Fixed-seat rowing versus sliding-seat rowing: Effects on physical fitness in breast cancer survivors

Citation: Gavala-González, J.; Real-Pérez, M.; Benítez-García, L.; Fernández-García, J.C. Fixed-Seat Rowing versus Sliding-Seat Rowing: Effects on Physical Fitness in Breast Cancer Survivors. Cancers 2024,16, 2207. https://doi.org/10.3390/ cancers16122207 Academic Editor: Samuel Cos Received: 16 May 2024 Revised: 8 June 2024 Accepted: 9 June 2024 Published: 13 June 2024 Copyright: © 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). cancers Article Fixed-Seat Rowing versus Sliding-Seat Rowing: Effects on Physical Fitness in Breast Cancer Survivors Juan Gavala-González 1,2 , Mateo Real-Pérez 2,* , Laura Benítez-García2and JoséC. Fernández-García2,3 1Department of Physical Education and Sports, Universidad de Sevilla, 41003 Sevilla, Spain; [email protected] 2Researching in Sport Science: Research Group (CTS-563) of the Andalusian Research Plan, University of Málaga, 41003 Málaga, Spain; [email protected] (J.C.F.-G.) 3Department of Didactics of Languages, Arts and Sport, University of Málaga, Andalucía-Tech, IBIMA, 29010 Málaga, Spain *Correspondence: mateo.realper[email protected] Simple Summary: Breast cancer is the most common cancer in women, often causing physical side effects like loss of muscle strength, reduced mobility, and fatigue. This study explores the impact of fixed-seat rowing (FSR) and sliding-seat rowing (SSR) on physical fitness and body composition in female breast cancer survivors to identify the more effective exercise modality. Forty participants rowed twice weekly for 24 weeks. The results indicate significant improvements in weight, body mass index, waist and hip circumference, muscle strength, aerobic capacity, and flexibility, with SSR showing better overall outcomes. These findings suggest that SSR may be a more beneficial exercise for breast cancer survivors. This research underscores the value of tailored exercise programs in improving recovery and quality of life for these women, potentially shaping future rehabilitation strategies within the research community. Abstract: This 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 ). The participants were divided into two groups: one rowed in fixed-seat rowing (FSR) boats (n = 20; 56.35 ± 4.89 years), and the other rowed in sliding-seat rowing (SSR) boats (n = 20; 57.20 ± 7.7 years). Both groups engaged in two 75 min 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/m 2 , SSR: − 0.67 kg/m 2 ), 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 the 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: rowing; breast cancer; physical activity; anthropometry; exercise 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 the early detection of the disease, as well as treatment and relapse prevention, resulting in improved survival rates after surgery [ 2 ], and what was previously a fatal disease has become a chronic one. Cancers 2024,16, 2207. https://doi.org/10.3390/cancers16122207 https://www.mdpi.com/journal/cancers Cancers 2024,16, 2207 2 of 13 The most common cancer treatments, such as chemotherapy, radiotherapy, and surgery, have side effects in the short and long term that compromise the physical conditions of the affected women [ 2 ]. Some of these negative effects are associated with 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 – 10 ], thereby improving the side effects of treatments, such as cancer-related fatigue or symptoms of depression [ 10 – 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 min of moderate physical activity or 75 min 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 – 18 ], most women significantly reduce their physical activity during cancer treatment [ 19 , 20 ], even below their pre-diagnosis levels [ 18 ]. 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 – 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]. When examining the technique in both modalities, it can be seen that FSR uses a stroke characterized by an 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 [ 1 , 5 , 16 , 26 ], but in the case of rowing, it is virtually nonexistent [9,22] . Therefore, the importance of our study is 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 is to determine which form of exercise and which boat (FSR boat vs. SSR boat) is better for improving the physical fitness of female breast cancer survivors in order to recommend a specific type of physical therapy. 