Effect of physical activity levels on oncological breast surgery recovery: a prospective cohort study

Ifat Klein, Leonid Kalichman, Noy Chen, Sergio Susmallian, Ifat Klein, Leonid Kalichman, Noy Chen, Sergio Susmallian

Abstract

After breast cancer (BC) surgery, women may experience a physical decline. The effect of physical activity (PA) on the course of recovery after BC surgery has not yet been thoroughly examined. To analyze the impact of physical activity performed by women undergoing breast cancer surgery on measures of function, range of motion, and self-efficacy. A prospective study was carried out in 157 patients who underwent surgery for BC between October 2018 and April 2019, divided into four groups according to the intensity of PA with 6 months follow-up. 50 sedentary patients and 107 active patients were enrolled; the mean age was 52.6. Women who performed physical activity, moderate to vigorous, demonstrated lower function disabilities (QuickDASH 2.22) compared with inactivity or light physical activity (QuickDASH 7.0, p < 0.001), with better shoulder flexion (159.0° vs. 150.7°, p = 0.007) and abduction (159.5° vs. 152.2°, p = 0.008). Higher PA levels, displayed in higher self-efficacy reports (9.5 vs. 8.8, p = 0.002), and return to prior job status (0.005). The PA level does not influence pain at one, three and 6 months postoperatively (p = 0.278, p = 0.304 and p = 0.304 respectively). High PA levels increase the risk of axillary web syndrome (p = 0.041), although, it reduces the incidence of chronic pain (p = 0.007). Women who practice physical activity recover better from BC surgery than sedentary women. The higher the intensity and frequency of training, the better the results. Vigorous activity cause axillary web syndrome, despite, it has a beneficial effect on lowering the rate of chronic pain.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
The effect of physical activity on function disability scores by activity level over time.
Figure 3
Figure 3
The effect of physical activity on abduction flexion range of motion by activity level over time.

