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Exercise Preserves Freedom of Movement After Breast Cancer Surgery

_http://www.cfah.org/hbns/archives/getDocument.cfm?documentID=22271_

(http://r20.rs6.net/tn.jsp?et=1103498003589 & s=535 & e=001z2iO1Jba-dkVhvXAMlvhb8D20\

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ew==)

By Milly Dawson, Contributing Writer--Health Behavior News Service

An active 72-year-old woman, had always enjoyed cooking.

However, after breast cancer surgery she found that she had less freedom of

movement and reaching jars on high shelves became quite painful. Her

plight is common.

A new Cochrane review finds that exercise programs help patients recover

shoulder movement and minimize loss of arm or shoulder function after

breast cancer surgery.

Many breast cancer survivors develop pain, shoulder stiffness and arm

swelling after treatment. These problems often persist for years. Physicians

usually prescribe arm and shoulder exercises after surgery to prevent pain

and stiffness in those areas on the side of the cancer. However, the best

type of exercise or how soon it should begin have been debated.

" There has been some concern that too much aggressive movement soon after

surgery might cause pain, delay healing, and increase the risk of arm

swelling, " said lead review author Margaret McNeely, an assistant professor of

physical therapy at the University of Alberta and clinical researcher at

the Cross Cancer Institute, in Canada.

McNeely's team examined 24 research studies comprising 2,132 women with a

confirmed breast cancer diagnosis and who had undergone surgery such as a

radical mastectomy, modified radical mastectomy, or a local wide excision

or lumpectomy. They had also all had surgery removing lymph nodes from the

axilla, or armpit, to determine the extent of the cancer.

Specially designed programs included range-of-motion movements for the

shoulders and stretching exercises.

The review showed that starting exercise early after surgery - within the

first to third day -might result in better shoulder movement in the early

weeks following surgery.

However, " starting exercise that soon after surgery may cause more wound

drainage and require drains to remain in place longer than if exercise is

delayed by about one week, " McNeely said. Early exercise lengthened

wound-healing time by about one day.

The review was published by The Cochrane Collaboration, an international

organization that evaluates medical research. Systematic reviews draw

evidence-based conclusions about medical practice after considering both the

content and quality of existing medical trials on a topic.

Fourteen studies compared the effect of structured exercise to usual care,

in which women received an exercise pamphlet or no exercise instruction at

all.

Of these, structured programs including physical therapy regimens in the

early postoperative period led to a significant improvement in shoulder

range of motion over the short and long term.

One problem that can affect women after breast surgery is lymphedema,

which is swelling caused by fluid buildup. This swelling begins in the

underarm area but can affect the entire arm, usually on the side of the breast

surgery, and can be uncomfortable or even painful.

Several persistent complications can greatly diminish a patient's quality

of life, said Blayney, M.D., medical director at the University of

Michigan's Comprehensive Cancer Center.

Blayney said that although current surgical treatment is attempting to

move away from disturbing the axilla, more women, especially younger women,

are choosing mastectomy over breast conserving surgery. Mastectomy has a

higher incidence of swelling and limited shoulder motion. There is a trend now

toward increasing use of radiation therapy to the axilla and this approach

also might increase the risk of swelling, he said.

" Combined, these trends in primary treatment of breast cancer make this

review highly relevant, " said Blayney, who has no affiliation with the

review. Nevertheless, he noted that making suitable exercise programs widely

available to breast cancer patients in a timely manner would be a challenge.

He said optimal breast cancer care now involves a team with a wide range

of health specialists: surgeons, radiation oncologists, medical

oncologists, reconstructive surgeons and others. " This review demonstrates that

early

involvement of a new team member who manages exercise or physical therapy

is also useful for the best outcome, " he said.

Blayney added that he finds few things as disheartening as seeing a

breast cancer survivor in long-term follow-up who is cured yet burdened with a

" frozen " shoulder or daily use of a lymphedema sleeve, an elastic

compression garment worn over the arm to help move fluid and reduce swelling.

" Implementation of modern primary treatment strategies - including early

intervention with suitable exercises - should reduce the incidence of these

heartbreaking complications, " Blayney said.

Exercise interventions for upper-limb dysfunction due to breast cancer

treatment

_http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD005211/f

rame.html_

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CpytCnJVqN2sQgilV6AVr4_vUEfqHd82xIB3XqSlo=)

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.

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