Intervention Review

Exercise interventions for upper-limb dysfunction due to breast cancer treatment

  1. Margaret L McNeely1,*,
  2. Kristin Campbell2,
  3. Maria Ospina3,
  4. Brian H Rowe4,
  5. Kelly Dabbs5,
  6. Terry P Klassen6,
  7. John Mackey7,
  8. Kerry Courneya8

Editorial Group: Cochrane Breast Cancer Group

Published Online: 16 JUN 2010

Assessed as up-to-date: 1 AUG 2008

DOI: 10.1002/14651858.CD005211.pub2

Database Title

Additional Information

How to Cite

McNeely ML, Campbell K, Ospina M, Rowe BH, Dabbs K, Klassen TP, Mackey J, Courneya K. Exercise interventions for upper-limb dysfunction due to breast cancer treatment. Cochrane Database of Systematic Reviews 2010, Issue 6. Art. No.: CD005211. DOI: 10.1002/14651858.CD005211.pub2.

Author Information

  1. 1

    University of Alberta, Department of Physical Therapy, Edmonton, Alberta, Canada

  2. 2

    University of British Columbia, Department of Physical Therapy, Vancouver, British Columbia, Canada

  3. 3

    Insitute of Health Economics, Medical Sciences, Edmonton, Alberta, Canada

  4. 4

    University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada

  5. 5

    University of Alberta, Department of Surgery, Edmonton, Alberta, Canada

  6. 6

    University of Alberta, Department of Pediatrics, Edmonton, Alberta, Canada

  7. 7

    University of Alberta and Cross Cancer Institute, Department of Medical Oncology, Edmonton, Alberta, Canada

  8. 8

    University of Alberta, Behavioural Medicine, Faculty of Physical Education and Recreation, Edmonton, Alberta, Canada

*Margaret L McNeely, Department of Physical Therapy, University of Alberta, 2-50, Corbett Hall, Edmonton, Alberta, T6G 2G4, Canada. mmcneely@rehabmed.ualberta.ca. mmcneely@ualberta.ca.

Publication History

  1. Publication Status: New
  2. Published Online: 16 JUN 2010

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Background

Upper-limb dysfunction is a commonly reported side effect of treatment for breast cancer and may include decreased shoulder range of motion (the range through which a joint can be moved) (ROM) and strength, pain and lymphedema.

Objectives

To review randomized controlled trials (RCTs) evaluating the effectiveness of exercise interventions in preventing, minimi sing, or improving upper-limb dysfunction due to breast cancer treatment.

Search strategy

We searched the Specialised Register of the Cochrane Breast Cancer Group, MEDLINE, EMBASE, CINAHL, and LILACS (to August 2008); contacted experts, handsearched reference lists, conference proceedings, clinical practice guidelines and other unpublished literature sources.

Selection criteria

RCTs evaluating the effectiveness and safety of exercise for upper-limb dysfunction.

Data collection and analysis

Two authors independently performed the data abstraction. Investigators were contacted for missing data.

Main results

We included 24 studies involving 2132 participants. Ten of the 24 were considered of adequate methodological quality.

Ten studies examined the effect of early versus delayed implementation of post-operative exercise. Implementing early exercise was more effective than delayed exercise in the short term recovery of shoulder flexion ROM (Weighted Mean Difference (WMD): 10.6 degrees; 95% Confidence Interval (CI):  4.51 to 16.6); however, early exercise also resulted in a statistically significant increase in wound drainage volume (Standardized Mean Difference (SMD) 0.31; 95% CI: 0.13 to 0.49) and duration (WMD: 1.15 days; 95% CI: 0.65 to 1.65).

Fourteen studies examined the effect of structured exercise compared to usual care/comparison. Of these, six were post-operative, three during adjuvant treatment and five following cancer treatment. Structured exercise programs in the post-operative period significantly improved shoulder flexion ROM in the short-term (WMD: 12.92 degrees; 95% CI:  0.69 to 25.16). Physical therapy treatment yielded additional benefit for shoulder function post-intervention (SMD: 0.77; 95% CI: 0.33 to 1.21) and at six-month follow-up (SMD: 0.75; 95% CI: 0.32 to 1.19). There was no evidence of increased risk of lymphedema from exercise at any time point.

Authors' conclusions

Exercise can result in a significant and clinically meaningful improvement in shoulder ROM in women with breast cancer. In the post-operative period, consideration should be given to early implementation of exercises, although this approach may need to be carefully weighed against the potential for increases in wound drainage volume and duration. High quality research studies that closely monitor exercise prescription factors (e.g. intensity), and address persistent upper-limb dysfunction are needed.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Exercise interventions for upper-limb dysfunction due to breast cancer

This summary of a Cochrane review presents what we know about the effect of exercise on arm and shoulder movement problems due to breast cancer.

