Effects of a scapula-oriented shoulder exercise programme on upper limb dysfunction in breast cancer survivors: a randomized controlled pilot trial

Abstract

Objective: To examine the effects of a scapula-oriented exercise on upper limb dysfunction in breast cancer survivors.

Study design: A prospective randomized, controlled pilot trial with historical control.

Setting: Rehabilitation department at a university hospital.

Subjects: Thirty-two women with breast cancer were randomly assigned to scapula-oriented exercise group (n = 16) and general exercise group (n = 16). An historical control group (n = 18) without exercise was enrolled from breast cancer survivors.

Interventions: The scapula-oriented exercises were designed focusing on scapulothoracic movement. The general exercise group performed body conditioning exercise. Exercise therapies were performed for one session per week for eight weeks.

Main outcome measures: Pain and physical disabilities related to upper limb dysfunction, quality of life and depression were used as subjective outcomes. Objective outcome measures included shoulder range of motion and strength. Outcomes were assessed at baseline and post exercise.

Results: At baseline, no significant difference was observed among the three groups. The scapula-oriented exercise group showed improvements in pain, physical function, social function, and global quality of life compared with baseline, whereas the general exercise group showed improved fatigue and range of motion. The change in global quality of life (P = 0.067; effect size, 0.33) and strength of external rotation (P = 0.001; effect size, 0.55) were significantly greater in the scapula-oriented exercise group than in the general exercise and control group.

Conclusion: Scapula-oriented exercise had beneficial effects on pain, quality of life and aspects of strength. The sample size required in a larger definitive study is 32 subjects per group.

Get full access to this article

View all access options for this article.

References

Newman LA , Sabel M. Advances in breast cancer detection and management. Med Clin North Am 2003; 87: 997-1028.

Turner J. , Hayes S. , Reul-Hirche H. Improving the physical status and quality of life of women treated for breast cancer: a pilot study of a structured exercise intervention. J Surg Oncol 2004; 86: 141-46.

Eakes GG Chronic sorrow: a response to living with cancer. Oncol Nurs Forum 1993; 20: 1327-34.

Kwan W. , Jackson J. , Weir LM , Dingee C. , McGregor G. , Olivotto IA Chronic arm morbidity after curative breast cancer treatment: prevalence and impact on quality of life. J Clin Oncol 2002 ; 20: 4242-48.

Beaulac SM , McNair LA , Scott TE , LaMorte WW , Kavanah MT Lymphedema and quality of life in survivors of early-stage breast cancer. Arch Surg 2002; 137: 1253-57.

Kim SM , Park JM Normal and abnormal US findings at the mastectomy site. Radiographics 2004; 24: 357-65.

Katz J. , Poleshuck EL , Andrus CH et al. Risk factors for acute pain and its persistence following breast cancer surgery. Pain 2005; 119: 16-25.

Yang JL , Lin JJ Reliability of function-related tests in patients with shoulder pathologies . J Orthop Sports Phys Ther 2006; 36: 572-76.

Lin JJ , Lim HK , Yang JL Effect of shoulder tightness on glenohumeral translation, scapular kinematics, and scapulohumeral rhythm in subjects with stiff shoulders. J Orthop Res 2006; 24: 1044-51.

10.

Rundquist PJ Alterations in scapular kinematics in subjects with idiopathic loss of shoulder range of motion. J Orthop Sports Phys Ther 2007; 37: 19-25.

11.

Borstad JD , Ludewig PM The effect of long versus short pectoralis minor resting length on scapular kinematics in healthy individuals. J Orthop Sports Phys Ther 2005; 35: 227-38.

12.

Pinto BM , Clark MM , Maruyama NC , Feder SI Psychological and fitness changes associated with exercise participation among women with breast cancer. Psychooncology 2003 ; 12: 118-26.

13.

Courneya KS , Mackey JR , Bell GJ , Jones LW , Field CJ , Fairey AS Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: cardiopulmonary and quality of life outcomes. J Clin Oncol. 2003; 21: 1660-68.

14.

Markes M. , Brockow T. , Resch KL Exercise for women receiving adjuvant therapy for breast cancer. Cochrane Database Syst Rev 2006; (4): CD005001.

15.

Yang EJ , Park WB , Seo KS , Kim SW , Heo CY , Lim JY Longitudinal change of treatment-related upper limb dysfunction and its impact on late dysfunction in breast cancer survivors: a prospective cohort study . J Surg Oncol 2010; 101: 84-91.

16.

Kibler WB , Sciascia AD , Uhl TL , Tambay N. , Cunningham T. Electromyographic analysis of specific exercises for scapular control in early phases of shoulder rehabilitation. Am J Sports Med 2008; 36: 1789-98.