References

    1. Oja P, Titze S, Kokko S, et al. Health benefits of different sport disciplines for adults: Systematic review of observational and intervention studies with meta-analysis. Br J Sports Med. 2015;49(7):434–440. doi: 10.1136/bjsports-2014-093885.
    1. Smith JJ, Eather N, Morgan PJ, et al. The health benefits of muscular fitness for children and adolescents: A systematic review and meta-analysis. Sports Med. 2014;44(9):1209–1223. doi: 10.1007/s40279-014-0196-4.
    1. Gradishar WJ, Bland KI, Klimberg VS, et al. The Breast: Comprehensive Management of Benign and Malignant Diseases. Elsevier; 2017. pp. 1–1136.
    1. Schiff R, Chamness GC, Brown PH. Advances in breast cancer treatment and prevention: Preclinical studies on aromatase inhibitors and new selective estrogen receptor modulators (SERMs) Breast Cancer Res. 2003;5(5):1–4. doi: 10.1186/bcr626.
    1. Costa RL, Czerniecki BJ. Clinical development of immunotherapies for HER2 breast cancer: A review of HER2-directed monoclonal antibodies and beyond. NPJ Breast Cancer. 2020;6(1):1–11. doi: 10.1038/s41523-020-0153-3.
    1. Ontario HQ. Gene expression profiling tests for early-stage invasive breast cancer: A health technology assessment. Ont Health Technol Assess Ser. 2020;20(10):1.
    1. Ilhan E, Chee E, Hush J, et al. The prevalence of neuropathic pain is high after treatment for breast cancer: a systematic review. Pain. 2017;158:2082–2091. doi: 10.1097/j.pain.0000000000001004.
    1. Bodai BI, Tuso P. Breast cancer survivorship: A comprehensive review of long-term medical issues and lifestyle recommendations. Perm J. 2015;19(2):48.
    1. Rietman DP, Debreczeni R, et al. Impairments, disabilities and health related quality of life after treatment for breast cancer: A follow-up study 27 years after surgery. Disability Rehabil. 2004;26(2):78–84. doi: 10.1080/09638280310001629642.
    1. Nesvold I, Fosså SD, Holm I, et al. Arm/shoulder problems in breast cancer survivors are associated with reduced health and poorer physical quality of life. Acta Oncol. 2010;49(3):347–353. doi: 10.3109/02841860903302905.
    1. De Groef A, Van Kampen M, Dieltjens E, et al. Effectiveness of postoperative physical therapy for upper limb impairments following breast cancer treatment: A systematic review. Arch Phys Med Rehabil. 2015;96(6):1140–1153. doi: 10.1016/j.apmr.2015.01.006.
    1. Mustian KM, Sprod LK, Palesh OG, et al. Exercise for the management of side effects and quality of life among cancer survivors. Curr Sports Med Rep. 2009;8(6):325. doi: 10.1249/JSR.0b013e3181c22324.
    1. McNeely M, Campbell K, Rowe B, et al. Effects of exercise on breast cancer patients and survivors: A systematic review and meta-analysis. CMAJ. 2006;175(1):34–41. doi: 10.1503/cmaj.051073.
    1. Volaklis KA, Halle M, Tokmakidis SP. Exercise in the prevention and rehabilitation of breast cancer. Wien Klin Wochenschr. 2013;125(11):297–301. doi: 10.1007/s00508-013-0365-8.
    1. Spei M, Samoli E, Bravi F, et al. Physical activity in breast cancer survivors: A systematic review and meta-analysis on overall and breast cancer survival. Breast. 2019;44:144–152. doi: 10.1016/j.breast.2019.02.001.
    1. McNeely M, Campbell K, Ospina M, et al. Exercise interventions for upper-limb dysfunction due to breast cancer treatment. Cochrane Database Syst. Rev. 2010;6:11005211. doi: 10.1002/14651858.CD005211.pub2.
    1. Nilsson H, Angerås U, Bock D, et al. Is preoperative physical activity related to post-surgery recovery? A cohort study of patients with breast cancer. BMJ Open. 2016;6(1):e007997. doi: 10.1136/bmjopen-2015-007997.
    1. Smoot B, Paul SM, Aouizerat BE, et al. Predictors of altered upper extremity function during the first year after breast cancer treatment. Am. J. Phys. Med. Rehabil. 2016;95(9):639. doi: 10.1097/PHM.0000000000000455.
    1. Baima J, Reynolds S, Edmiston K, et al. Teaching of independent exercises for prehabilitation in breast cancer. J Cancer Educ. 2017;32(2):252–256. doi: 10.1007/s13187-015-0940-y.
    1. Sabiston CM, Wrosch C, Castonguay AL, et al. Changes in physical activity behavior and C-reactive protein in breast cancer patients. Ann. Behav. Med. 2018;52(7):545–551. doi: 10.1093/abm/kax010.
    1. Speck RM, Courneya KS, Mâsse LC, et al. An update of controlled physical activity trials in cancer survivors: A systematic review and meta-analysis. J. Cancer Surv. 2010;4(2):87–100. doi: 10.1007/s11764-009-0110-5.
    1. Craig CL, Marshall AL, Sjöström M, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35(8):1381–1395. doi: 10.1249/01.MSS.0000078924.61453.FB.
