Researchers randomized 392 women undergoing breast cancer surgery who were at risk for upper limb morbidity 1:1 to receive usual care alone or in combination with a structured exercise program. The exercise group involved a physiotherapy program with stretching, strengthening, physical activity, and behavior changes to promote adherence to exercise; it was introduced 7 to 10 days postoperatively, with follow-up appointments at one and three months.
The primary endpoint was between-group difference in Disabilities of the Arm, Hand and Shoulder (DASH) questionnaire scores (0-100, from least to most severe disability) at 12 months based on an intent-to-treat analysis.
Mean DASH scores were significantly lower at 12 months in the exercise group (16.3) than in the usual care group (23.7), with an adjusted between-group difference of 7.81, researchers report in The BMJ.
"The take-home message is that if you introduce a structured rehab program after breast/axillary surgery, with support from trained therapists and follow the program, you are likely to have better arm function and lower disability over a year," said lead study author Dr. Julie Bruce of the University of Warwick in the UK.
For the exercise program, therapists met with patients for an hour-long assessment to review exercise options and select activities from a menu that included work targeting the shoulder and upper arm such as flexion, abduction, and abduction with external rotation movements. Patients also used resistance bands, and practiced adherence techniques such as journaling and goal setting.
Exercise was also associated with significantly lower pain scores at 12 months (1.9 out of 10) than usual care (2.6).
In addition, a smaller proportion of people in the exercise group reported moderate to severe pain at 12 months (16%) than with usual care (31%).
There was no significant difference between groups in neuropathic pain or lymphedema at 12 months, however.
One limitation of the study is the lack of objective measurement of lymphedema based on water displacement, arm circumference, or instrumental measurements, the study team notes.
Another limitation common in exercise therapy trials is that patients and clinicians were not masked to treatment. In addition, more patients than expected were lost to follow-up, the authors write.
Even so, the results suggest that exercise interventions like this one may be beneficial to women undergoing non-reconstructive breast cancer surgery, Dr. Bruce said.
"Those women taking part in the study were having axillary clearance or radiotherapy to the axilla and many had a high body mass index or shoulder problems, so we know these ladies were at higher risk of having functional problems after their operation, yet they benefited from it," Dr. Bruce said by email. "We could see a difference between groups at six months, when many were still having active treatment - and differences were greater between groups at one year."
SOURCE: https://bit.ly/3G579aD The BMJ, online November 10, 2021.
By Lisa Rapaport
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