Upper limb progressive resistance training and stretching exercises following surgery for early breast cancer: a randomized controlled trial

Abstract

The aim of this study was to determine whether an exercise program, commencing 4-6 weeks post-operatively, reduces upper limb impairments in women treated for early breast cancer. Women (n = 160) were randomized to either an 8-week exercise program (n = 81) or to a control group (n = 79) following stratification for axillary surgery. The exercise program comprised a weekly session and home program of passive stretching and progressive resistance training for shoulder muscles. The control group attended fortnightly assessments but no exercises were provided. The primary outcome was self-reported arm symptoms derived from the EORTC breast cancer-specific questionnaire (BR23), scored out of 100 with a low score indicative of fewer symptoms. The secondary outcomes included physical measures of shoulder range of motion, strength, and swelling (i.e., lymphedema). Women were assessed immediately following the intervention and at 6 months post-intervention. The change in symptoms from baseline was not significantly different between groups immediately following the intervention or at 6 m post-intervention. The between group difference immediately following the intervention was 4 (95% CI -1 to 9) and 6 months post-intervention was 4 (-2 to 10). However, the change in range of motion for flexion and abduction was significantly greater in the exercise group immediately following the intervention, as was change in shoulder abductor strength. In conclusion, a supervised exercise program provided some, albeit small, additional benefit at 6 months post-intervention to women who had been provided with written information and reminders to use their arm. Both the groups reported few impairments including swelling immediately following the intervention and 6 months post-intervention. Notably, resistance training in the post-operative period did not precipitate lymphedema.

Effects of 12‐week resistance training during radiotherapy in breast cancer patients

“…Beyond chemotherapy, this observation seems also to be valid for surgery‐related aspects as we were able to reveal that strength gain in shoulder rotators was higher on the affected side in comparison to the non‐affected. Comparable findings were reported by others (Kilbreath et al., ).…”

Effects of 12‐week resistance training during radiotherapy in breast cancer patients

“…Beyond chemotherapy, this observation seems also to be valid for surgery‐related aspects as we were able to reveal that strength gain in shoulder rotators was higher on the affected side in comparison to the non‐affected. Comparable findings were reported by others (Kilbreath et al., ).…”

Effectiveness of Physiotherapy Intervention on the Quality of Life of Women with Breast Cancer who Underwent Sentinel Lymph Node Biopsy.

“…In the other variables, with no statistically significant effect after adjustment, the Experimental Group maintained the favorable estimate effect. This matches other studies that report a statistically significant GHS improvement in the same postsurgery period in the group submitted to physiotherapy or to an exercise program when compared to a Control Group [19,29,31,47]. In the other function and symptoms scales there were no statistically significant differences between groups.…”

Long‐Term Shoulder Dysfunction After Breast and Axillary Surgery: Impact of Surgical Extent and Predictors of Function

“…Lauridsen et al similarly noted that patients with early dysfunction, though worse initially, gained most from rehabilitation [30]. In our cohort, the timing of physiotherapy, whether inpatient or post-discharge, did not significantly affect outcomes, consistent with randomized studies by Torres-Lacomba et al and Kilbreath et al demonstrating minimal long-term differences when exercise protocols were standardized [31,32]. Symptom-directed rather than universal early therapy may therefore represent a more efficient rehabilitation approach.…”

Effects of 12‐week resistance training during radiotherapy in breast cancer patients

“…Beyond chemotherapy, this observation seems also to be valid for surgery‐related aspects as we were able to reveal that strength gain in shoulder rotators was higher on the affected side in comparison to the non‐affected. Comparable findings were reported by others (Kilbreath et al., ).…”

Effectiveness of Physiotherapy Intervention on the Quality of Life of Women with Breast Cancer who Underwent Sentinel Lymph Node Biopsy.

“…In the other variables, with no statistically significant effect after adjustment, the Experimental Group maintained the favorable estimate effect. This matches other studies that report a statistically significant GHS improvement in the same postsurgery period in the group submitted to physiotherapy or to an exercise program when compared to a Control Group [19,29,31,47]. In the other function and symptoms scales there were no statistically significant differences between groups.…”

Long‐Term Shoulder Dysfunction After Breast and Axillary Surgery: Impact of Surgical Extent and Predictors of Function

“…Lauridsen et al similarly noted that patients with early dysfunction, though worse initially, gained most from rehabilitation [30]. In our cohort, the timing of physiotherapy, whether inpatient or post-discharge, did not significantly affect outcomes, consistent with randomized studies by Torres-Lacomba et al and Kilbreath et al demonstrating minimal long-term differences when exercise protocols were standardized [31,32]. Symptom-directed rather than universal early therapy may therefore represent a more efficient rehabilitation approach.…”

Effects of 12‐week resistance training during radiotherapy in breast cancer patients

“…Beyond chemotherapy, this observation seems also to be valid for surgery‐related aspects as we were able to reveal that strength gain in shoulder rotators was higher on the affected side in comparison to the non‐affected. Comparable findings were reported by others (Kilbreath et al., ).…”

Effectiveness of Physiotherapy Intervention on the Quality of Life of Women with Breast Cancer who Underwent Sentinel Lymph Node Biopsy.

“…In the other variables, with no statistically significant effect after adjustment, the Experimental Group maintained the favorable estimate effect. This matches other studies that report a statistically significant GHS improvement in the same postsurgery period in the group submitted to physiotherapy or to an exercise program when compared to a Control Group [19,29,31,47]. In the other function and symptoms scales there were no statistically significant differences between groups.…”

Long‐Term Shoulder Dysfunction After Breast and Axillary Surgery: Impact of Surgical Extent and Predictors of Function

“…Lauridsen et al similarly noted that patients with early dysfunction, though worse initially, gained most from rehabilitation [30]. In our cohort, the timing of physiotherapy, whether inpatient or post-discharge, did not significantly affect outcomes, consistent with randomized studies by Torres-Lacomba et al and Kilbreath et al demonstrating minimal long-term differences when exercise protocols were standardized [31,32]. Symptom-directed rather than universal early therapy may therefore represent a more efficient rehabilitation approach.…”