Effectiveness of a self-administered, home-based exercise rehabilitation program for women following a modified radical mastectomy and axillary node dissection: a preliminary study. Effects of supervised exercise therapy in patients receiving radiotherapy for breast cancer. A Randomized Controlled Trial on the Prevention of Seroma after Partial or Total Mastectomy and Axillary Lymph Node Dissection. Evaluation of immediate versus delayed shoulder exercises after breast cancer surgery including lymph node dissection--a randomised controlled trial. Efficacy of comprehensive group rehabilitation for women with early breast cancer in South Korea. Effects of a scapula-oriented shoulder exercise programme on upper limb dysfunction in breast cancer survivors: a randomized controlled pilot trial. The effectiveness of early rehabilitation in patients with modified radical mastectomy. Two exercise schemes in postoperative breast cancer: comparison of effects on shoulder movement and lymphatic disturbance. Delayed shoulder exercises in reducing seroma frequency after modified radical mastectomy: a prospective randomized study. Rehabilitation of the mastectomy patient: a randomized, blind, prospective study. Shoulder function following early mobilization of the shoulder after mastectomy and axillary dissection. A pilot study of a supervised group exercise programme as a rehabilitation treatment for women with breast cancer receiving adjuvant treatment. Shoulder movement after breast cancer surgery: results of a randomised controlled study of postoperative physiotherapy. Benefits of supervised group exercise programme for women being treated for early stage breast cancer: pragmatic randomised controlled trial. Timing of shoulder exercise after modified radical mastectomy: a prospective study. Dance and movement program improves quality-of-life measures in breast cancer survivors. [Upper limbs exercises during radiotherapy for breast cancer and quality of life]. Psychological and fitness changes associated with exercise participation among women with breast cancer. Pectoral stretching program for women undergoing radiotherapy for breast cancer. [Efficacy of massage and mobilization of the upper limb after surgical treatment of breast cancer]. Immediate versus delayed shoulder exercises after axillary lymph node dissection. The efficacy of the ROM Dance Program for adults with rheumatoid arthritis.
This pilot study examined the effects of a self-administered, home-based exercise (HBE) rehabilitation programme designed to help women regain shoulder mobility immediately following surgery for a modified radical mastectomy and axillary node dissection.
                Twenty-seven women who were scheduled for surgery were randomly assigned to either a post-surgical experimental HBE rehabilitation group (n = 16) or a usual care group (UC; n = 11). Women assigned to the HBE group followed an 11 day (days 3-14 post-surgery), home-based rehabilitation programme consisting of shoulder flexibility and stretching exercises that were described on videotape. The videotape programme was modelled after the exercises and guidelines described in a brochure produced by the Canadian Cancer Society.
                As a result of the exercise programme intervention, there was a time x group interaction indicating that the HBE group demonstrated a significantly greater increase in shoulder flexion range of motion (ROM) (p = 0.003) and abduction ROM (p = 0.036) when compared to the UC. There were no statistical differences in shoulder strength between groups over time. External rotation (p = 0.036) and grip strength (p = 0.001) significantly increased in both groups during the intervention period but there were no interaction effects. With respect to the forearm circumferences, there was a significant decrease over time (p < 0.001) but no interaction between groups.
                This HBE rehabilitation programme is an effective way to improve shoulder mobility and ROM during the immediate 2-week recovery period following surgery. Postoperative radiotherapy for breast cancer has a number of associated complications. This study examined whether supervised moderate-intensity exercise could mitigate the complications that occur during radiotherapy.
                Forty women were randomized before radiotherapy after various operations for breast cancer. Seventeen patients who were assigned to the exercise group performed supervised moderate-intensity exercise therapy for 50 min 3 times per week for 5 weeks. Twenty-three patients in the control group were asked to perform self-shoulder stretching exercise. The World Health Organization Quality of Life-BREF (WHOQOL-BREF), brief fatigue inventory (BFI), range of motion (ROM) of the shoulder, and pain score were assessed before and after radiotherapy.
                There were no significant differences noted at baseline between groups. In the exercise group, there was an increase in the WHOQOL-BREF and shoulder ROM and decrease in BFI and pain score after radiotherapy. On the other hand, patients in the control group showed decrease in the WHOQOL-BREF and shoulder ROM and increase in BFI and pain score after radiotherapy. There were statistically significant differences in the changes in the WHOQOL, BFI, shoulder ROM, and pain score between the groups.
