Home Exercise Program is an effective tool in improving upper limb function and quality of life in breast cancer survivors: A retrospective observational study

Bruno Corrado, Gianluca Ciardi, Clemente Servodio Iammarrone, Grazia Arpino

Abstract

Background: Home Exercise Program is a mainstay of upper limb dysfunction prevention in breast cancer survivors. However, only subjective assessment instruments have been used until now in order to prove its effectiveness. In the present observational retrospective study, we assessed, for the first time, the effects of Home Exercise Program on the upper limb function of breast cancer survivors via tridimensional motion analysis. We also aimed to show that good upper extremity performance positively influenced the quality of life of breast cancer survivors. Methods: From the 2016 database of breast cancer survivors who underwent upper limb tridimensional motion analysis 1 and 3 months after modified radical mastectomy, we enrolled 15 patients who spontaneously refused to undergo the post-surgical 14-day Home Exercise Program (group A). In addition, 15 patients who were homogeneous to those of group A, but who agreed to normally undergo Home Exercise Program were selected from the same database, in order to compare upper limb performance (group B). The Constant-Murley, Brief Fatigue Inventory and European Organization for Research and Treatment of Cancer quality of life scores during follow-up were analyzed and compared. Results: Compared to those in group A, on tridimensional motion analysis, patients in group B showed a wider range of motion of the upper limb, with consequently better shoulder and elbow performance, lower incidence of lymphedema, minor fatigue, and better quality of life. Conclusions: We show objectively, by means of tridimensional motion analysis, that Home Exercise Program is an effective tool for preventing upper extremity dysfunction in breast cancer survivors. Hence, it should always be recommended to such patients as it positively influences their quality of life.


Keywords

Breast neoplasms; Surgical procedures; Upper extremity; Movement; Rehabilitation; Quality of life

References

Abe, M., Iwase, T., Takeuchi, T., Murai, H. and Miura, S. (1998). A randomised controlled trial on the prevention of seroma after partial or total mastectomy and axillary lymph node dissection. Breast Cancer 5(1),67–70. https://doi.org/10.1007/BF02967417

Baan H., Dubbeldam R., Nene A.V., van de Laar M.A. (2012). Gait analysis of the lower limb in patients with rheumatoid arthritis: a systematic review. Semin Arthritis Rheum Jun;41(6):768-788.e8. https://doi.org/10.1016/j.semarthrit.2011.11.009

Bergmann, A., da Costa Leite Ferreira, M.G., de Aguiar, S.S., de Almeida Dias, R., de Souza Abrahao, K., Paltrinieri, E.M., Martinez Allende, R.G. and Andrade M.F. (2014). Physiotherapy in upper limb lymphedema after breast cancer treatment: a randomized study. Lymphology 47(2),82-91. PMID: 25282874

Blair, C.K., Morey, M.C., Desmond, R.A., Cohen, H.J., Sloane, R., Snyder, D.C. and Demark-Wahnefried, W. (2014). Light-intensity activity attenuates functional decline in older cancer survivors. Med. Sci. Sports Exerc., 46(7),1375-1383. https://doi.org/10.1249/MSS.0000000000000241

Blomqvist, L., Stark, B., Engler, N. and Malm, M. (2004). Evaluation of arm and shoulder mobility and strength after modified radical mastectomy and radiotherapy. Acta Oncol 43:280–283. https://doi.org/10.1080/02841860410026170

Bonaiuti, D. (2011). Scale di Misura in Riabilitazione, Società Editrice Universo, Rome, Italy, 3rd edition.

Boudarham J., Roche N., Pradon D., Bonnyaud C., Bensmail D., Zory R. (2013). Variations in kinematics during clinical gait analysis in stroke patients. PLoS One Jun 17;8(6):e66421. https://doi.org/10.1371/journal.pone.0066421

Bower, J.E., Ganz, P.A., Desmond, K.A., Rowland, J.H., Meyerowitz, B.E. and Belin, T.R. (2000). Fatigue in Breast Cancer Survivors: Occurrence, Correlates, and Impact on Quality of Life. J Clin Oncol 18(4),743–753. https://doi.org/10.1200/JCO.2000.18.4.743

Box, R.C, Reul-Hirche, H.M., Bullock-Saxton, J.E., and Furnival, C.M. (2002). Shoulder movement after breast cancer surgery: results of a randomized controlled study of postoperative physiotherapy. Breast Cancer Research and Treatment 75(1):35–50. https://doi.org/10.1023/A:1016571204924

