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Min J, Kim JY, Ryu J, Park S, Courneya KS, Ligibel J, Kim SI, Jeon JY. Early Implementation of Exercise to Facilitate Recovery After Breast Cancer Surgery: A Randomized Clinical Trial. JAMA Surg 2024:2819794. [PMID: 38837150 PMCID: PMC11154354 DOI: 10.1001/jamasurg.2024.1633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/21/2024] [Indexed: 06/06/2024]
Abstract
Importance Recovery of shoulder function following breast cancer surgery is crucial for physical functioning and quality of life. While early implementation of shoulder rehabilitation exercises may enhance recovery, the optimal timing and exercise program remain unclear. Objective To investigate whether an early exercise intervention, initiated 1 day postsurgery and continued for 1 month through subsequent visits, could improve shoulder range of motion (ROM) and strength in patients with breast cancer. Design, Setting, and Participants A parallel-group, 2-arm randomized clinical trial was conducted between June 2020 and October 2021 at the Breast Cancer Center in Seoul, South Korea. Fifty-six patients (of 119 screened) with early-stage breast cancer who were scheduled for partial or total mastectomy were randomized into a tailored resistance exercise group (n = 28) or a usual care group (n = 28). Data were analyzed from November 2021 to June 2022. Interventions The exercise intervention commenced 1 day postsurgery and consisted of 4 supervised exercise education sessions corresponding with surgeon visits and daily home-based exercises for the first postoperative month. Tailored programs, including stretching and strength exercises, were adjusted based on individual shoulder function recovery status. Main Outcomes and Measures Primary end points were shoulder ROM and strength at 1 and 6 months postsurgery. Physical activity, body composition, and quality of life were assessed at 6 months. Results Of 56 patients randomized (mean [SD] age, 50.3 [6.6] years), 54 completed the trial (96%), with 100% and 97% compliance to supervised and home-based exercise sessions, respectively. At 1 month postsurgery, 19 (67.9%) in the exercise group had fully recovered shoulder strength compared to 1 (3.6%) in the usual care group (P < .001). At 6 months, 22 (78.6%) in the exercise group had fully recovered shoulder ROM and 24 (85.7%) had fully recovered strength compared to 6 (21.4%) and 5 (17.9%), respectively, in the usual care group (P < .001). The exercise group exhibited less loss in muscle mass and improved physical activity and quality of life compared to the usual care group. Conclusion and Relevance In this trial, 1-month tailored exercise program, initiated immediately after breast cancer surgery and supplemented with supervised sessions coinciding with surgeon visits, significantly improved shoulder function in patients with breast cancer. Trial Registration WHO International Clinical Trials Registry identifier: KCT0006997.
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Affiliation(s)
- Jihee Min
- National Cancer Control Institute, National Cancer Center, Goyang-si, South Korea
- Department of Sport Industry Sciences, Yonsei University, Seoul, South Korea
| | - Jee Ye Kim
- Division of Breast Surgery, College of Medicine, Yonsei University, Seoul, South Korea
| | - Jiin Ryu
- Department of Sport Industry Sciences, Yonsei University, Seoul, South Korea
| | - Seho Park
- Division of Breast Surgery, College of Medicine, Yonsei University, Seoul, South Korea
| | - Kerry S. Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Ligibel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Seung Il Kim
- Division of Breast Surgery, College of Medicine, Yonsei University, Seoul, South Korea
| | - Justin Y. Jeon
- Department of Sport Industry Sciences, Yonsei University, Seoul, South Korea
- Exercise Medicine Center for Diabetes and Cancer Patients, Institute of Convergence Science, Yonsei University, Seoul, South Korea
- Cancer Prevention Center, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University, Seoul, South Korea
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Park YJ, Na SJ, Kim MK. Effect of progressive resistance exercise using Thera-band on edema volume, upper limb function, and quality of life in patients with breast cancer-related lymphedema. J Exerc Rehabil 2023; 19:105-113. [PMID: 37163184 PMCID: PMC10164527 DOI: 10.12965/jer.2346046.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/14/2023] [Indexed: 05/11/2023] Open
Abstract
This study aimed to determine the effects of progressive resistive exercise (PRE), including complex decongestive physical therapy (CDPT), on edema volume, handgrip strength, upper extremity function, and quality of life (QoL) in patients with breast cancer-related lymphedema (BCRL). Twenty patients were randomized between the progressive resistance exercise group (PREG) and the self-home resistance exercise group (SREG). Two patients in each group dropped out of the study, leaving 16 patients: n=8 in the exercise group and n=8 in the SREG. First, the PREG and the SREG received CDPT. Subsequently, the patients in the PREG performed PRE, whereas the patients in the SREG performed self-home resistance exercises. Interventions were performed for 50 min, 3 times a week, for 6 weeks. The results showed that, for the edema volume, a significant intergroup variation was absent, whereas the intragroup variation was significant. The inter- and intragroup variations were significant for both handgrip strength and upper extremity function. Regarding QoL, a significant difference was observed in global health status/QoL and role function between the groups. Furthermore, significant differences were observed within the PREG in global health status/QoL; physical, role, and cognitive function; and dyspnea. No significant differences were observed within the SREG. The results collectively suggest that the exercise program was an intervention with a greater potential contribution to reducing edema and enhancing physical function in patients with BCRL.
