Gautam, A.P., Maiya, A.G., & Vidyasagar, M.S. (2011). Effect of home-based exercise program on lymphedema and quality of life in female postmastectomy patients: Pre-post intervention study. Journal of Rehabilitation Research and Development, 48(10), 1261–1268.

To determine the effectiveness of a home-based independent exercise regimen, comprised of upper-limb resistance exercises and deep breathing exercises, in relieving lymphedema symptoms and improving quality of life

Participants received education from a qualified physiotherapist on how to perform the at-home exercise regimen for the first few sessions. Once satisfactory performance of the exercises had been completed, the patients received a handout about the exercise program and a log book to journal their progress. The exercise regimen was to be performed five days a week. Deep breathing exercises were to be performed between each set. It was recommended to only increase the weight if 2 sets of 15 repetitions became very easy to perform. The exercise regimen consisted of scapular retraction, shoulder extension, scapular protraction, scapular depression, elbow flexion, elbow extension, wrist flexion and extension, and ball squeeze. Patients were monitored weekly via telephone, and the fourth week all patients had a follow-up appointment with the investigators either in the home or at the hospital.  
 

• The sample (N = 32) was comprised of female patients with breast cancer (stages I–II).
• Mean age of the sample was 46.56 years.
• All patients had underwent a unilateral mastectomy.
• One and a half years before study participation, patients completed neoadjuvent chemotherapy and radiation (March 2006–February 2008).
   

The study took place at multiple sites in Manipal, India.

Patients were transitioning between phases of care.

The study used a pre-post design. 

• The arms were measured using two different methods, arm circumference and water displacement, to determine volumetric changes.
• Quality of life was assessed using the 36-Item Short-Form Health Survey (SF-36).

A statistically significant reduction in upper-limb circumference was found at three measurements (p < 0.001) and in affected upper-limb volume (p<0.001). The mean volume reduction was 122 ml. The metacarpophalanfeal joint circumference reduction measurement was not found to be statistically significant (p = 0.04). A statistically significant change in quality-of-life score from the SF-36 was found after completion of the exercise regimen.

The study has shown statistically significant improvements in limb volume and circumference reduction as well as improvement in QOL using this at-home exercise program.

• The sample was small (N < 100).
• The study did not have a control group or random assignment (all patients received the intervention).
• Patient adherence to the exercise regimen can affect results.

Because the findings from the study is statistically significant, it would be great for this research to be repeated with a more rigorous study design (i.e., randomized controlled trial) with a larger sample size to clarify effectiveness of the exercise regimen. If repeatedly proven that this exercise regimen is effective in reducing lymphedema, it would be a good program for nurses to teach their patients during discharge instructions because it is extremely simple and anyone can complete the exercises with common household items.