Effect of exercise on shoulder function and morbidity following mastectomy with axillary dissection in patients with breast cancer: a prospective randomized clinical study

Abstract

Background: There are no guidelines for the exercises performed in physical rehabilitation after breast cancer surgery and, specifically, for how to minimize these postoperative complications. Hence this study was conducted to study the effect of exercise intervention on upper extremity range of motion, strength, lymphedema, pain and activities of daily living (ADL).Methods: A total of 75 patients were included in the study in accordance to inclusion criteria. They were randomized into exercise group (n=38) and no exercise group (n=37). Patients in the exercise group were given a set of 19 active or active assisted range of motion exercises and strengthening exercises with frequent follow up. The other group were did not receive any strict exercise, they were given a few free hand exercise when they had some shoulder complaints based on treating physician discretion. Apart from demographic data other parameters studied were pain, numbness, active shoulder range of motion, muscle strength, lymphedema and ADL. These were evaluated before surgery, 24 hours after drain removal and 3 weeks /6 weeks/ 3 months of post-surgery.Results: Demographic parameters were comparable between the groups. Pain score, shoulder ROM were better in the exercise group compared to no exercise group and this difference was found to be significant (p <0.001). More patients in no exercise group experienced numbness. There was no statistically significant difference in the grip strength between the two groups. The incidence of lymphedema was higher in no exercise group compared to exercise group and this was extremely significant. (p < 0.001). Patients in no exercise group had higher disability scores for ADL which was significant compared to exercise group.Conclusions: Exercise interventions resulted in significantly reduced pain, improved shoulder ROM and lowered ADL impairment. Exercise intervention significantly reduced the incidence of lymphedema, but there was no effect on strength.