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Affiliation(s)
- Yun-Jin Park
- Department of Health Rehabilitation, Osan University, Osan,
Korea
| | - Song-Ju Na
- Department of Rehabilitation Medicine, Yeouido St. Mary’s Hospital, Seoul,
Korea
| | - Myung-Ki Kim
- School of Global Sport Studies, Korea University, Sejong,
Korea
- Corresponding author: Myung-Ki Kim, School of Global Sport Studies, Korea University, 2511 Sejong-ro, Jochiwon-eup, Sejong 30019, Korea,
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Sayan M, Kilic SS, Vergalasova I, Jan I, Eladoumikdachi F, Haffty B, Kumar S, Ohri N. Risk Factors for the Development of Clinical and Subclinical Lymphedema Detected by Bioimpedance Spectroscopy. Clin Breast Cancer 2022; 22:553-559. [DOI: 10.1016/j.clbc.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/15/2022] [Indexed: 11/03/2022]
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Omar MTA, Gwada RFM, Omar GSM, El-Sabagh RM, Mersal AEAE. Low-Intensity Resistance Training and Compression Garment in the Management of Breast Cancer-Related Lymphedema: Single-Blinded Randomized Controlled Trial. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:1101-1110. [PMID: 31243692 DOI: 10.1007/s13187-019-01564-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
There is limited evidence regarding the combined effect of exercise and compression garment on breast cancer-related lymphedema (BCRL). Therefore, we investigate the effect of low-intensity resistance training alone or in combination with a compression garment on lymphedema volume, self-reported lymphedema symptoms, and shoulder mobility and function. A total of 60 women with unilateral BCRL were randomly assigned to low-intensity resistance exercises (Rex group, n = 30) or exercises and compression garment (Rex-Com-group, n = 30). Both groups take part in exercises program consisted of 10-12 repetitions at 50 to 60% of one repetition maximum (IRM), three times weekly, for 8 weeks. The primary outcome was lymphedema volume determined by percentage reduction of excess limb volume (ELV). Secondary outcomes were lymphedema symptoms (pain, heaviness, and tightness) and shoulder mobility and function using the disabilities of the arm, shoulder, and hand (DASH) questionnaire. All measurements were standardized and performed before (week 0, W0), after the intervention (week 8, W8), and at follow-up (week 12, W12). A significant reduction in percentage of ELV (p < 0.01), pain severity (p < 0.05), a sensation of heaviness (p < 0.05) and tightness (p < 0.001), and improvement in shoulder range of motion (p < 0.05) and function on DASH scores (p < 0.05) were observed at W8 and W12 in both groups. However, no between-group differences were observed over time. These findings suggest that low-intensity resistance training, irrespective of garment use, can effectively reduce limb volume and lymphedema symptoms, and increase shoulder mobility and function.
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Affiliation(s)
- Mohammed T A Omar
- Physical Therapy Department for Surgery, Faculty of Physical Therapy, Cairo University, 7 Ahmad Al-Zayat St., Bain El-Sarayat, Giza, 12612, Egypt.
| | - Rehab F M Gwada
- Physical Therapy Department, National Heart Institute, Giza, Egypt
| | - Ghada S M Omar
- Physical Therapy Department for Surgery, Faculty of Physical Therapy, Cairo University, 7 Ahmad Al-Zayat St., Bain El-Sarayat, Giza, 12612, Egypt
- Physical Therapy Department, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | - Rokia M El-Sabagh
- Physical Therapy Department, El-Mattaria Teaching Hospital, Cairo, Egypt
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McLaughlin SA, DeSnyder SM, Klimberg S, Alatriste M, Boccardo F, Smith ML, Staley AC, Thiruchelvam PTR, Hutchison NA, Mendez J, MacNeill F, Vicini F, Rockson SG, Feldman SM. Considerations for Clinicians in the Diagnosis, Prevention, and Treatment of Breast Cancer-Related Lymphedema, Recommendations from an Expert Panel: Part 2: Preventive and Therapeutic Options. Ann Surg Oncol 2017; 24:2827-2835. [DOI: 10.1245/s10434-017-5964-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Indexed: 12/25/2022]
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Harvey LA, Katalinic OM, Herbert RD, Moseley AM, Lannin NA, Schurr K. Stretch for the treatment and prevention of contractures. Cochrane Database Syst Rev 2017; 1:CD007455. [PMID: 28146605 PMCID: PMC6464268 DOI: 10.1002/14651858.cd007455.pub3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Contractures are a common complication of neurological and non-neurological conditions, and are characterised by a reduction in joint mobility. Stretch is widely used for the treatment and prevention of contractures. However, it is not clear whether stretch is effective. This review is an update of the original 2010 version of this review. OBJECTIVES The aim of this review was to determine the effects of stretch on contractures in people with, or at risk of developing, contractures.The outcomes of interest were joint mobility, quality of life, pain, activity limitations, participation restrictions, spasticity and adverse events. SEARCH METHODS In November 2015 we searched CENTRAL, DARE, HTA; MEDLINE; Embase; CINAHL; SCI-EXPANDED; PEDro and trials registries. SELECTION CRITERIA We included randomised controlled trials and controlled clinical trials of stretch applied for the purpose of treating or preventing contractures. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, extracted data, and assessed risk of bias. The outcomes of interest were joint mobility, quality of life, pain, activity limitations, participation restrictions and adverse events. We evaluated outcomes in the short term (up to one week after the last stretch) and in the long term (more than one week). We expressed effects as mean differences (MD) or standardised mean differences (SMD) with 95% confidence intervals (CI). We conducted meta-analyses with a random-effects model. We assessed the quality of the body of evidence for the main outcomes using GRADE. MAIN RESULTS Forty-nine studies with 2135 participants met the inclusion criteria. No study performed stretch for more than seven months. Just over half the studies (51%) were at low risk of selection bias; all studies were at risk of detection bias for self reported outcomes such as pain and at risk of performance bias due to difficulty of blinding the intervention. However, most studies were at low risk of detection bias for objective outcomes including range of motion, and the majority of studies were free from attrition and selective reporting biases. The effect of these biases were unlikely to be important, given that there was little benefit with treatment. There was high-quality evidence that stretch did not have clinically important short-term effects on joint mobility in people with neurological conditions (MD 2°; 95% CI 0° to 3°; 26 studies with 699 participants) or non-neurological conditions (SMD 0.2, 95% CI 0 to 0.3, 19 studies with 925 participants).In people with neurological conditions, it was uncertain whether stretch had clinically important short-term effects on pain (SMD 0.2; 95% CI -0.1 to 0.5; 5 studies with 174 participants) or activity limitations (SMD 0.2; 95% CI -0.1 to 0.5; 8 studies with 247 participants). No trials examined the short-term effects of stretch on quality of life or participation restrictions in people with neurological conditions. Five studies