2.1. Study Design This study is a part of parallel clinical trials, and for this purpose, a 24-week, twiceweekly training program was designed that could be carried out in both FSR and SSR boats (Figure 1). On the other hand, several associations of women with breast cancer were contacted and offered the possibility of a free 24-week rowing program and a physical assessment before and at the end of the program. The only requirements for participation were to Cancers 2024,16, 2207 3 of 13 have suffered from breast cancer and to have the approval of their oncologist for moderate physical activity. Cancers 2024, 16, x FOR PEER REVIEW 3 of 14 On the other hand, several associations of women with breast cancer were contacted and offered the possibility of a free 24-week rowing program and a physical assessment before and at the end of the program. The only requirements for participation were to have suffered from breast cancer and to have the approval of their oncologist for moderate physical activity. Figure 1. Study’s temporal line. Before initiating the training program, a meeting was held to explain the nature of the study, the objectives, and the commitments involved. The participants (Figure 2) 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 [27] and the ethical considerations of Sport and Exercise Science Research [28]. This study was registered and approved by the Ethics Committee of the University of Malaga with the number 65-2020-H. All of the information included in the research was collected following the Organic Law 3/2018 of 5 December on Personal Data Protection and guarantee of digital rights, regarding the protection of personal data of Spanish legislation. Figure 2. A flow diagram of the sample selected for this study. 2.2. 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 oncologists to perform physical activity. Table 1. A description of the characteristics of the participating subjects (affected breast, diagnosed stage, and intervention performed). Breast (%) Right 37.5 Lef t 57.5 Both 5.0 Stage (%) I 7.5 II 37.5 Figure 1. Study’s temporal line. Before initiating the training program, a meeting was held to explain the nature of the study, the objectives, and the commitments involved. The participants (Figure 2) 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 [ 27 ] and the ethical considerations of Sport and Exercise Science Research [ 28 ]. This study was registered and approved by the Ethics Committee of the University of Malaga with the number 65-2020-H. All of the information included in the research was collected following the Organic Law 3/2018 of 5 December on Personal Data Protection and guarantee of digital rights, regarding the protection of personal data of Spanish legislation. Cancers 2024, 16, x FOR PEER REVIEW 3 of 14 On the other hand, several associations of women with breast cancer were contacted and offered the possibility of a free 24-week rowing program and a physical assessment before and at the end of the program. The only requirements for participation were to have suffered from breast cancer and to have the approval of their oncologist for moderate physical activity. Figure 1. Study’s temporal line. Before initiating the training program, a meeting was held to explain the nature of the study, the objectives, and the commitments involved. The participants (Figure 2) 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 [27] and the ethical considerations of Sport and Exercise Science Research [28]. This study was registered and approved by the Ethics Committee of the University of Malaga with the number 65-2020-H. All of the information included in the research was collected following the Organic Law 3/2018 of 5 December on Personal Data Protection and guarantee of digital rights, regarding the protection of personal data of Spanish legislation. Figure 2. A flow diagram of the sample selected for this study. 2.2. 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 oncologists to perform physical activity. Table 1. A description of the characteristics of the participating subjects (affected breast, diagnosed stage, and intervention performed). Breast (%) Right 37.5 Lef t 57.5 Both 5.0 Stage (%) I 7.5 II 37.5 Figure 2. A flow diagram of the sample selected for this study. 