                Patients receiving radiotherapy for breast cancer may benefit in physical and psychological aspects from supervised moderate-intensity exercise therapy. BACKGROUND: Wound seroma is one of the most frequent complications of mastectomy, but an effective strategy for its prevention has not yet been established. The purpose of this study was to determine the effectiveness of delayed shoulder exercise on the prevention of wound seroma after partial or total mastectomy with axillary dissection for the treatment of cancer. METHODS: This study prospectively randomized two exercise schemes after mastectomy with axillary lymph node dissection. The immediate exercise group (n =58) started shoulder exercise on the first postoperative day. In the delayed exercise group (n =58) the movement of the upper limb was limited to usual daily activities during the first postoperative week. RESULTS: Preoperative levels of shoulder function were regained within one month when shoulder exercise was delayed for one week after operation. Significant decrease of drainage volume and lower incidence of seroma formation were seen in the delayed exercise group. CONCLUSION: These observations suggest that seven days of unrestricted moverment and avoiding active exercise of the shoulder joint, is the optimal routine reduce seroma formation after mastectomy. Two hundred and thirty women who had undergone surgery for breast cancer were randomised to a prospective study, comparing early (group A) and delayed (group B) shoulder exercise. Preoperatively, group A received instructions and an exercise programme supervised by a physiotherapist, whereas group B received written instructions to use the arm normally but to avoid heavy work. Two weeks after surgery both groups were given identical exercise programmes. Shoulder mobility, hand strength and arm volume were measured preoperatively, 1 month, 6 months and 2 years postoperatively. After 2 years 13.8% of the women had lymphoedema, but there were no significant differences between the groups. Grip strength was slightly decreased during the postoperative period in both groups (n.s.). Postoperatively, all movements in both groups were decreased after 2 weeks and 1 month and shoulder elevation and abduction remained decreased at 2 years. Mobility in group A recovered significantly earlier than in group B. The purpose of this study was to evaluate the effects of a comprehensive group rehabilitation program on the range of motion of the shoulder joint, psychosocial adjustment, and the quality of life for early breast cancer patients. Fifty-five women with early breast cancer were assigned to an intervention group or a control group. Intervention was provided three times per week for 10 weeks. The results showed an increased range of motion of the shoulder joint, and psychosocial adjustment and quality of life were shown to be significantly higher in the intervention group than in the control group. The rehabilitation program comprised psychology-based education, exercise, and peer support group activity to promote recovery of the affected shoulder joint range of motion, alleviate physical symptoms, and improve psychosocial adjustment and quality of life for early breast cancer patients in South Korea. To examine the effects of a scapula-oriented exercise on upper limb dysfunction in breast cancer survivors.
                A prospective randomized, controlled pilot trial with historical control.
                Rehabilitation department at a university hospital.
                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.
                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.
                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.
                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.
                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. The aim of this prospective study was to investigate the effects of early onset rehabilitation program on shoulder mobility, functional status, lymphedema, and the incidence of postoperative complications in patients who had modified radical mastectomy. Fifty-seven women were randomly assigned to either treatment group or home exercise program groups, which were consisted of 27 and 30 patients, respectively. After removal of the drains, the patients were instructed to 15 sessions of individual rehabilitation program and continued with home-based physical activity program. The home exercise program groups only received a form including the exercises, which could be performed by themselves after removal of the drains. Range of motion of the shoulder joint and upper extremity circumferential difference were measured. Functional status was assessed by functional index score. Each patient was assessed preoperatively and then postoperatively at fifth day and first, third, and sixth months. The improvement in measurements of flexion, abduction, and adduction movements of the shoulder joint and the functional questionnaire scores were significantly better in treatment group. There was no statistically significant difference in the development of lymphedema and postoperative complications in both groups. Early onset rehabilitation program after modified radical mastectomy provides improvement in shoulder mobility and functional capacity without causing adverse effect in postoperative period. We attempted to determine the best method of performing the exercises in rehabilitation after breast cancer surgery and their influence on postoperative complications. Currently, there are no guidelines for these exercises. The scope of this study was to evaluate the effect of two schemes of physiotherapy exercises (directed or free) on shoulder function and lymphatic disturbance in postoperative rehabilitation.