involving 145 participants reported eight adverse events including skin breakdown, bruising, blisters and pain but it was not possible to statistically analyse these data.In people with non-neurological conditions, there was high-quality evidence that stretch did not have clinically important short-term effects on pain (SMD -0.2, 95% CI -0.4 to 0.1; 7 studies with 422 participants) and moderate-quality evidence that stretch did not have clinically important short-term effects on quality of life (SMD 0.3, 95% CI -0.1 to 0.7; 2 studies with 97 participants). The short-term effect of stretch on activity limitations (SMD 0.1; 95% CI -0.2 to 0.3; 5 studies with 356 participants) and participation restrictions were uncertain (SMD -0.2; 95% CI -0.6 to 0.1; 2 studies with 192 participants). Nine studies involving 635 participants reported 41 adverse events including numbness, pain, Raynauds' phenomenon, venous thrombosis, need for manipulation under anaesthesia, wound infections, haematoma, flexion deficits and swelling but it was not possible to statistically analyse these data. AUTHORS' CONCLUSIONS There was high-quality evidence that stretch did not have clinically important effects on joint mobility in people with or without neurological conditions if performed for less than seven months. Sensitivity analyses indicate results were robust in studies at risk of selection and detection biases in comparison to studies at low risk of bias. Sub-group analyses also suggest the effect of stretch is consistent in people with different types of neurological or non-neurological conditions. The effects of stretch performed for periods longer than seven months have not been investigated. There was moderate- and high-quality evidence that stretch did not have clinically important short-term effects on quality of life or pain in people with non-neurological conditions, respectively. The short-term effects of stretch on quality of life and pain in people with neurological conditions, and the short-term effects of stretch on activity limitations and participation restrictions for people with and without neurological conditions are uncertain.
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Affiliation(s)
- Lisa A Harvey
- Kolling Institute, Northern Sydney Local Health DistrictJohn Walsh Centre for Rehabilitation ResearchRoyal North Shore HospitalSt LeonardsNSWAustralia2065
| | - Owen M Katalinic
- Telstra HealthEmerging Systems18/9 Hoyle AvenueCastle HillNSWAustralia2154
| | - Robert D Herbert
- Neuroscience Research AustraliaBarker StreetRandwickSydneyAustralia2031
| | - Anne M Moseley
- The George Institute for Global Health, Sydney Medical School, The University of SydneyPO Box M201Missenden RdSydneyNSWAustralia2050
| | - Natasha A Lannin
- La Trobe UniversityOccupational Therapy, Department of Community and Clinical Allied Health, School of Allied Health, College of Science, Health and EngineeringMelbourneVictoriaAustralia
| | - Karl Schurr
- Bankstown HospitalPhysiotherapy DepartmentLocked Bag 1600BankstownNSWAustralia2200
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Lee SY, Sim MK, Do J, Jeong SY, Jeon JY. Pilot study of effective methods for measuring and stretching for pectoral muscle tightness in breast cancer patients. J Phys Ther Sci 2016; 28:3030-3035. [PMID: 27942114 PMCID: PMC5140794 DOI: 10.1589/jpts.28.3030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/19/2016] [Indexed: 12/01/2022] Open
Abstract
[Purpose] To evaluate differences in pectoral muscle tightness according to arm abduction
angle and to determine the best arm abduction angle for stretching of pectoral muscle
tightness in breast cancer patients. [Subjects and Methods] Horizontal abduction
differences of shoulders were measured bilaterally by arm abduction to 45°, 90°, and 135°
to determine the best arm abduction angle for measuring pectoral muscle tightness.
Thirty-two patients were divided into three pectoral muscle stretching groups (A: 45°, B:
90°, and C: 135°). We measured the shoulder range of motion, scores of the Disabilities of
the Arm, Shoulder, and Hand, European Organization for Research and Treatment of Cancer
Quality of Life Questionnaire and the Breast Module, and pain levels (using a visual
analog scale) before and after therapy. [Results] The differences in degree of horizontal
abduction between shoulders were significantly larger for arm abduction to 90° and 135°
than that to 45°. Groups B and C showed greater improvements in horizontal abduction
limitations than group A. [Conclusion] Horizontal abduction differences between shoulders
are prominent when arms are abducted to 90° and 135°. The appropriate arm abduction angle
for measuring horizontal abduction and effective stretching of pectoral muscle tightness
may be >90°.
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Affiliation(s)
- So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Republic of Korea; Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Republic of Korea
| | - Mi Kyung Sim
- Ilsan Median Rehabilitation Hospital, Republic of Korea; Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Republic of Korea
| | - Junghwa Do
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
| | - Soon Young Jeong
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
| | - Jae Yong Jeon
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
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Moloney N, Sung JMW, Kilbreath S, Dylke E. Prevalence and risk factors associated with pain 21 months following surgery for breast cancer. Support Care Cancer 2016; 24:4533-9. [PMID: 27271868 DOI: 10.1007/s00520-016-3292-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 05/30/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE This study investigated (1) the prevalence of pain following breast cancer treatment including moderate-to-severe persistent pain and (2) the association of risk factors, present 1 month following surgery, with pain at 21 months following surgery. This information may aid the development of clinical guidelines for early pain assessment and intervention in this population. METHODS This study was a retrospective analysis of core and breast modules of the European Organisation for Research and Treatment of Cancer (EORTC) questionnaire from 121 participants with early breast cancer. The relationships between potential risk factors (subscales derived from the EORTC), measured within 1 month following surgery, and pain at 21 months following surgery were analysed using univariable and multi-variable logistic regression. RESULTS At 21 months following surgery, 46.3 % of participants reported pain, with 24 % categorised as having moderate or severe pain. Prevalence of pain was similar between those who underwent axillary lymph node dissection versus biopsy. Univariate logistic regression identified baseline pain (odds ratio (95 % CI): 2.7 (1.1 to 6.4)); baseline arm symptoms (11.2 (1.4 to 89.8)); emotional function (0.4 (0.1 to 0.8)) and insomnia (2.3 (1.1 to 4.7) as significantly associated with pain at 21 months. In multi-variable analysis, two factors were independently associated with pain at 21 months-baseline arm symptoms and emotional subscale scores. CONCLUSION Pain is a significant problem following breast cancer treatment in both the early post-operative period and months following surgery. Risk factors for pain at long-term follow-up included arm symptoms and higher emotional subscale scores at baseline.