2.2. 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 oncologists to perform physical activity. Table 1. A 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 Cancers 2024,16, 2207 4 of 13 2.3. Data Records Height was measured with an SECA model 213 portable stadiometer (Seca GmbH & Co. KG, Hamburg, Germany), using the Frankfurt plane for head positioning. For weight, a Tanita BC 545N (Tanita Corporation, Tokyo, Japan) 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 ± 1 cm) and the handgrip test to measure hand and forearm muscle strength with Takei 5401 dynamometer (Takei Scientific Instruments Co., Ltd., Niigata, Japan); accuracy of ± 2 kgf. Cardiac endurance was measured using the 6 min 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 (Cescorf, Porto Alegre, Brazil) with an accuracy of ±1 mm was used to measure circumferences. 2.4. Procedure Of all the women who showed interest, a series of physical fitness tests were carried out and, with equal anthropometric parameters (weight, height, BMI) and test results, one was assigned to one group (FSR or SSR), and the one with the most similar results was assigned to the other group (SSR or FSR). The sample was divided into two training groups with similar measurements (Table 2): Table 2. Descriptive analysis of study subjects according to training group. TOTAL (SSR + FSR) Fixed-Seat Rowing (FSR) Sliding-Seat Rowing (SSR) Difference of Means (FSR-SSR) p Age (years) (SD) 56.78 (6.38) 56.35 (4.89) 57.20 (7.7) −0.85 (2.04) 0.679 Height (cm) (SD) 162.05 (5.59) 161.90 (4.91) 162.20 (6.33) −0.3 (1.79) 0.868 Weight (kg) (SD) 69.49 (9.8) 72.05 (8.11) 66.92 (10.85) 3.22 (3.11) 0.307 BMI (kg/m2) (SD) 26.48 (3.58) 27.48 (2.73) 25.47 (4.09) 1.50 (1.18) 0.215 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, different measurements were taken. To carry out the comparative study, a training protocol was implemented for a period of 6 months, where two 75 min 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 (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 (Table 3). These stages are marked by progressive increases 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) [29]. Table 3. Exercise prescription design for program. Stage/Duration Content Timming Börg Scale 1st (8 weeks) Initial phase with mobility exercises, proprioceptive exercises, and postural control exercises. 8 min 5–6 Main phase with rowing training. 60 min Final phase with stretching. 7 min Cancers 2024,16, 2207 5 of 13 Table 3. Cont. Stage/Duration Content Timming Börg Scale 2nd (8 weeks) Initial phase with mobility exercises, proprioceptive exercises, and postural control exercises. 8 min 6–7 Main phase with rowing training. 60 min Final phase with stretching. 7 min 3rd (8 weeks) Initial phase with mobility exercises, proprioceptive exercises, and postural control exercises. 8 min 7–8 Main phase with rowing training. 60 min Final phase with stretching. 7 min 2.5. Statistical Analysis All analyses were performed with the IBM SPSS Statistics 25 statistical package. The level of significance was set at p< 0.05. A frequency analysis was carried out for the variables of 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 the 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, a graphic analysis of the different variables was carried out using box and whisker plots. The analysis of the statistically significant differences in the comparison between groups was made with Student’s t-test for independent groups. 3. Results Table 4displays 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 virtually statistically significant 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= 0.258). The critical levels for Cohen effect sizes identified in a t-test (d) are 0.20 for minor effects, 0.50 for medium effects, and 0.80 for significant effects. The following figures compare the changes produced according to the different training protocols. Focusing on body composition, Figure 3shows a slight improvement in both groups (FSR: ∆pre-post BMI = − 0.73/SSR: ∆pre-post BMI = − 0.67; p= 0.000), although it is slightly higher in the FSR group. In Figure 4, statistically significant improvements were detected in both waist circumference (FSR: ∆pre-post waist circumference = − 2.83/SSR: ∆pre-post waist circumference = − 3.66; p= 0.000) and hip circumference (FSR: ∆pre-post hip circumference = − 2.2/SSR: ∆pre-post hip circumference = − 2.88; p= 0.000), although the values were slightly higher in the SSR group. Cancers 2024,16, 2207 6 of 13 Table 4. Between-subject analysis of study variables according to boat type. Fixed-Seat Rowing (FSR) Sliding-Seat Rowing (SSR) Interaction Effect Boat Measurement Effect Size Pre-Test (SD) Post-Test (SD) ∆Pre- Post Pre-Test (SD) Post-Test (SD) ∆Pre- 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 0.000 ** 0.64 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 0.000 ** 0.71 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 0.000 ** 0.47 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 0.48 0.000 ** 0.51 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 0.65 0.000 ** 0.62 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 0.000 ** 0.8 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 0.15 0.000 ** 0.97 Aerobic capacity 6 min walk test (m) 817.25 (51.1) 880.3 (69.96) +63.05 752.3 (127.37) 845.95 (132.58) +93.65 42,185.02 4.25 0.000 ** 0.67 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 0.02 0.027 *0.35 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 0.02 * 0.22 Non-dominant back scratch test (cm) 0.32 (6.11) −4.13 (6.76) −3.81 −2.80 (7.18) −1.08 (6.23) +1.72 97.66 2.08 0.258 0.25 Interaction Effect Boat*Measurement refers to the influence of the type of boat used according to the training group on the variables; * p< 0.05; ** p< 0.001. Cancers 2024, 16, x FOR PEER REVIEW 6 of 14 Table 4. Between-subject analysis of study variables according to boat type. Fixed-Seat Rowing (FSR) Sliding-Seat Rowing (SSR) Interaction Effect Boat Measurement Effect Size 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 0.000 ** 0.64 BMI (kg/m 2 ) 27.48 (2.73) 26.75 (2.66) −0.73 25.47 (4.09) 24.8 (3.89) −0.67 40.49 3.34 0.000 ** 0.71 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 0.000 ** 0.47 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 0.48 0.000 ** 0.51 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 0.65 0.000 ** 0.62 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 0.000 ** 0.8 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 0.15 0.000 ** 0.97 Aerobic capacity 6 min walk test (m) 817.25 (51.1) 880.3 (69.96) +63.05 752.3 (127.37) 845.95 (132.58) +93.65 42,185.02 4.25 0.000 ** 0.67 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 0.02 0.027 * 0.35 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 0.02 * 0.22 Non-dominant back scratch test (cm) 0.32 (6.11) −4.13 (6.76) −3.81 −2.80 (7.18) −1.08 (6.23) +1.72 97.66 2.08 0.258 0.25 Interaction Effect Boat*Measurement refers to the influence of the type of boat used according to the training group on the variables; * p < 0.05; ** p < 0.001. The following figures compare the changes produced according to the different training protocols. Focusing on body composition, Figure 3 shows a slight improvement in both groups (FSR: Δ pre-post BMI = −0.73/SSR: Δ pre-post BMI = −0.67; p = 0.000), although it is slightly higher in the FSR group. Figure 3. Comparison of BMI (kg/m 2 ) pre- and post-rowing training. BMI = Body Mass Index; FSR = Fixed-Seat Rowing; SSR = Sliding-Seat Rowing. * p< 0.05; ** p< 0.001. Regarding the parameters associated with flexibility, Figure 5shows significant improvements in both groups for the general flexibility variable with the sit-and-reach test Cancers 2024,16, 2207 7 of 13 (FSR: ∆pre-post sit and reach = +3.53; p= 0.027/SSR: ∆pre-post sit and reach = +4.4/p= 0.027). An 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: ∆pre-post dominant BST = − 5.55; p= 0.02) and the non-dominant arm, although this was not significant (FSR: ∆pre-post non-dominant BST = − 3.81; p= 0.258). Conversely, data from subjects participating in the SSR training program showed improvements in both the dominant arm (SSR: ∆pre-post dominant BST = +1.75; p= 0.02) and the non-dominant arm (SSR: ∆pre-post non-dominant BST = +1.72; p= 0.258). Cancers 2024, 16, x FOR PEER REVIEW 7 of 14 Figure 3. Comparison of BMI (kg/m2) pre- and post-rowing training. BMI = Body Mass Index; FSR = Fixed-Seat Rowing; SSR = Sliding-Seat Rowing. * p < 0.05; ** p < 0.001. In