Upper-limb dysfunction following breast cancer surgery:

The use of upper-limb ROM, stretching and strengthening exercises after breast cancer surgery have been shown to improve recovery of shoulder movement. However, there are different views on what type of exercise is best and how soon exercises should be started following surgery. Moreover, it is not known if exercise is helpful in addressing upper-limb problems that persist following surgery and there is some concern that upper-limb exercise may increase the risk of developing lymphedema in the arm. In this review, a total of 24 studies examined the benefit of exercise on upper-limb dysfunction. Ten studies examined whether it was better to start exercise early after surgery or to delay exercise by about one week. Six studies examined structured exercise programs compared to usual care (exercise pamphlet or no exercise) following surgery. Three studies examined exercise interventions carried out during cancer treatment and five studies examined exercise interventions carried out following cancer treatment.

Best estimate of the effect of upper-limb exercise for women with breast cancer:

1) This review found that upper-limb exercise (e.g. shoulder ROM and stretching) is helpful in recovering upper-limb movement following surgery for breast cancer. Starting exercise early after surgery (day 1 to day 3) may result in better shoulder movement in the short term; however, it may also result in more wound drainage and require the drains to be in place longer than if exercise is delayed by about one week.

2) This review showed that more structured exercise programs, such as physical therapy, delivered in the early weeks following surgery are beneficial to regain movement in, and use of the shoulder and arm for daily activities such as reaching overhead.

3) This review did not find any evidence that upper-limb exercise, whether carried out following surgery, or during/ following other cancer treatments, resulted in more patients developing arm lymphedema.

 

Resumen

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Antecedentes

Intervenciones con ejercicios para los trastornos funcionales del miembro superior después de la cirugía de cáncer de mama

Los trastornos funcionales del miembro superior constituyen un efecto secundario comúnmente informado del tratamiento del cáncer de mama, y pueden incluir reducción de la amplitud de movimiento del hombro (rango de movimiento de una articulación) (AM) y de la fuerza, dolor y linfedema.

Objetivos

Examinar ensayos controlados aleatorios (ECA) que evalúen la efectividad de las intervenciones con ejercicios para prevenir, reducir o mejorar los trastornos funcionales del miembro superior después de la cirugía de cáncer de mama.

Estrategia de búsqueda

Se hicieron búsquedas en el Registro Especializado del Grupo Cochane de Cáncer de Mama (Cochrane Breast Cancer Group), MEDLINE, EMBASE, CINAHL y en LILACS (hasta agosto 2008); se contactó con expertos, se hicieron búsquedas manuales en las listas de referencias, actas de congresos, guías de práctica clínica y en otras fuentes de literatura no publicada.

Criterios de selección

ECA que evalúen la efectividad y la seguridad de los ejercicios para los trastornos funcionales del miembro superior.

Obtención y análisis de los datos

Dos revisores, de forma independiente, realizaron la extracción de datos. Se estableció contacto con los investigadores para obtener datos que faltaban.

Resultados principales

Se incluyeron 24 estudios con 2132 participantes. Diez de los 24 fueron considerados de adecuada calidad metodológica.

Diez estudios evaluaron el efecto de la implementación temprana versus tardía de los ejercicios después de la cirugía. La implementación temprana del ejercicio fue más efectiva que la tardía en la recuperación de la amplitud de movimiento del hombro a corto plazo (diferencia de medias ponderada [DMP]: 10,6 grados; intervalo de confianza [IC] del 95%: 4,51 a 16,6); sin embargo, el ejercicio temprano también dio lugar a un aumento estadísticamente significativo del volumen del drenaje de la herida (diferencia de medias estandarizada [DME] 0,31; IC del 95%: 0,13 a 0,49) y de la duración (DMP: 1,15 días; IC del 95%: 0,65 a 1,65).

Catorce estudios evaluaron el efecto del ejercicio estructurado en comparación con la atención habitual/comparación. Seis de estos estudios se realizaron después de la cirugía, tres durante el tratamiento adyuvante y cinco después del tratamiento del cáncer. Los programas de ejercicios estructurados en el período posoperatorio mejoraron significativamente la AM de flexión del hombro a corto plazo (DMP: 12,92 grados; IC del 95%: 0,69 a 25,16). El tratamiento de fisioterapia produjo beneficios adicionales para las funciones del hombro después de la cirugía (DME: 0.77; IC del 95%: 0,33 a 1,21) y a los seis meses de seguimiento (DME: 0.75; IC del 95%: 0,32 a 1,19). No hubo pruebas de un mayor riesgo de linfedema a partir del ejercicio en ningún punto temporal.

Conclusiones de los autores

El ejercicio puede dar lugar a una mejoría importante clínicamente significativa en la AM del hombro en las mujeres con cáncer de mama. Se debe considerar la implementación temprana de ejercicios en el período posoperatorio, aunque este abordaje necesita sopesarse cuidadosamente con la posibilidad de aumentos del volumen del drenaje de la herida y de la duración. Se necesitan estudios de investigación de alta calidad que evalúen detenidamente los factores de prescripción del ejercicio (p.ej. intensidad), y que aborden los trastornos funcionales persistentes del miembro superior.

Traducción

Traducción realizada por el Centro Cochrane Iberoamericano

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