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Affiliation(s)
- Niamh Moloney
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia. .,Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Ground Floor, 75 Talavera Road, Sydney, NSW, 2113, Australia.
| | - Jennie Man Wai Sung
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Sharon Kilbreath
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Elizabeth Dylke
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
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Shah C, Arthur DW, Wazer D, Khan A, Ridner S, Vicini F. The impact of early detection and intervention of breast cancer-related lymphedema: a systematic review. Cancer Med 2016; 5:1154-62. [PMID: 26993371 PMCID: PMC4924374 DOI: 10.1002/cam4.691] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 02/05/2016] [Accepted: 02/08/2016] [Indexed: 01/18/2023] Open
Abstract
Breast cancer-related lymphedema (BCRL) has become an increasingly important clinical issue as noted by the recent update of the 2015 NCCN breast cancer guidelines which recommends to "educate, monitor, and refer for lymphedema management." The purpose of this review was to examine the literature regarding early detection and management of BCRL in order to (1) better characterize the benefit of proactive surveillance and intervention, (2) clarify the optimal monitoring techniques, and (3) help better define patient groups most likely to benefit from surveillance programs. A Medline search was conducted for the years 1992-2015 to identify articles addressing early detection and management of BCRL. After an initial search, 127 articles were identified, with 13 of these studies focused on early intervention (three randomized (level of evidence 1), four prospective (level of evidence 2-3), six retrospective trials (level of evidence 4)). Data from two, small (n = 185 cases), randomized trials with limited follow-up demonstrated a benefit to early intervention (physiotherapy, manual lymphatic drainage) with regard to reducing the rate of chronic BCRL (>50% reduction) with two additional studies underway (n = 1280). These findings were confirmed by larger prospective and retrospective series. Several studies were identified that demonstrate that newer diagnostic modalities (bioimpedance spectroscopy, perometry) have increased sensitivity allowing for the earlier detection of BCRL. Current data support the development of surveillance programs geared toward the early detection and management of BCRL in part due to newer, more sensitive diagnostic modalities.
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Affiliation(s)
- Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Douglas W Arthur
- Department of Radiation Oncology, Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
| | - David Wazer
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, Massachusetts.,Department of Radiation Oncology, Brown University, Providence, Rhode Island
| | - Atif Khan
- Department of Radiation Oncology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Sheila Ridner
- School of Nursing, Vanderbilt University, Nashville, Tennessee
| | - Frank Vicini
- Michigan Healthcare Professionals/21st Century Oncology, Farmington Hills, Michigan
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Paramanandam VS, Roberts D. Weight training is not harmful for women with breast cancer-related lymphoedema: a systematic review. J Physiother 2014; 60:136-43. [PMID: 25086730 DOI: 10.1016/j.jphys.2014.07.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 04/27/2014] [Accepted: 07/01/2014] [Indexed: 10/25/2022] Open
Abstract
QUESTION Is weight-training exercise intervention harmful to women with or at risk of breast cancer-related lymphoedema? DESIGN Systematic review with meta-analysis of randomised trials. PARTICIPANTS Women with or at risk of breast cancer-related lymphoedema. INTERVENTION Progressive weight-training exercise. OUTCOME MEASURES The primary outcomes were severity (volume difference) and incidence of arm lymphoedema. Secondary outcomes included muscle strength of the upper and lower limbs, quality of life and body mass index. RESULTS Eleven studies from eight trials involving 1091 women were included. Weight-training exercise of low to moderate intensity with relatively slow progression significantly improved the upper limb strength (SMD 0.93, 95% CI 0.73 to 1.12) and lower limb strength (SMD 0.75, 95% CI 0.47 to 1.04) without increasing the arm volume (SMD -0.09, 95% CI -0.23 to 0.05) or incidence of breast cancer-related lymphoedema (RR 0.77, 95% CI 0.52 to 1.15). No significant effects were noted for body mass index (SMD -0.10, 95% -0.31 to 0.11). Some aspects of quality of life may improve with weight training. PARTICIPANTS in all trials used pressure garments and received supervision; no trials used high-intensity weight training. CONCLUSIONS Weight training appears to be safe and beneficial in improving limb strength and physical components of quality of life in women with or at risk of lymphoedema. Pressure garments, supervision and limiting the intensity of the weight training may each be important, but this could not be confirmed with this review. REGISTRATION PROSPERO CRD42012002737.
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Affiliation(s)
| | - Dave Roberts
- Faculty of Health and Life Sciences, Oxford Brookes University, United Kingdom
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11
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Leonidou A, Woods DA. A preliminary study of manipulation under anaesthesia for secondary frozen shoulder following breast cancer treatment. Ann R Coll Surg Engl 2014; 96:111-5. [PMID: 24780667 DOI: 10.1308/003588414x13824511649652] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of this paper is to present the results of manipulation under anaesthesia (MUA) and injection of local anaesthetic and corticosteroid followed by a physiotherapy regime for secondary frozen shoulder after breast cancer treatment (surgery, radiotherapy), and to compare them with a control group. METHODS Patients referred to the senior author for secondary frozen shoulder following breast cancer treatment over a ten-year period were investigated. Recorded data included age, treatment for breast cancer, length of symptoms, Oxford shoulder score (OSS) and range of motion before and after shoulder MUA. These data were compared with a control group of patients with frozen shoulder. RESULTS A total of 263 patients were referred with 281 frozen shoulders. Of these, 7 patients (7 shoulders) had undergone previous breast cancer treatment and the remaining 256 patients (274 shoulders) formed the control group. None of the patients were diabetic. The mean preoperative OSS was 31 for the study group and 27 for the control group, improving to 43 for both groups following MUA. Forty-two per cent of the study group and fifteen per cent of the control group had a second MUA subsequently. At the long-term follow-up appointment, 71% of the study group patients were satisfied with their result. CONCLUSIONS The results of this preliminary study suggest that MUA, corticosteroid injection and subsequent physiotherapy have achieved good final results in a series of patients with frozen shoulder secondary to breast cancer treatment. Members of the multidisciplinary team looking after breast cancer patients should be aware of this management option and, on manifestation of this pathology, should refer the patient to an orthopaedic surgeon.