Figure 4, statistically significant improvements were detected in both waist circumference (FSR: Δpre-post waist circumference = −2.83/SSR: Δpre-post waist circumference = −3.66; p = 0.000) and hip circumference (FSR: Δpre-post hip circumference = −2.2/SSR: Δpre-post hip circumference = −2.88; p = 0.000), although the values were slightly higher in the SSR group. Regarding the parameters associated with flexibility, Figure 5 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 = 0.027/SSR: Δpre-post sit and reach = +4.4/p = 0.027). An 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 = 0.02) and the non-dominant arm, although this was not significant (FSR: Δpre-post non-dominant BST = −3.81; p = 0.258). Conversely, data from subjects participating in the SSR training program showed improvements in both the dominant arm (SSR: Δpre-post dominant BST = +1.75; p = 0.02) and the non-dominant arm (SSR: Δpre-post non-dominant BST = +1.72; p = 0.258). Figure 4. Comparison of circumferences (cm) pre- and post-rowing training. WC = Waist Circumference; HC = Hip Circumference; FSR = Fixed-Seat Rowing; SSR = Sliding-Seat Rowing. * p < 0.05; ** p < 0.001. Figure 4. Comparison of circumferences (cm) pre- and post-rowing training. WC = Waist Circumference; HC = Hip Circumference; FSR = Fixed-Seat Rowing; SSR = Sliding-Seat Rowing. * p< 0.05; ** p< 0.001. Cancers 2024, 16, x FOR PEER REVIEW 8 of 14 Figure 5. 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 < 0.05; ** p < 0.001. Regarding the muscle strength tests, Figure 6 shows a significant improvement in women who trained in both fixed-seat (FSR: Δpre-post CMJ = +2.99; p = 0.000) and slidingseat boats (SSR: Δpre-post CMJ = +3.11; p = 0.000), although the results are slightly higher in the latter group. Figure 6. Counter movement jump (CMJ) (cm) pre- and postrowing training. FSR = Fixed-Seat Rowing; SSR = Sliding-Seat Rowing. ** p < 0.001. No statistically significant differences in comparison between groups (Student’s t-test for independent groups). Figure 7 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 = 0.000) and the non-dominant arm (FSR: Figure 5. 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< 0.05; ** p< 0.001. Cancers 2024,16, 2207 8 of 13 Regarding the muscle strength tests, Figure 6shows a significant improvement in women who trained in both fixed-seat (FSR: ∆pre-post CMJ = +2.99; p= 0.000) and slidingseat boats (SSR: ∆pre-post CMJ = +3.11; p= 0.000), although the results are slightly higher in the latter group. Cancers 2024, 16, x FOR PEER REVIEW 8 of 14 Figure 5. 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 < 0.05; ** p < 0.001. Regarding the muscle strength tests, Figure 6 shows a significant improvement in women who trained in both fixed-seat (FSR: Δpre-post CMJ = +2.99; p = 0.000) and slidingseat boats (SSR: Δpre-post CMJ = +3.11; p = 0.000), although the results are slightly higher in the latter group. Figure 6. Counter movement jump (CMJ) (cm) pre- and postrowing training. FSR = Fixed-Seat Rowing; SSR = Sliding-Seat Rowing. ** p < 0.001. No statistically significant differences in comparison between groups (Student’s t-test for independent groups). Figure 7 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 = 0.000) and the non-dominant arm (FSR: Figure 6. Counter movement jump (CMJ) (cm) pre- and postrowing training. FSR = Fixed-Seat Rowing; SSR = Sliding-Seat Rowing. ** p< 0.001. No statistically significant differences in comparison between groups (Student’s t-test for independent groups). Figure 7illustrates the results of the handgrip test with significant improvements in both training groups, both for the dominant arm (FSR: ∆pre-post dominant handgrip = +4.13/SSR: ∆pre-post dominant handgrip = +4.34; p= 0.000) and the non-dominant arm (FSR: ∆pre-post non-dominant handgrip = +3.67/SSR: ∆pre-post non-dominant handgrip = +3.32; p= 0.000). Cancers 2024, 16, x FOR PEER REVIEW 9 of 14 Δpre-post non-dominant handgrip = +3.67/SSR: Δpre-post non-dominant handgrip = +3.32; p = 0.000). Figure 7. Handgrip (kgf) comparison pre- and post-rowing training. DHG = Dominant Handgrip; NDHG = Non-Dominant Handgrip; FSR = Fixed-Seat Rowing; SSR = Sliding-Seat Rowing. * p < 0.05; ** p < 0.001. Finally, regarding endurance, Figure 8 shows a significant improvement in the SSR training group (SSR: Δpre-post 6 min walk test = +93.65; p = 0.000) and also in the FSR group, but the latter results are somewhat lower (FSR: Δpre-post 6 min walk test = +63.05; p = 0.000). Figure 8. A comparison of the distance in the 6 min walk test (m) pre- and post-rowing training. 