Exercise Preserves Freedom of Movement After Breast Cancer Surgery

An active 72-year-old woman, Claire Mitchell 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.