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Affiliation(s)
- A Leonidou
- Great Western Hospitals NHS Foundation Trust, UK
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12
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Armer JM, Hulett JM, Bernas M, Ostby P, Stewart BR, Cormier JN. Best Practice Guidelines in Assessment, Risk Reduction, Management, and Surveillance for Post-Breast Cancer Lymphedema. CURRENT BREAST CANCER REPORTS 2013; 5:134-144. [PMID: 26246870 DOI: 10.1007/s12609-013-0105-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Breast cancer-related lymphedema (LE) is a progressive, chronic disease that affects millions of cancer survivors and primarily results from surgical lymphatic vessel/node removal and radiation therapy. Patient education and support for importance of early detection is essential in helping health care providers detect lymphedema early, when there is the best chance to prevent progression. Improved imaging and surgical techniques have decreased the incidence of LE; however, effective risk-reduction and treatment have historically lacked the level of evidence necessary to standardize effective treatment. The purpose of this article is to report an extensive review of literature, including highlighted multidisciplinary studies within the past three years, in order to update best practice guidelines in assessment, risk reduction, management, and surveillance for post-breast cancer lymphedema.
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Affiliation(s)
- Jane M Armer
- Sinclair School of Nursing Director, Nursing Research, Ellis Fischel Cancer Center Director, American Lymphedema Framework Project DC 116.05 Suite 415 EFCC University of Missouri-Columbia Columbia, MO 62011
| | | | | | - Pam Ostby
- Sinclair School of Nursing University of Missouri-Columbia
| | - Bob R Stewart
- College of Education and Sinclair School of Nursing University of Missouri-Columbia
| | - Janice N Cormier
- Departments of Surgical Oncology and Biostatistics The University of Texas MD Anderson Cancer Center Houston, TX
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Kilbreath SL, Lee MJ, Refshauge KM, Beith JM, Ward LC, Simpson JM, Black D. Transient swelling versus lymphoedema in the first year following surgery for breast cancer. Support Care Cancer 2013; 21:2207-15. [DOI: 10.1007/s00520-013-1770-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 02/19/2013] [Indexed: 12/20/2022]
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Chang CJ, Cormier JN. Lymphedema Interventions: Exercise, Surgery, and Compression Devices. Semin Oncol Nurs 2013; 29:28-40. [DOI: 10.1016/j.soncn.2012.11.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mishra SI, Scherer RW, Geigle PM, Berlanstein DR, Topaloglu O, Gotay CC, Snyder C. Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database Syst Rev 2012; 2012:CD007566. [PMID: 22895961 PMCID: PMC7387117 DOI: 10.1002/14651858.cd007566.pub2] [Citation(s) in RCA: 360] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cancer survivors experience numerous disease and treatment-related adverse outcomes and poorer health-related quality of life (HRQoL). Exercise interventions are hypothesized to alleviate these adverse outcomes. HRQoL and its domains are important measures for cancer survivorship. OBJECTIVES To evaluate the effectiveness of exercise on overall HRQoL and HRQoL domains among adult post-treatment cancer survivors. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, PEDRO, LILACS, SIGLE, SportDiscus, OTSeeker, and Sociological Abstracts from inception to October 2011 with no language or date restrictions. We also searched citations through Web of Science and Scopus, PubMed's related article feature, and several websites. We reviewed reference lists of included trials and other reviews in the field. SELECTION CRITERIA We included all randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing exercise interventions with usual care or other nonexercise intervention to assess overall HRQoL or at least one HRQoL domain in adults. Included trials tested exercise interventions that were initiated after completion of active cancer treatment. We excluded trials including people who were terminally ill, or receiving hospice care, or both, and where the majority of trial participants were undergoing active treatment for either the primary or recurrent cancer. DATA COLLECTION AND ANALYSIS Five paired review authors independently extracted information on characteristics of included trials, data on effects of the intervention, and assessed risk of bias based on predefined criteria. Where possible, meta-analyses results were performed for HRQoL and HRQoL domains for the reported difference between baseline values and follow-up values using standardized mean differences (SMD) and a random-effects model by length of follow-up. We also reported the SMDs between mean follow-up values of exercise and control group. Because investigators used many different HRQoL and HRQoL domain instruments and often more than one for the same domain, we selected the more commonly used instrument to include in the SMD meta-analyses. We also report the mean difference for each type of instrument separately. MAIN RESULTS We included 40 trials with 3694 participants randomized to an exercise (n = 1927) or comparison (n = 1764) group. Cancer diagnoses in study participants included breast, colorectal, head and neck, lymphoma, and other. Thirty trials were conducted among participants who had completed active treatment for their primary or recurrent cancer and 10 trials included participants both during and post cancer treatment. Mode of the exercise intervention included strength training, resistance training, walking, cycling, yoga, Qigong, or Tai Chi. HRQoL and its domains were measured using a wide range of measures.The results suggested that exercise compared with control has a positive impact on HRQoL and certain HRQoL domains. Exercise resulted in improvement in: global HRQoL at 12 weeks' (SMD 0.48; 95% confidence interval (CI) 0.16 to 0.81) and 6 months' (0.46; 95% CI 0.09 to 0.84) follow-up, breast cancer concerns between 12 weeks' and 6 months' follow-up (SMD 0.99; 95% CI 0.41 to 1.57), body image/self-esteem when assessed using the Rosenberg Self-Esteem scale at 12 weeks (MD 4.50; 95% CI 3.40 to 5.60) and between 12 weeks' and 6 months' (mean difference (MD) 2.70; 95% CI 0.73 to 4.67) follow-up, emotional well-being at 12 weeks' follow-up (SMD 0.33; 95% CI 0.05 to 0.61), sexuality at 6 months' follow-up (SMD 0.40; 95% CI 0.11 to 0.68), sleep disturbance when comparing follow-up values by comparison group at 12 weeks' follow-up (SMD -0.46; 95% CI -0.72 to -0.20), and social functioning at 12 weeks' (SMD 0.45; 95% CI 0.02 to 0.87) and 6 months' (SMD 0.49; 95% CI 0.11 to 0.87) follow-up. Further, exercise interventions resulted in decreased anxiety at 12 weeks' follow-up (SMD -0.26; 95% CI -0.07 to -0.44), fatigue at 12 weeks' (SMD -0.82; 95% CI -1.50 to -0.14) and between 12 weeks' and 6 months' (SMD -0.42; 95% CI -0.02 to -0.83) follow-up, and pain at 12 weeks' follow-up (SMD -0.29; 95% CI -0.55 to -0.04) when comparing follow-up values by comparison group.Positive trends and impact of exercise intervention existed for depression and body image (when analyzing combined instruments); however, because few studies measured these outcomes the robustness of findings is uncertain.No conclusions can be drawn regarding the effects of exercise interventions on HRQoL domains of cognitive function, physical functioning, general health perspective, role function, and spirituality.Results of the review need to be interpreted cautiously owing to the risk of bias. All the trials reviewed were at high risk for performance bias. In addition, the majority of trials were at high risk for detection, attrition, and selection bias. AUTHORS' CONCLUSIONS This systematic review indicates that exercise may have beneficial effects on HRQoL and certain HRQoL domains including cancer-specific concerns (e.g. breast cancer), body image/self-esteem, emotional well-being, sexuality, sleep disturbance, social functioning, anxiety, fatigue, and pain at varying follow-up periods. The positive results must be interpreted cautiously due to the heterogeneity of exercise programs tested and measures used to assess HRQoL and HRQoL domains, and the risk of bias in many trials. Further research is required to investigate how to sustain positive effects of exercise over time and to determine essential attributes of exercise (mode, intensity, frequency, duration, timing) by cancer type and cancer treatment for optimal effects on HRQoL and its domains.
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Mishra SI, Scherer RW, Snyder C, Geigle PM, Berlanstein DR, Topaloglu O. Exercise interventions on health-related quality of life for people with cancer during active treatment. Cochrane Database Syst Rev 2012; 2012:CD008465. [PMID: 22895974 PMCID: PMC7389071 DOI: 10.1002/14651858.cd008465.pub2] [Citation(s) in RCA: 284] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND People with cancer undergoing active treatment experience numerous disease- and treatment-related adverse outcomes and poorer health-related quality of life (HRQoL). Exercise interventions are hypothesized to alleviate these adverse outcomes. HRQoL and its domains are important measures of cancer survivorship, both during and after the end of active treatment for cancer. OBJECTIVES To evaluate the effectiveness of exercise on overall HRQoL outcomes and specific HRQoL domains among adults with cancer during active treatment. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed MEDLINE, EMBASE, CINAHL, PsycINFO, PEDRO, LILACS, SIGLE, SportDiscus, OTSeeker, Sociological Abstracts from inception to November 2011 with no language or date restrictions. We also searched citations through Web of Science and Scopus, PubMed's related article feature, and several websites. We reviewed reference lists of included trials and other reviews in the field. SELECTION CRITERIA We included all randomized controlled trials (RCTs) and quasi-randomized controlled clinical trials (CCTs) comparing exercise interventions with usual care or other type of non-exercise comparison intervention to maintain or enhance, or both, overall HRQoL or at least one distinct domain of HRQoL. Included trials tested exercise interventions that were initiated when adults with cancer were undergoing active cancer treatment or were scheduled to initiate treatment. DATA COLLECTION AND ANALYSIS Five paired review authors independently extracted information on characteristics of included trials, data on effects of the intervention, and assessed risk of bias based on predefined criteria. Where possible, we performed meta-analyses for HRQoL and HRQoL domains for the reported difference between baseline values and follow-up values using standardized mean differences (SMDs) and a random-effects model by length of follow-up. We also reported the SMD at follow-up between the exercise and control groups. Because investigators used many different HRQoL and HRQoL domain instruments and often more than one for the same domain, we selected the more commonly used instrument to include in the SMD meta-analyses. We also report the mean difference for each type of instrument separately. MAIN RESULTS We included 56 trials with 4826 participants randomized to an exercise (n = 2286) or comparison (n = 1985) group. Cancer diagnoses in trial participants included breast, prostate, gynecologic, hematologic, and other. Thirty-six trials were conducted among participants who were currently undergoing active treatment for their cancer, 10 trials were conducted among participants both during and post active cancer treatment, and the remaining 10 trials were conducted among participants scheduled for active cancer treatment. Mode of exercise intervention differed across trials and included walking by itself or in combination with cycling, resistance training, or strength training; resistance training; strength training; cycling; yoga; or Qigong. HRQoL and its domains were assessed using a wide range of measures.The results suggest that exercise interventions compared with control interventions have a positive impact on overall HRQoL and certain HRQoL domains. Exercise interventions resulted in improvements in: HRQoL from baseline to 12 weeks' follow-up (SMD 0.33; 95% CI 0.12 to 0.55) or when comparing difference in follow-up scores at 12 weeks (SMD 0.47; 95% CI 0.16 to 0.79); physical functioning from baseline to 12 weeks' follow-up (SMD 0.69; 95% CI 0.16 to 1.22) or 6 months (SMD 0.28; 95% CI 0.00 to 0.55); or when comparing differences in follow-up scores at 12 weeks (SMD 0.28; 95% CI 0.11 to 0.45) or 6 months (SMD 0.29; 95% CI 0.07 to 0.50); role function from baseline to 12 weeks' follow-up (SMD 0.48; 95% CI 0.07 to 0.90) or when comparing differences in follow-up scores at 12 weeks (SMD 0.17; 95% CI 0.00 to 0.34) or 6 months (SMD 0.32; 95% CI 0.03 to 0.61); and, in social functioning at 12 weeks' follow-up (SMD 0.54; 95% CI 0.03 to 1.05) or when comparing differences in follow-up scores at both 12 weeks (SMD 0.16; 95% CI 0.04 to 0.27) and 6 months (SMD 0.24; 95% CI 0.03 to 0.44). Further, exercise interventions resulted in a decrease in fatigue from baseline to 12 weeks' follow-up (SMD -0.38; 95% CI -0.57 to -0.18) or when comparing difference in follow-up scores at follow-up of 12 weeks (SMD -0.73; 95% CI -1.14 to -0.31). Since there is consistency of findings on both types of measures (change scores and difference in follow-up scores) there is greater confidence in the robustness of these findings.When examining exercise effects by subgroups, exercise interventions had significantly greater reduction in anxiety for survivors