too busy, have no one to exercise with, and despite other health problems," said lead author Kerry S. Courneya, PhD, professor of physical education at the University of Alberta in Edmonton, Canada.

"If they can overcome those barriers, they are on their way to maintaining a very healthful behavior," noted Courneya.

That sounds like a tall order, and it was. Even these women, described in the article as "a very motivated subset of breast cancer survivors" because they were training for a competition, missed one-third of their twice-weekly training sessions.

That means that most breast cancer survivors would be even less likely to follow a recommended three-times-a-week exercise program, the authors wrote.

This underscores the need for understanding why these women may lack the motivation, and finding ways to help them get it.

"Research has begun to show that exercising during and after cancer treatments has many benefits," Courneya said of his own motivation to study exercise in breast-cancer survivors. "It can improve their functional as well as emotional well-being, not to mention reduce their risk for future diseases."

"It is clear that exercise adherence is difficult at the best of times and would be especially difficult after a cancer diagnosis," he said.

"Two factors, motivation and opportunity, are thought to be the key individual determinants of a behavior [such as exercise]," he said.

Motivation refers to how hard one is willing to work to stick to an exercise program. Most theories view this as the most important factor in staying with the program, he said.

Then, there is opportunity — whether patients think they have the necessary skill, time, and resources to exercise, he said.

"Women have more responsibilities than men, such as housework, children, shopping, etc," explained Courneya. "And without the support of others, it is very difficult for them to commit to an exercise program."

Family, friends, doctors, and nurses need to make it clear that they think exercise is a good thing for cancer survivors to do, noted Courneya.

"Help the cancer survivors exercise by giving them accurate information, referring them to appropriate resources, offering programs, helping them find the time to exercise, and even exercising with them," Courneya said.

"Exercise motivation is a challenge for people, even the general healthy population," he said.

"Everybody knows exercise is good for you," said Frank Baker, PhD, director of the American Cancer Society (ACS) behavioral research center. "The problem is how do you get people to adhere to this?" The ACS has begun a campaign to educate the public about the benefits of exercise and diet as a way to prevent disease.

After diagnosis, many patients experience unfamiliar tests, procedures, and treatments that can leave them with a profound sense of loss of control, said Colleen Doyle, MS, RD, director of nutrition and physical activity for the American Cancer Society.

"Being physically active is one of the ways patients can exert some control at a time when they feel so many things are completely out of their control," Doyle said. "This is a good strategy for family members and caregivers as well. This is a time of high stress for them, too."

"Physical activity has been shown to reduce anxiety and depression, improve mood, boost self-esteem, and reduce symptoms of nausea, fatigue, pain, and diarrhea," Doyle said.

"There are times when exercise may not be advised, but in general, patients and survivors should be encouraged to do so, said Doyle.

Patients and survivors with metastasis to the bone, or with bone loss related to therapy, should avoid activities that involve jumping or twisting at the hips, because of concern about fractures, Doyle said.

Survivors with chemotherapy-induced neuropathy that affects balance should be especially careful to avoid the risk of falling, she noted.

She noted patients and survivors "may not know who to go to for advice on exercising. This is a relatively new area of research, and recommendations about exercise in this population are not 'mainstream' yet."

The bottom line is, talk to your health-care provider first, Doyle said.