                Sixty women who underwent a modified radical mastectomy or quadrantectomy with axillary dissection were randomized into two groups.
                The physiotherapy technique used was kinesiotherapy. The directed group performed physiotherapy following a regimen of 19 exercises. The free group performed the exercises following the biomechanical physiological movements of the shoulder without a previously defined sequence or number of repetitions.
                The averages of the flexion, abduction and external rotational movements of the shoulder showed better recovery with statistical significance in the directed group compared to the free group. There was no significant difference between the groups in lymphatic disturbance.
                At the end of 42 days of follow-up, the movements of flexion, extension, abduction and external rotation of the shoulder were better rehabilitated in the directed group. The two schemes of exercises were not different with regard to lymphatic disturbance. Seromas and impaired shoulder function are well-known complications after modified radical mastectomy for breast cancer. Early postoperative physiotherapy is a common treatment to avoid shoulder dysfunction. The aim of this study was to evaluate if the frequency of postoperative seromas could be reduced, without increasing shoulder dysfunction, by delayed postoperative shoulder exercises.
                In a prospective study 163 patients with breast cancer undergoing modified radical mastectomy were randomized to physiotherapy starting on postoperative day 1 or day 7. Patients were seen by the surgeons and the physiotherapists during hospital stay and in the outpatient department. Seromas and other complications were registered by the surgeons. The physiotherapists instructed the patients pre- and postoperatively and assessed shoulder function.
                There was a significantly higher incidence of postoperative seromas in the group of patients that started physiotherapy postoperative day 1 (38%) compared to the group that started physiotherapy postoperative day 7 (22%) (p < 0.05). There was no significant difference between the groups in the late outcome of shoulder function.
                The incidence of seromas after modified radical mastectomy for breast cancer is reduced by delaying shoulder exercises one week postoperatively. Earlier postoperative physiotherapy is not necessary to avoid impaired shoulder function. After biopsy confirmation of breast carcinoma, women who were scheduled to undergo a modified radical mastectomy had demographic data collected, goniometric measurements of shoulder flexion and abduction, and functional evaluation of the ipsilateral shoulder performed, and upper extremity circumferential measurements at five levels determined. Patients were then randomly assigned either to a group that received immediate postoperative physical therapy or to one that did not. Results represent the combination of data from a pilot study and this subsequent study following appropriate statistical analysis. Sixty-four women in the treatment group showed a statistically significant increase in shoulder range of motion in both abduction and flexion as compared to 51 women who received no physical therapy. The treated group also had fewer problems with five of the six upper extremity functional tasks that were assessed. There were no significant differences between the groups for length of hospital stay, postoperative complications, or upper extremity edema. The authors conclude that early physical therapy intervention makes a significant contribution to return to normal function without increasing the incidence of postoperative complications or prolonging hospital stay. A prospective clinical trial was conducted to determine the effect of axillary node dissection for breast carcinoma on shoulder function and seroma production. 59 Operations were carried out in 57 patients. The patients were divided into two groups. In group A, shoulder exercises were started, under the guidance of a physiotherapist, immediately following surgery, and in group B the exercises were begun on the seventh postoperative day. A full range of motion within six months was achieved in 25 patients of group A (81%) and in 22 of group B (79%). There was no significant difference in wound drainage between the two groups. Restricted shoulder movement was often seen after local wound complications following axillary radiotherapy or after seriously disturbed wound healing. This pilot study examined whether exercise as an adjunctive rehabilitation therapy could benefit women who have early stage breast cancer and are currently receiving chemotherapy/radiotherapy. The study was designed as a randomised controlled trial (RCT). Physical functioning, fatigue and Quality of Life (QoL) outcomes were evaluated pre and post a 12-week intervention. The results showed that after 12 weeks the women who participated in the exercise programme (n = 12) displayed significantly higher levels of physical functioning and reported higher QoL scores than the controls (n = 10). Changes in fatigue and satisfaction with life favoured the intervention group but did not reach significance. These results are encouraging and suggest that a structured group exercise programme during adjuvant treatment is a safe, well tolerated and effective way of providing physical and psychological health benefits