Kilgour, R, Jones, D. Keyserlink, J. (2008). Effectiveness of a self-administered, home-based exercise rehabilitation program for women following a modified radical mastectomy and axillary node dissection: A preliminary study, Breast Cancer Research and Treatment, 109(2), 285–295.

To study the effects of a self-administered home-based exercise video program designed to help women regain shoulder mobility immediately following surgery for modified radical mastectomy and axillary node dissection

Patients were randomly assigned to usual care control or home-based exercise groups. Usual care consisted of standard written information on diet and skin care and a nine-page brochure entitled “Exercise Guide After Breast Surgery”. Participants were not encouraged to follow exercises, nor were they instructed not to do the exercises. The study was conducted during the immediate two-week recovery period following surgery. Over the next 11 days, women assigned to the home-based exercise intervention received the usual care education and followed the home-based exercise video program. Exercises involved upper-extremity movement designed to increase general range of motion, various neck movements, and stretches.

• The study sample was comprised of female patients.
• Mean age for the control group was 49.1 years and for the home-based exercise group was 50.6 years.
• All patients had a modified radical mastectomy with axillary node dissection.
• Patients were excluded from the study if they had a history or presence of shoulder dysfunction, were older than 65 years, or had sentinel node biopsy dissection only.

The study took place at an outpatient setting in Montreal, Canada.

The study used a randomized controlled trial design.

• The Oxford Manual Muscle Testing Scale
• Hand-grip dynamometry
• Circumferential tape measurements of both extremities
• Participant self-report using the CR-10 Pain Scale and Borg's Category Scale for Rate of Perceived exertion

The experimental group demonstrated a significantly greater increase in flexion (p = 0.003) and abduction (p = 0.036) of shoulder. There was no significant difference in forearm circumference measurements, external rotation, grip strength, or pain. None of the patients in the home-based exercise group demonstrated any significant change in forearm circumference that would indicate lymphedema. Fifty percent of the patients in the home-based exercise group did not complete exercises because of pain at the shoulder joint and axillary swelling, 25% because of lack of support from family and others, 12.5% for no specific reason.

Self-directed home exercise was associated with greater improvement in some range of motion over time and did not appear to aggravate lymphedema development. There was generally low adherence to the self-directed program.

• The study had a small sample size (N < 30).
• The study was short, with insufficient evidence about how the program might affect women at longer intervals.
• Because the control group was aware of the exercise arm of the study, they may have completed more exercise than they otherwise would have, and no control was put in place to not exercise.
• In the home-based exercise group, 50% did not adhere to the exercise program for a variety of reasons.
• It is not clear if the exercise program contributed to join pain and axillary swelling experienced by 25% of patients.

Poor adherence to the home based self-directed program point to the challenges associated with the approach described in the study.