de Rezende, L.F., Franco, R.L., de Rezende, M.F., Beletti, P.O., Morais, S.S., & Gurgel, M.S. (2006). Two exercise schemes in postoperative breast cancer: Comparison of effects on shoulder movement and lymphatic disturbance. Tumori, 92(1), 55–61.

The study compared the effects on shoulder movement and lymphatic disturbance of two exercise schemes after surgery in patients with breast cancer. Subjects were randomly assigned to two exercise groups based on kinesiotherapy: directed group guided by a physiotherapist with a regimen of 19 exercises (exercises were performed 10 times with 60-second intervals between exercises) and free group, which had no defined sequence or number of repetitions. Both groups began with three exercises beginning on the first day after surgery. Exercises were performed in outpatient physiotherapy department. The study was reviewed by the Research Commission and Ethics Committee of the faculty of medical sciences. Patients participated in a 40-minute session three times weekly for a period of 42 days.

• The study sample (N = 60) was comprised of female patients who had undergone modified radical mastectomy or quadrantectomy with axillary dissection for breast cancer.
• Patients were excluded from the study if they
  • Underwent immediate reconstruction
  • Had bilateral breast surgery
  • Had greater than 2 cm difference in arm circumference before surgery
  • Experience any limitation of limb movement prior to surgery
  • Had greater than 20° difference in flexion and abduction before surgery.
  • Were unable to understand proposed exercises.

Patients were recruited from State University of Campinas, Brazil.

• Manual goniometer (no passive support given) was used to measure range of motion.
• Arm circumference was measured using a universal tape measure; measurement points were 7.5 cm above the humeroradial joint and 7.5 cm below the humeroradial joint, at ulnar styloid at wrist, and at metacarpophalangeal joints.
• Demographic data collected along with age, BMI, number of lymph nodes, and number of PT sessions.

No difference in groups was found in terms of individual characteristics and clinical-surgical characteristics. Incidence of infection was similar in both groups. Lymphatic disturbance showed no statistical difference between groups. Incidence of seroma was not statistically different between groups. The directed exercise group had more recovery of range of motion in shoulder in flexion, abduction, and external rotation compared with the free group. Patients who received directed exercises achieved better function and return to premorbid function than those patients who did free exercise.

• The small sample size limits generalizability.
• Access, time, and cost could be patient barriers.
• Comorbidities are not addressed or described.