to women during treatment for early stage breast cancer. Since this was a pilot study the numbers did not allow appropriately powered analyses of some variables of interest and favoured relatively young and socio-economically advantaged women. Future studies need to address these issues and determine if these short-term benefits can be sustained. Breast screening programmes have facilitated more conservative approaches to the surgical and radiotherapy management of women diagnosed with breast cancer. This study investigated changes in shoulder movement after surgery for primary, operable breast cancer to determine the effect of elective physiotherapy intervention. Sixty-five women were randomly assigned to either the treatment (TG) or control group (CG) and assessments were completed preoperatively, at day 5 and at 1 month, 3, 6, 12 and 24 months postoperatively. The CG only received an exercise instruction booklet in comparison to the TG who received the Physiotherapy Management Care Plan (PMCP). Analyses of variance revealed that abduction returned to preoperative levels more quickly in the TG than in the CG. The TG women had 14 degrees more abduction at 3 months and 7 degrees at 24 months. Functional recovery at 1 month was greater in those randomised to the TG, with a dominant operated arm (OA) or receiving breast-conserving surgery. However, it was not possible to predict recovery over the 2 years postoperatively on the basis of an individual woman's recovery at 1 month postoperatively. The eventual recovery of abduction or flexion range of movement was not related to the dominance of the OA nor to the surgical procedure performed. The PMCP provided in the early postoperative period is effective in facilitating and maintaining the recovery of shoulder movement over the first 2 years after breast cancer surgery. To determine functional and psychological benefits of a 12 week supervised group exercise programme during treatment for early stage breast cancer, with six month follow-up.
                Pragmatic randomised controlled prospective open trial.
                Three National Health Service oncology clinics in Scotland and community exercise facilities.
                203 women entered the study; 177 completed the six month follow-up.
                Supervised 12 week group exercise programme in addition to usual care, compared with usual care.
                Functional assessment of cancer therapy (FACT) questionnaire, Beck depression inventory, positive and negative affect scale, body mass index, seven day recall of physical activity, 12 minute walk test, and assessment of shoulder mobility.
                Mixed effects models with adjustment for baseline values, study site, treatment at baseline, and age gave intervention effect estimates (intervention minus control) at 12 weeks of 129 (95% confidence interval 83 to 176) for metres walked in 12 minutes, 182 (75 to 289) for minutes of moderate intensity activity reported in a week, 2.6 (1.6 to 3.7) for shoulder mobility, 2.5 (1.0 to 3.9) for breast cancer specific subscale of quality of life, and 4.0 (1.8 to 6.3) for positive mood. No significant effect was seen for general quality of life (FACT-G), which was the primary outcome. At the six month follow-up, most of these effects were maintained and an intervention effect for breast cancer specific quality of life emerged. No adverse effects were noted.
                Supervised group exercise provided functional and psychological benefit after a 12 week intervention and six months later. Clinicians should encourage activity for their patients. Policy makers should consider the inclusion of exercise opportunities in cancer rehabilitation services. Trial registration Current controlled trials ISRCTN12587864 [controlled-trials.com]. There are several factors those contribute to the amount of axillary drainage after modified radical mastectomy. The drains should be removed as early as possible. Whether the active shoulder movement of the lesion side increases the amount of axillary drainage needs to be studied prospectively.
                From 1994 through 1995, 344 consecutive patients were randomly divided into three groups. One hundred sixteen patients in the early group performed upper arm exercises including pendulum, wall climbing and pulley exercises beginning the third post-operative day. One hundred fifteen patients in the later group patients did the same exercises beginning the sixth post-operative day and 113 patients in the delayed group did the same exercises after all the drains were removed.
                There were no significant differences in patient characteristics, including age, body weight, operation methods and the pathology in the three groups. The amount of axilla fossa drainage was significantly less in the patients in the delayed group than in the early and later group (485 ml, 568 ml, 559 ml, respectively, p = 0.032). However, there were no differences in the amount of chest wall site drainage or the number of aspiration of seroma among the three groups. The drains were removed on the average of seventh and ninth post-operative day in the delayed and early group patients, respectively (p = 0.124). Although the range of motion (ROM) of the shoulders in the delayed group patients was slightly limited during the first month after operation, ROM returned at 3 months and no difference was found 6 months after operation.