Cornette, T., Vincent, F., Mandigout, S., Antonini, M.T., Leobon, S., Labrunie, A., Venat, L., Lavau-Denes, S. and Tubiana-Mathieu, N. (2015). Effects of home-based exercise training on vo2 in breast cancer patients under adjuvant or neoadjuvant chemotherapy (sapa). Eur. J. Phys. Rehabil. Med., 52(2):223-32. Epub 2015 May 19. PMID: 25986222

Demark-Wahnefried, W., Morey, M.C., Sloane, R., Snyder, D.C., Miller, P.E., Hartman, T.J., and Cohen, H.J. (2012). Reach out to enhance wellness home-based diet-exercise intervention promotes reproducible and sustainable long-term improvements in health behaviors, body weight, and physical functioning in older, overweight/obese cancer survivors. J. Clin. Oncol., 30(19),2354-2361. https://doi.org/10.1200/JCO.2011.40.0895

Esposito M., Dubbioso R., Peluso S., Picone A., Corrado B., Servodio Iammarone C., Allocca R., Manganelli F., Santoro L., Fasano A. (2017). Cervical dystonia patients display subclinical gait changes. Parkinsonism Relat. Disord., 43:97-100. https://doi.org/10.1016/j.parkreldis.2017.07.005

Esquenazi A. (2014). Gait analysis in lower-limb amputation and prosthetic rehabilitation. Phys Med Rehabil Clin N Am. Feb;25(1):153-67. https://doi.org/10.1016/j.pmr.2013.09.006

Garbelotti S.A. Jr, Lucareli P.R., Ramalho A. Jr, de Godoy W., Bernal M., D'Andréa Greve J.M. (2014). An investigation of the value of tridimensional kinematic analysis in functional diagnosis of lumbar spinal stenosis. Gait Posture 40(1):150-3. https://doi.org/10.1016/j.gaitpost.2014.03.013

Gartner, R., Jensen, M.B., Kronborg, L., Ewertz, M., Kehlet, H. and Kroman, N. (2010). Self-reported arm-lymphedema and functional impairment after breast cancer treatment—a nationwide study of prevalence and associated factors. Breast 19(6),506–515. https://doi.org/10.1016/j.breast.2010.05.015

Gautam, A.P., Maiya, A.G. and Vidyasagar, M.S. (2011). Effect of home-based exercise program on lymphedema and quality of life in female postmastectomy patients: pre-post intervention study. J. Rehabil. Res. Dev., 48(10),1261-1268. https://doi.org/10.1682/JRRD.2010.05.0089

Hormes, J.M., Bryan, C., Lytle, L.A., Gross, C.R., Ahmed, R.L., Troxel, A.B. and Schmitz, K.H. (2010). Impact of lymphedema and arm symptoms on quality of life in breast cancer survivors. Lymphology 43(1),1–13. PMID: 20552814

International Agency for Research on Cancer, World Health Organization (2014). World Cancer Report 2014.

International Agency for Research on Cancer (2008).World Cancer Report. Retrieved 2011-02-26.

Jeffs, E. and Wiseman, T. (2013). Randomised controlled trial to determine the benefit of daily home-based exercise in addition to self-care in the management of breast cancer-related lymphoedema: a feasibility study. Support. Care Cancer 21(4),1013-1023. https://doi.org/10.1007/s00520-012-1621-6

Johansson, K., Klernäs, P., Weibull, A. and Mattsson, S. (2014). A home-based weight lifting program for patients with arm lymphedema following breast cancer treatment: a pilot and feasibility study. Lymphology 47(2),51-64. PMID: 25282871

Kaunisto, M.A., Jokela, R., Tallgren, M., Kambur, O., Tikkanen, E., Tasmuth, T., Sipilä, R., Palotie, A., Estlander, A.M., Leidenius, M., Ripatti, S. and Kalso, E.A. (2013). Pain in 1,000 women treated for breast cancer: a prospective study of pain sensitivity and postoperative pain. Anesthesiology 119(6),1410–1421. https://doi.org/10.1097/ALN.0000000000000012

Lauridsen, M.C.L., Christiansen, P., and Hessov, I. (2005). The effect of physiotherapy on shoulder function in patients surgically treated for breast cancer: a randomized stud. Acta Oncol 44(5),449-457. https://doi.org/10.1080/02841860510029905

Letellier, M.E., Towers, A., Shimony, A. and Tidhar, D. (2014). Breast cancer-related lymphedema: a randomized controlled pilot and feasibility study. Am. J. Phys. Med. Rehabil., 93(9),751-759. https://doi.org/10.1097/PHM.0000000000000089

Ligibel, J.A. (2011). Role of adjuvant and post treatment exercise programs in breast health. J. Natl. Compr. Canc. Netw., 9(2),251-256. https://doi.org/10.6004/jnccn.2011.0020