with breast cancer than those with other types of cancer. Further, there was greater reduction in depression, fatigue, and sleep disturbances, and improvement in HRQoL, emotional wellbeing (EWB), physical functioning, and role function for cancer survivors diagnosed with cancers other than breast cancer but not for breast cancer. There were also greater improvements in HRQoL and physical functioning, and reduction in anxiety, fatigue, and sleep disturbances when prescribed a moderate or vigorous versus a mild exercise program.Results of the review need to be interpreted cautiously owing to the risk of bias. All the trials reviewed were at high risk for performance bias. In addition, the majority of trials were at high risk for detection, attrition, and selection bias. AUTHORS' CONCLUSIONS This systematic review indicates that exercise may have beneficial effects at varying follow-up periods on HRQoL and certain HRQoL domains including physical functioning, role function, social functioning, and fatigue. Positive effects of exercise interventions are more pronounced with moderate- or vigorous-intensity versus mild-intensity exercise programs. The positive results must be interpreted cautiously because of the heterogeneity of exercise programs tested and measures used to assess HRQoL and HRQoL domains, and the risk of bias in many trials. Further research is required to investigate how to sustain positive effects of exercise over time and to determine essential attributes of exercise (mode, intensity, frequency, duration, timing) by cancer type and cancer treatment for optimal effects on HRQoL and its domains.
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Moattari M, Jaafari B, Talei A, Piroozi S, Tahmasebi S, Zakeri Z. The effect of combined decongestive therapy and pneumatic compression pump on lymphedema indicators in patients with breast cancer related lymphedema. IRANIAN RED CRESCENT MEDICAL JOURNAL 2012; 14:210-7. [PMID: 22754683 PMCID: PMC3385799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Accepted: 01/29/2012] [Indexed: 11/03/2022]
Abstract
BACKGROUND Lymphedema treatment is difficult and there is no consensus on the best treatment. This study evaluated the effect of combined decongestive therapy (CDT) and pneumatic compression pump on lymphedema indicators in patients with breast cancer related lymphedema (BCRL). METHODS Twenty one women with BCRL were enrolled. The volume difference of upper limbs, the circumference at 9 areas and shoulder joint range of motion were measured in all patients. CDT was done by an educated nurse in two phases. In first phase, CDT was accompanied by use of a compression pump for 4 weeks, 3 days per week. In second phase, CDT was performed daily without compression pump for 4 weeks by patients at home. At the end of each phase, the same primary measurements were done for patients. RESULTS The mean volume difference of the upper limbs and mean difference in circumference in all areas at different phases decreased significantly. Mean flexion, extension, abduction and external rotation (in degrees) at different phases increased significantly. CONCLUSION CDT significantly reduced mean volume and mean circumference of the affected limb, and significantly increased shoulder joint range of motion. The findings support the optimal effects of CDT in the treatment of secondary lymphedema of upper extremity. CLINICAL TRIAL REGISTRATION NUMBER 138902212621N8.
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Affiliation(s)
- M Moattari
- Department of Nursing, College of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Marzieh Moattari, PhD, Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, PO Box: 71935-1314, Shiraz, Iran. Tel.: +98-711-6467460, +98-711-6474250, Fax: +98-711-8215324, +98-711-6474251, E-mail:
| | - B Jaafari
- Department of Nursing, College of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - A Talei
- Department of General Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - S Piroozi
- Department of Physiotherapy, College of Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran
| | - S Tahmasebi
- Department of General Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Z Zakeri
- Cancer Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Kilbreath SL, Refshauge KM, Beith JM, Ward LC, Lee M, Simpson JM, Hansen R. Upper limb progressive resistance training and stretching exercises following surgery for early breast cancer: a randomized controlled trial. Breast Cancer Res Treat 2012; 133:667-76. [DOI: 10.1007/s10549-012-1964-1] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Accepted: 01/16/2012] [Indexed: 11/24/2022]
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Kwan ML, Cohn JC, Armer JM, Stewart BR, Cormier JN. Exercise in patients with lymphedema: a systematic review of the contemporary literature. J Cancer Surviv 2011; 5:320-36. [PMID: 22002586 DOI: 10.1007/s11764-011-0203-9] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 09/28/2011] [Indexed: 12/27/2022]
Abstract
BACKGROUND Controversy exists regarding the role of exercise in cancer patients with or at risk for lymphedema, particularly breast. We conducted a systematic review of the contemporary literature to distill the weight of the evidence and provide recommendations for exercise and lymphedema care in breast cancer survivors. METHODS Publications were retrieved from 11 major medical indices for articles published from 2004 to 2010 using search terms for exercise and lymphedema; 1,303 potential articles were selected, of which 659 articles were reviewed by clinical lymphedema experts for inclusion, yielding 35 articles. After applying exclusion criteria, 19 articles were selected for final review. Information on study design/objectives, participants, outcomes, intervention, results, and study strengths and weaknesses was extracted. Study evidence was also rated according to the Oncology Nursing Society Putting Evidence Into Practice® Weight-of-Evidence Classification. RESULTS Seven studies were identified addressing resistance exercise, seven studies on aerobic and resistance exercise, and five studies on other exercise modalities. Studies concluded that slowly progressive exercise of varying modalities is not associated with the development or exacerbation of breast cancer-related lymphedema and can be safely pursued with proper supervision. Combined aerobic and resistance exercise appear safe, but confirmation requires larger and more rigorous studies. CONCLUSIONS Strong evidence is now available on the safety of resistance exercise without an increase in risk of lymphedema for breast cancer patients. Comparable studies are needed for other cancer patients at risk for lymphedema. IMPLICATIONS FOR CANCER SURVIVORS With reasonable precautions, it is safe for breast cancer survivors to exercise throughout the trajectory of their cancer experience, including during treatment.