                Upper arm exercise can start after the drains in the axilla are removed. The delay does not limit the shoulder function at 6 months after modified radical mastectomy. A pilot research study was conducted at 2 cancer centers in Connecticut to determine the effect of a dance and movement program on quality of life and shoulder function in breast cancer survivors treated within the prior 5 years. Thirty-five women completed the trial that included a 12-week intervention, using The Lebed Method, Focus on Healing Through Movement and Dance. The study design was a randomized control trial with a wait list control group crossover to active treatment in weeks 13 to 25, with the treatment group receiving the program in weeks 1 to 12, and no program in weeks 13 to 25. Outcome measures were the Breast Cancer Quality of Life (FACT-B), Shoulder range of motion (ROM), and Body Image Scale. FACT-B significantly improved in the intervention group at 13 weeks from 102.0 +/- 15.8 to 116.7 +/- 16.9, compared to the wait list group 108.1 +/- 16.4 to 107.1 +/- 21.3 (time x group effect, P = .008). During the crossover phase, the FACT-B score increased in the wait list group and was stable in the treatment group. The overall effect of the training at 26 weeks was significant (time effect, P = .03), and the order of training was also significant (P = .015). Shoulder ROM increased in both groups at 13 weeks--15 degrees and 8 degrees in the intervention and wait list groups (Time effect, P = .03; time x group, P = .58). Body Image improved similarly in both groups at 13 weeks (time effect, P = .001; time x group, P = .25), and at 26 weeks. There was no significant effect of the order of training for these outcome measures. A dance movement program that addressed the physical and emotional needs of women following treatment for breast cancer substantially improved a breast cancer-specific quality-of-life measure. Larger studies are justified to determine the acceptability of this therapy as part of the continuum of care for breast cancer survivors. To assess the influence of physiotherapy performed during radiotherapy (RT) on the quality of life (QL) of women under treatment for breast cancer.
                This was a randomized clinical trial conducted on 55 women under RT treatment, 28 of whom were assigned to a group submitted to physiotherapy (PG) and 27 to the control group receiving no PG (CG). The physiotherapy technique used for PG was kinesiotherapy for the upper limbs using 19 exercises actively performed, with a series of ten rhythmic repetitions or stretching movements involving flexion, extension, abduction, adduction, internal and external shoulder rotation, separate or combined. QL was evaluated using the Functional Assessment of Cancer Therapy-Breast (FACT-B), at the beginning and at the end of RT and six months after the end of RT. The physiotherapy sessions were started concomitantly with RT, 90 days after surgery, on average.
                There was no difference between subgroups regarding the following subscales: physical well-being (p=0.8), social/family well-being (p=0.3), functional well-being (p=0.2) and breast subscale (p=0.2) at the three time points assessed. A comparison of the emotional subscale applied at the three evaluations demonstrated a better behavior of PG as compared to CG (p=0.01), with both groups presenting improvement on the breast subscale between the beginning and the end of RT (PG p=0.0004 and CG p=0.003). There was improvement in FACT-B scores at the end of RT in both groups (PG p=0.0006 and CG p=0.003). However, at the sixth month after RT, this improvement was maintained only in PG (p=0,005). QL assessed along time by the FACT B (p=0.004) and the Trial Outcome Index (TOI) (sums of the physical and functional well-being subscales and of the breast subscale) was better for PG (p=0.006). There was no evidence of negative effects associated with the exercises.
                The execution of exercises for the upper limbs was beneficial for QL during and six months after RT. Exercise participation has been shown to improve cardiovascular fitness and reduce psychological distress among women receiving chemotherapy and/or radiation. The purpose of this pilot study was to examine the changes in distress and body image, and fitness following exercise participation among 24 women who had been diagnosed with breast cancer within the previous 3 years. The women were randomly assigned to participate in a 12-week supervised aerobic exercise program in a hospital setting or a wait-list control group. Assessments of distress and body image were conducted at pre- and post-treatment. Data showed that the women in the exercise group improved significantly in body image (Physical Condition and Weight Concerns subscales) vs control group participants at post-treatment. Reductions in distress were also noted in the exercise group, but these were nonsignificant. At post-treatment, there were modest improvements in fitness in the exercise group.