6MWT = 6 min walk test; FSR = fixed-seat rowing; SSR = sliding-seat rowing. * p < 0.05; ** p < 0.001. Figure 7. Handgrip (kgf) comparison pre- and post-rowing training. DHG = Dominant Handgrip; NDHG = Non-Dominant Handgrip; FSR = Fixed-Seat Rowing; SSR = Sliding-Seat Rowing. * p< 0.05; ** p< 0.001. Cancers 2024,16, 2207 9 of 13 Finally, regarding endurance, Figure 8shows a significant improvement in the SSR training group (SSR: ∆pre-post 6 min walk test = +93.65; p= 0.000) and also in the FSR group, but the latter results are somewhat lower (FSR: ∆pre-post 6 min walk test = +63.05; p= 0.000). Cancers 2024, 16, x FOR PEER REVIEW 9 of 14 Δpre-post non-dominant handgrip = +3.67/SSR: Δpre-post non-dominant handgrip = +3.32; p = 0.000). Figure 7. Handgrip (kgf) comparison pre- and post-rowing training. DHG = Dominant Handgrip; NDHG = Non-Dominant Handgrip; FSR = Fixed-Seat Rowing; SSR = Sliding-Seat Rowing. * p < 0.05; ** p < 0.001. Finally, regarding endurance, Figure 8 shows a significant improvement in the SSR training group (SSR: Δpre-post 6 min walk test = +93.65; p = 0.000) and also in the FSR group, but the latter results are somewhat lower (FSR: Δpre-post 6 min walk test = +63.05; p = 0.000). Figure 8. A comparison of the distance in the 6 min walk test (m) pre- and post-rowing training. 6MWT = 6 min walk test; FSR = fixed-seat rowing; SSR = sliding-seat rowing. * p < 0.05; ** p < 0.001. Figure 8. A comparison of the distance in the 6 min walk test (m) pre- and post-rowing training. 6MWT = 6 min walk test; FSR = fixed-seat rowing; SSR = sliding-seat rowing. * p< 0.05; ** p< 0.001. 4. Discussion Several studies [ 16 , 30 ] have concluded that the regular practice of physical activity and its relationship with cancer has multiple benefits at the cellular level, and it can improve the quality of life of patients undergoing multiple drug treatments, reduce the side effects of anti-cancer therapies, and improve prognosis and survival after cancer [ 10 , 13 , 17 ]. It is therefore important to be aware of the potential benefits for the body from maintaining a healthy lifestyle and to encourage the maintenance of physical activity and exercise levels in a controlled and professionally supervised manner as a complementary nonpharmacological therapy for the treatment of patients with cancer [30]. In this study, it was found that after the intervention program, both the FSR and SSR training groups showed positive and significant changes in the anthropometric and physical fitness variables measured, including muscle strength, aerobic capacity, and general flexibility. Consequently, it can be reported that 6 months of rowing training had positive effects on physical fitness and anthropometric measures in female breast cancer survivors. These results coincide with those of previous studies [ 8 – 10 ] showing that rowing can be a safe and effective sport to not only improve the fitness of patients but also their quality of life. Unlike some currently published studies, such as those by Moro et al. [ 31 ], where no statistically significant differences were found after a 12-week dragon boat intervention protocol in variables associated with body composition (BMI and upper limb circumference), we observed significant results in both training groups regarding the obtained anthropometric measures. In this regard, the importance of maintaining adequate BMI levels in cancer is related to the role of insulin and the risk of non-insulin-dependent diabetes, which are strongly influenced by body fat distribution and physical activity levels [ 16 ]. Additionally, hyperinsulinemia causes an increase in insulin-like growth factor (IGF)-1 and a decrease in its binding proteins. Specifically, IGF-1 plays a primary role in carcinogenesis [ 32 ]. Recent research has revealed that exercise can significantly reduce the postoperative levels of IGF-1 and proteins related to inflammatory processes, such as C-reactive protein (CRP), tumor necrosis factor-alpha (TNF α ), and interleukin-6 (IL-6) in adult and elderly women