17.

Smith J. , Dahm DL , Kaufman KR et al. Electromyographic activity in the immobilized shoulder girdle musculature during scapulothoracic exercises. Arch Phys Med Rehabil 2006; 87: 923-27.

18.

Moseley JB Jr. , Jobe FW , Pink M. , Perry J. , Tibone J. EMG analysis of the scapular muscles during a shoulder rehabilitation program. Am J Sports Med 1992; 20: 128-34.

19.

Hudak PL , Amadio PC , Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 1996; 29: 602-8.

20.

Lee JY , Lim JY , Oh JH , Ko YM Cross-cultural adaptation and clinical evaluation of a Korean version of the disabilities of arm, shoulder, and hand outcome questionnaire (K-DASH). J Shoulder Elbow Surg 2008; 17: 570-74.

21.

Wewers ME , Lowe NK A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health 1990; 13: 227-36.

22.

Cleeland CS , Ladinsky JL , Serlin RC , Nugyen CT Multidimensional measurement of cancer pain: comparisons of US and Vietnamese patients. J Pain Symptom Manage 1988; 3: 23-27.

23.

Cleeland C. Research in cancer pain. What we know and what we need to know. Cancer 1991; 67: 823-27.

24.

Beck AT , Steer RA , Brown GK Beck Depression Inventory Manual. San Antonio, TX: The Psychological Corp, 1996.

25.

Fayers PM , Aaronson NK , Bjordal, K. , Groenvold, M. , Curran D. , Bottomley, A. On behalf of the EORTC quality of life group. The EORTC QLQ-C30 scoring manual , third edition. Brussels: European Organization for Research and Treatment of Cancer, 2001 .

26.

Hayes S. , Battistutta D. , Newman B. Objective and subjective upper body function six months following diagnosis of breast cancer. Breast Cancer Res Treat 2005; 94: 1-10.

27.

Segal R. , Evans W. , Johnson D. et al. Structured exercise improves physical functioning in women with stages I and II breast cancer: results of a randomized controlled trial. J Clin Oncol 2001; 19: 657-65.

28.

Campbell A. , Mutrie N. , White F. , McGuire F. , Kearney N. A pilot study of a supervised group exercise programme as a rehabilitation treatment for women with breast cancer receiving adjuvant treatment. Eur J Oncol Nurs 2005; 9: 56-63.

29.

Beurskens CH , van Uden CJ , Strobbe LJ , Oostendorp RA , Wobbes T. The efficacy of physiotherapy upon shoulder function following axillary dissection in breast cancer, a randomized controlled study. BMC Cancer 2007; 7: 166.

30.

Ohira T. , Schmitz KH , Ahmed RL , Yee D. Effects of weight training on quality of life in recent breast cancer survivors: the Weight Training for Breast Cancer Survivors (WTBS) study. Cancer 2006; 106: 2076-83.

31.

Lee TS , Kilbreath SL , Refshauge KM , Pendlebury SC , Beith JM , Lee MJ Pectoral stretching program for women undergoing radiotherapy for breast cancer . Breast Cancer Res Treat 2007; 102: 313-21.

32.

Morimoto T. , Tamura A. , Ichihara T. et al. Evaluation of a new rehabilitation program for postoperative patients with breast cancer. Nurs Health Sci 2003; 5: 275-82.

33.

Hwang JH , Chang HJ , Shim YH et al. Effects of supervised exercise therapy in patients receiving radiotherapy for breast cancer. Yonsei Med J 2008; 49: 443-50.

34.

Ormel J. , Kempen GI , Deeg DJ , Brilman EI , van Sonderen E. , Relyveld J. Functioning, well-being, and health perception in late middle-aged and older people: comparing the effects of depressive symptoms and chronic medical conditions . J Am Geriatr Soc 1998; 46: 39-48.

35.

Shamley D. , Srinaganathan R. , Oskrochi R. , Lascurain-Aguirrebena I. , Sugden E. Three-dimensional scapulothoracic motion following treatment for breast cancer . Breast Cancer Res Treat 2008; 118: 315-22.

36.

Knols R. , Aaronson NK , Uebelhart D. , Fransen J. , Aufdemkampe G. Physical exercise in cancer patients during and after medical treatment: a systematic review of randomized and controlled clinical trials. J Clin Oncol 2005; 23: 3830-42.

37.

Daley AJ , Crank H. , Saxton JM , Mutrie N. , Coleman R. , Roalfe A. Randomized trial of exercise therapy in women treated for breast cancer. J Clin Oncol 2007; 25: 1713-21.