                Copyright 2002 John Wiley & Sons, Ltd. Surgery and radiotherapy commonly cause adverse musculoskeletal problems, particularly loss of strength and range of motion, in the upper quadrant of breast cancer patients. Few well-designed studies have investigated whether these impairments can be prevented. Stretching is an effective technique for increasing range of motion, hence the aim of this study was to investigate whether a stretching program reduced acute musculoskeletal impairments in patients undergoing radiotherapy for breast cancer. Sixty-four women were recruited prior to commencement of radiotherapy following breast cancer surgery. Participants were randomised to either a control or stretch group. Participants in both groups were reviewed by the physical therapist on a weekly basis for approximately 6 weeks, and were given general information about skin care and lymphedema. The control group received no advice about exercise. The stretch group received instruction on low-load, prolonged pectoral stretches, which were to be performed daily and were checked at weekly visits. Shoulder range of motion, strength, arm circumference, and quality of life measurements were taken prior to, and at completion of radiotherapy, and at 7 months after radiotherapy. There was no difference in any outcome between groups. Breast symptoms increased for both groups during radiotherapy, without loss of strength or range of movement. The incidence of lymphedema during the study was low for both groups and did not differ between groups. The pectoral stretching program did not influence the outcomes measured because the symptoms reported by patients were not a consequence of contracture. We have compared different modes of rehabilitation after breast cancer surgery on a population of 257 patients treated at the Institute Gustave-Roussy in 1990 and 1991. The mode of rehabilitation was randomized according to a 2 X 2 design, between physiotherapy alone, shoulder movement alone, both or neither. Treatment began the day after breast surgery and continued for 7 days. Afterwards, all patients had physiotherapy and shoulder movements until the end of hospitalisation. Treatment efficacy was evaluated at day 7 by the volume of lymph drained, and by degree of shoulder movement. The volume of lymph collected by day 7 was reduced in the physiotherapy groups, but was not modified in the groups with shoulder movement. The degree of motion was larger in the group who had had both physiotherapy and shoulder movement. The frequencies of complications at day 7 and later were similar in the four treatment groups, but locoregional pain was less frequent in the two groups with shoulder movement than in the two other groups. An early treatment including both physiotherapy and shoulder movement seems advisable. A total of 144 evaluable patients with breast cancer were enrolled in a multicenter, randomized, prospective study to establish the role of delayed shoulder exercises on wound drainage and shoulder function after axillary lymph node dissection. Patients in group 1 (n = 78) started active shoulder exercises 1 day postoperatively. Patients in group 2 (n = 66) started on the eight postoperative day, following 1 week of immobilization of the arm. Patients in group 2 had 14% less wound drainage volume than those in group 1 (600 +/- 436 mL versus 701 +/- 398 mL); this difference, however, was not significant. Also, no differences could be established between the two groups when duration and volume of wound drainage, number and volume of seroma aspirations, wound complication rates, and shoulder function were compared 6 months after surgery. This study examined the efficacy of an exercise and relaxation program for adults with rheumatoid arthritis. The program integrates principles of occupational therapy and T'ai-Chi Ch'uan and was expected to be more effective than traditional exercise and rest regimens because of its expressive and pleasurable elements. There were significant differences between 17 experimental and 16 control subjects on two categories of dependent variables after the former group's participation in the experimental program. These dependent variables were range of motion measures and subject self-reports of frequency, enjoyment, and benefits of home exercise and rest routines. Pretest, posttest, and 4-month follow-up data were analyzed. Program participants showed significantly greater upper extremity range of motion 4 months after completing the program although the reported frequency of exercise and rest was greater in the control group. Postprogram reports of enjoyment were significantly higher for experimental than for control subjects. If these initial results are confirmed in further studies, the efficacy of the use of purposeful activity for exercise and rest will be supported. This study also supports the integration of Eastern and Western frames of reference in the treatment of patients with chronic illness.
Exercise can result in a significant and clinically meaningful improvement in shoulder ROM in women with breast cancer. In the post-operative period, consideration should be given to early implementation of exercises, although this approach may need to be carefully weighed against the potential for increases in wound drainage volume and duration. High quality research studies that closely monitor exercise prescription factors (e.g. intensity), and address persistent upper-limb dysfunction are needed.