A Pilot Randomized Controlled Trial on the Effects of a Progressive Exercise Program on the Range of Motion and Upper Extremity Grip Strength in Young Adults With Breast Cancer

• Published in: Clinical breast cancer 2018-02, Vol.18 (1), p.e55-e64
• Main Authors: Ibrahim, Marize, Muanza, Thierry, Smirnow, Nadia, Sateren, Warren, Fournier, Beatrice, Kavan, Petr, Palumbo, Michael, Dalfen, Richard, Dalzell, Mary-Ann
• Format: Article
• Language: English
• Subjects: Adult; Axilla; Breast - surgery; Breast Neoplasms - therapy; Exercise Therapy - methods; Female; Hand Strength - physiology; Humans; Mastectomy - adverse effects; Pain; Physiotherapy; Pilot Projects; Prospective Studies; Radiotherapy; Radiotherapy, Adjuvant - adverse effects; Radiotherapy, Adjuvant - methods; Range of Motion, Articular; ROM; Shoulder Joint - physiology; Shoulder Pain - etiology; Shoulder Pain - rehabilitation; Treatment Outcome; Weakness; Young Adult
• ISSN: 1526-8209; 1938-0666
• DOI: 10.1016/j.clbc.2017.06.007

Young women with breast cancer commonly experience residual long-term arm morbidity after treatment. In the present clinical trial (n = 59), a 12-week exercise program improved short-term arm mobility and pain; however, these improvements were not sustained 18 months after radiation. The clinical characteristics that affected arm mobility included surgery type, radiation field, and dose fractionation. The diagnosis of breast cancer in young women (aged 18-45 years) has been increasing. Women are commonly left coping with treatment-related disabilities of the upper limb that can persist for > 2 years postoperatively. A total of 59 young breast cancer patients (29 in the intervention group and 30 in the control group) participated in a pilot prospective randomized controlled trial to determine whether a 12-week postradiation exercise program would improve long-term arm mobility, pain, and handgrip strength. During an 18-month period, range of motion, handgrip strength, and pain with shoulder movements were evaluated at 6 points. Although the differences were not statistically significant, external rotation and horizontal abduction of the shoulder improved in the intervention group immediately after the exercise intervention (3 months) and showed a trend toward less pain on movement. However, at 18 months after radiation the control and intervention groups both retained a residual loss of range and persistent pain with movement. Radiation to the axilla and/or chest wall yielded long-term (18 months) limitations in flexion and horizontal abduction compared with hypofractionation, which resulted in greater flexion and external rotation at 18 months. The median grip strength of the study participants corresponded to the 10th percentile of healthy aged-matched white women. The exercise intervention timed shortly after radiation improved short-term shoulder mobility and pain; however, these gains were not sustained at 18 months after radiation.