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Affiliation(s)
- Marilyn L Kwan
- Division of Research, Kaiser Permanente, Oakland, CA 94612, USA.
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Cancer Rehabilitation with a Focus on Evidence-Based Outpatient Physical and Occupational Therapy Interventions. Am J Phys Med Rehabil 2011; 90:S5-15. [PMID: 21765263 DOI: 10.1097/phm.0b013e31820be4ae] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Katalinic OM, Harvey LA, Herbert RD, Moseley AM, Lannin NA, Schurr K. Stretch for the treatment and prevention of contractures. Cochrane Database Syst Rev 2010:CD007455. [PMID: 20824861 DOI: 10.1002/14651858.cd007455.pub2] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Contractures are a common complication of neurological and musculoskeletal conditions, and are characterised by a reduction in joint mobility. Stretch is widely used for the treatment and prevention of contractures. However, it is not clear whether stretch is effective. OBJECTIVES To determine the effects of stretch on contractures in people with, or at risk of, contractures. SEARCH STRATEGY Electronic searches were conducted on CENTRAL, DARE, HTA (The Cochrane Library); MEDLINE; CINAHL; EMBASE; SCI-EXPANDED; and PEDro (April 2009). SELECTION CRITERIA Randomised controlled trials and controlled clinical trials of stretch applied for the purpose of treating or preventing contractures were included. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, extracted data, and assessed risk of bias. The primary outcomes of interest were joint mobility and quality of life. The secondary outcomes were pain, spasticity, activity limitation and participation restriction. Outcomes were evaluated immediately after intervention, in the short term (one to seven days) and in the long term (> one week). Effects were expressed as mean differences or standardised mean differences with 95% confidence intervals (CI). Meta-analyses were conducted with a random-effects model. MAIN RESULTS Thirty-five studies with 1391 participants met the inclusion criteria. No study performed stretch for more than seven months. In people with neurological conditions, there was moderate to high quality evidence to indicate that stretch does not have clinically important immediate (mean difference 3 degrees ; 95% CI 0 to 7), short-term (mean difference 1 degrees ; 95% CI 0 to 3) or long-term (mean difference 0 degrees ; 95% CI -2 to 2) effects on joint mobility. The results were similar for people with non-neurological conditions. For all conditions, there is little or no effect of stretch on pain, spasticity, activity limitation, participation restriction or quality of life. AUTHORS' CONCLUSIONS Stretch does not have clinically important effects on joint mobility in people with, or at risk of, contractures if performed for less than seven months. The effects of stretch performed for periods longer than seven months have not been investigated.
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Affiliation(s)
- Owen M Katalinic
- Rehabilitation Studies Unit, Northern Clinical School, Sydney Medical School, The University of Sydney, PO Box 6, Ryde, NSW, Australia, 1680
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Chan DNS, Lui LYY, So WKW. Effectiveness of exercise programmes on shoulder mobility and lymphoedema after axillary lymph node dissection for breast cancer: systematic review. J Adv Nurs 2010; 66:1902-14. [PMID: 20626480 DOI: 10.1111/j.1365-2648.2010.05374.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM This article is a report of a review of the effectiveness of exercise programmes on shoulder mobility and lymphoedema in postoperative patients with breast cancer having axillary lymph node dissection, as revealed by randomized controlled trials. BACKGROUND Breast cancer is the most common malignancy in women. After surgery, the most common postoperative complications are reduced range of motion in the shoulder, muscle weakness in the upper extremities, lymphoedema, pain and numbness. To reduce these impairments, shoulder exercises are usually prescribed. However, conflicting results regarding the effect and timing of such exercises have been reported. Data sources. Studies were retrieved from a systematic search of published works over the period 2000-2009 indexed in the Cumulative Index to Nursing and Allied Health Literature, Ovid Medline, the British Nursing Index, Proquest, Science Direct, Pubmed, Scopus and the Cochrane Library, using the combined search terms 'breast cancer', 'breast cancer surgery', 'exercise', 'lymphoedema', 'shoulder mobility' and 'randomized controlled trials'. METHODS A quantitative review of effectiveness was carried out. Studies were critically appraised by three independent reviewers, and categorized according to levels of evidence defined by the Joanna Briggs Institute. RESULTS Six studies were included in the review. Early rather than delayed onset of training did not affect the incidence of postoperative lymphoedema, but early introduction of exercises was valuable in avoiding deterioration in range of shoulder motion. CONCLUSION Further studies are required to investigate the optimal time for starting arm exercises after this surgery. Nurses have an important role in educating and encouraging patients to practise these exercises to speed up recovery.
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Affiliation(s)
- Dorothy N S Chan
- Department of Surgery, Ruttonjee and Tang Shiu Kin Hospital, Hong Kong SAR, China
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