Lin, P.P., Allison, D.C., Wainstock, J., Miller, K.D., Dooley, W.C., Friedman, N. and Baker, R.R. (1993). Impact of axillary lymph node dissection on the therapy of breast cancer patients. J Clin Oncol 11(8),1536–1544. https://doi.org/10.1200/JCO.1993.11.8.1536

Magermans, D.J., Chadwick, E.K., Veeger, H.E. and van der Helm, F.C. (2005). Requirements for upper extremity motions during activities of daily living. Clin Biomech (Bristol, Avon) Jul;20(6):591–599. https://doi.org/10.1016/j.clinbiomech.2005.02.006

Markes, M.L., Brockow, T. and Resch, K.L. (2006). Exercise for women receiving adjuvant therapy for breast cancer. Cochrane Database Syst Rev 18(4): CD005001. https://doi.org/10.1002/14651858.CD005001.pub2

Markowski, J., Wilcox, J.P. and Helm, P.A. (1981) Lymphedema incidence after specific postmastectomy therapy. Archives of Physical Medicine and Rehabilitation 62(9),449–452. PMID: 7283687

Mascherini G, Giannelli C, Ghelarducci G, Degl'Innocenti S, Petri C, Galanti G. (2017). Active lifestyle promotion with home-based exercises in breast cancer survivors. Journal of Human Sport and Exercise, 12(1), 119-128. https://doi.org/10.14198/jhse.2017.121.10

Mascherini G, Tosi B, Giannelli C, Grifoni E, Degl'innocenti S, Galanti G. (2018). Breast cancer: effectiveness of a one-year unsupervised exercise program. J Sports Med Phys Fitness. 2018 Mar 1. doi: 10.23736/S0022-4707.18.08131-8. [Epub ahead of print]. PMID: 29498250

Mayich D.J., Novak A., Vena D., Daniels T.R., Brodsky J.W. (2014). Gait analysis in orthopedic foot and ankle surgery--topical review, part 1: principles and uses of gait analysis. Foot Ankle Int. Jan;35(1):80-90. https://doi.org/10.1177/1071100713508394

McNeely, M.L., Campbell, K., Ospina, M., Rowe, B.H., Dabbs, K., Klassen, T.P., Mackey, J. and Courneya, K. (2010). Exercise interventions for upper-limb dysfunction due to breast cancer treatment. Cochrane Database Syst Rev 16;(6):CD005211. https://doi.org/10.1002/14651858.CD005211.pub2

McNeely, M., Campbell, K.L., Rowe, B.H., Klassen, T.P., Mackey, J.R. and Courneya, K.S. (2006). Effects of exercise on breast cancer patients and survivors: A systematic review and meta-analysis. CMAJ 175(1),34-41. https://doi.org/10.1503/cmaj.051073

Meneses-Echávez, J.F., González-Jiménez, E. and Ramírez-Vélez, R.. (2015). Effects of supervised exercise on cancer-related fatigue in breast cancer survivors: a systematic review and meta-analysis. BMC Cancer 21;15:77. https://doi.org/10.1186/s12885-015-1069-4

Migliore, C. (2011). Quale riabilitazione dopo il carcinoma mammario? Available at: http://lilt.it/pubblicazione.php?id=1121&area=1160

Minton, O., Berger, A., Barsevick, A., Cramp, F., Goedendorp, M., Mitchell, S.A. and Stone, P.C. (2013). Cancer-related fatigue and its impact on functioning. Cancer 1;119 Suppl 11:2124-30. https://doi.org/10.1002/cncr.28058

Morone, G., Iosa, M., Fusco, A., Scappaticci, A., Alcuri, M.R., Saraceni, V.M., Paolucci, S. and Paolucci, T. (2014). Effects of a multidisciplinary educational rehabilitative intervention in breast cancer survivors: the role of body image on quality of life outcomes. Scientific World Journal, 451935. https://doi.org/10.1155/2014/451935

Mosqueda, T., James, M.A., Petuskey, K., Bagley, A., Abdala, E. and Rab, G. (2004). Kinematic assessment of the upper extremity in brachial plexus birth palsy. J Pediatr Orthop 24(6),695–699. https://doi.org/10.1097/01241398-200411000-00018

Murtezani, A., Ibraimi, Z., Bakalli, A., Krasniqi, S., Disha, E.D. and Kurtishi, I. (2014). The effect of aerobic exercise on quality of life among breast cancer survivors: a randomized controlled trial. J Cancer Res Ther 10(3),658-664. DOI: 10.4103/0973-1482.137985. PMID: 25313756

Mustian, K.M., Sprod, L.K., Palesh, O.G., Peppone, L.J., Janelsins, M.C., Mohile, S.G. and Carroll, J. (2009). Exercise for the management of side effects and quality of life among cancer survivors. Curr. Sports Med. Rep., 8(6), 325-330. https://doi.org/10.1249/JSR.0b013e3181c22324

Paci, E., Cariddi, A., Barchielli, A., Bianchi, S., Cardona, G., Distante, V., Giorgi, D., Pacini, P., Zappa, M. and Del Turco, M.R. (1996). Long-term sequelae of breast cancer surgery. Tumori 82(4),321–324. https://doi.org/10.1177/030089169608200405

Prue, G., Rankin, J., Allen, J., Gracey, J. and Cramp, F. (2006). Cancer-related fatigue: a critical appraisal. Eur J Cancer 42(7),846–863. https://doi.org/10.1016/j.ejca.2005.11.026

Rathinam C., Bateman A., Peirson J., Skinner J. (2014). Observational gait assessment tools in paediatrics--a systematic review. Gait Posture Jun;40(2):279-85. https://doi.org/10.1016/j.gaitpost.2014.04.187

Ridner, S.H. (2005). Quality of life and a symptom cluster associated with breast cancer treatment-related lymphedema. Support Care Cancer 13(11) 904–911. https://doi.org/10.1007/s00520-005-0810-y

Rogers, L.Q., Courneya, K.S., Anton, P.M., Hopkins-Price, P., Verhulst, S., Vicari, S.K., Robbs, R.S., Mocharnuk, R. and McAuley, E. (2015). Effects of the BEAT Cancer physical activity behavior change intervention on physical activity, aerobic fitness, and quality of life in breast cancer survivors: a multicenter randomized controlled trial. Breast Cancer Res. Treat., 149(1),109-119. https://doi.org/10.1007/s10549-014-3216-z

Shamley, D.L., Lascurain-Aguirrebeña, I., Oskrochi, R. and Srinaganathan, R. (2012). Shoulder morbidity after treatment for breast cancer is bilateral and greater after mastectomy. Acta Oncologica. 51(8),1045-1053. https://doi.org/10.3109/0284186X.2012.695087

Smith, S.L., Singh-Carlson, S., Downie, L., Payeur, N. and Wai, E.S. (2011). Survivors of breast cancer: patient perspectives on survivorship care planning. J. Cancer Surviv., 5(4),337-344. https://doi.org/10.1007/s11764-011-0185-7

Spector, D., Deal, A.M., Amos, K.D., Yang, H. and Battaglini, C.L. (2014). A pilot study of a home-based motivational exercise program for African American breast cancer survivors: clinical and quality-of-life outcomes. Integr. Cancer Ther., 13(2),121-132. https://doi.org/10.1177/1534735413503546

van Waart, H., Stuiver, M.M., van Harten, W.H., Geleijn, E., Kieffer, J.M., Buffart, L.M., de Maaker-Berkhof, M., Boven, E., Schrama, J., Geenen, M.M., Meerum Terwogt, J.M., van Bochove, A., Lustig, V., van den Heiligenberg, S.M., Smorenburg, C.H., Hellendoorn-van Vreeswijk, J.A., Sonke, G.S. and Aaronson, N.K. (2015). Effect of Low-Intensity Physical Activity and Moderate- to High-Intensity Physical Exercise during Adjuvant Chemotherapy on Physical Fitness, Fatigue, and Chemotherapy Completion Rates: Results of the PACES Randomized Clinical Trial. J. Clin. Oncol., 33(17),1918-1927. https://doi.org/10.1200/JCO.2014.59.1081

Vincent, F., Labourey, J.L., Leobon, S., Antonini, M.T., Lavau-Denes, S. and Tubiana-Mathieu, N. (2013). Effects of a home-based walking training program on cardiorespiratory fitness in breast cancer patients receiving adjuvant chemotherapy: a pilot study. Eur. J. Phys. Rehabil. Med., 49(3),319-329. PMID: 23480974

van Andel, C.J., Wolterbeek, N., Doorenbosch, C.A., Veeger, D.H. and Harlaar, J. (2008). Complete 3D kinematics of upper extremity functional tasks. Gait Posture 27(1):120-127. https://doi.org/10.1016/j.gaitpost.2007.03.002

Wenzel, J.A., Griffith, K.A., Shang, J., Thompson, C.B., Hedlin, H., Stewart, K.J., DeWeese, T. and Mock, V. (2013). Impact of a home-based walking intervention on outcomes of sleep quality, emotional distress, and fatigue in patients undergoing treatment for solid tumors. Oncologist, 18(4),476-484. https://doi.org/10.1634/theoncologist.2012-0278




DOI: https://doi.org/10.14198/jhse.2018.134.19





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