    1. Ainsworth BE, Haskell WL, Whitt MC, et al. Compendium of physical activities: An update of activity codes and MET intensities. Med. Sci. Sports Exerc. 2000;32(9):S498–S516. doi: 10.1097/00005768-200009001-00009.
    1. Stefani L, Galanti G, Klika R. Clinical implementation of exercise guidelines for cancer patients: Adaptation of ACSM’s guidelines to the Italian model. J. Funct. Morphol. Kinesiol. 2017;2(1):4. doi: 10.3390/jfmk2010004.
    1. Gummesson C, Ward MM, Atroshi I. The shortened disabilities of the arm, shoulder and hand questionnaire (quick DASH): Validity and reliability based on responses within the full-length DASH. BMC Musculoskelet Disord. 2006;7(1):44. doi: 10.1186/1471-2474-7-44.
    1. Vercelli S, Sartorio F, Bravini E, et al. DrGoniometer: A reliable smartphone app for joint angle measurement. Br. J. Sports Med. 2017;51(23):1703–1704. doi: 10.1136/bjsports-2016-096727.
    1. Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J. Clin. Nurs. 2005;14(7):798–804. doi: 10.1111/j.1365-2702.2005.01121.x.
    1. Harder H, Langridge C, Solis-Trapala I, et al. Post-operative exercises after breast cancer surgery: Results of a RCT evaluating standard care versus standard care plus additional yoga exercise. Eur. J. Integr. Med. 2015;7(3):202–210. doi: 10.1016/j.eujim.2015.02.002.
    1. Hunsaker F, Cioffi D, Amadio P, et al. The american academy of orthopaedic surgeons outcomes instruments : Normative values from the general population. J. Bone Joint Surg. Am. 2002;84(2):208–215. doi: 10.2106/00004623-200202000-00007.
    1. Yang A, Sokolof J, Gulati A. The effect of preoperative exercise on upper extremity recovery following breast cancer surgery: A systematic review. Int. J. Rehabil. Res. 2018;41(3):189–196. doi: 10.1097/MRR.0000000000000288.
    1. Nelson SH, Marinac CR, Patterson RE, Nechuta SJ, Flatt SW, Caan BJ, Kwan ML, Poole EL, Chen WY, Shu X, Pierce JP. Impact of very low physical activity, BMI, and comorbidities on mortality among breast cancer survivors. Breast Cancer Res. Treat. 2016;155(3):551–557. doi: 10.1007/s10549-016-3694-2.
    1. Bach PB, Schrag D, Brawley OW, Galaznic A, Yakren S, Begg CB. Survival of blacks and whites after a cancer diagnosis. JAMA. 2002;28716:2106–2113. doi: 10.1001/jama.287.16.2106.
    1. De Glas NA, et al. Physical activity and survival of postmenopausal, hormone receptor–positive breast cancer patients: Results of the Tamoxifen Exemestane Adjuvant Multicenter Lifestyle study. Cancer. 2014;120(18):2847–2854. doi: 10.1002/cncr.28783.
    1. Ribeiro IL, Moreira RFC, Ferrari AV, et al. Effectiveness of early rehabilitation on range of motion, muscle strength and arm function after breast cancer surgery: A systematic review of randomized controlled trials. Clin Rehabil. 2019;33(12):1876–1886. doi: 10.1177/0269215519873026.
    1. Wilson DJ. Exercise for the patient after breast cancer surgery. Semin Oncol. Nurs. 2017;33(1):98–105. doi: 10.1016/j.soncn.2016.11.010.
    1. Galantino ML, Stout NL. Exercise interventions for upper limb dysfunction due to breast cancer treatment. Phys. Ther. 2013;93(10):1291–1297. doi: 10.2522/ptj.20120049.32.
    1. Lanser P, Gessel S. Pain management: The fifth vital sign. Healthc. Benchmarks. 2001;8(6):68–70.
    1. Pickett M, Mock V, Ropka ME, et al. Adherence to Moderate-Intensity exercise during breast cancer therapy. Cancer Pract. 2002;10(6):284–292. doi: 10.1046/j.1523-5394.2002.106006.x.
    1. Mijwel S, Jervaeus A, Bolam KA, et al. High-intensity exercise during chemotherapy induces beneficial effects 12 months into breast cancer survivorship. J. Cancer Surv. 2019;13(2):244–256. doi: 10.1007/s11764-019-00747-z.
    1. Schulz SVW, Laszlo R, Otto S, et al. Feasibility and effects of a combined adjuvant high-intensity interval/strength training in breast cancer patients: A single-center pilot study. Disabil. Rehabil. 2018;40(13):1501–1508. doi: 10.1080/09638288.2017.1300688.
    1. Levy EW, Pfalzer LA, Danoff J, et al. Predictors of functional shoulder recovery at 1 and 12 months after breast cancer surgery. Breast Cancer Res. Treat. 2012;134(1):315–324. doi: 10.1007/s10549-012-2061-1.
    1. Lee MK, Kang HS, Lee KS, et al. Three-year prospective cohort study of factors associated with return to work after breast cancer diagnosis. J. Occup. Rehabil. 2017;27(4):547–558. doi: 10.1007/s10926-016-9685-7.
    1. Johansson K, Tibe K, Weibull A, Newton RU. Low intensity resistance exercise for breast cancer patients with arm lymphedema with or without compression sleeve. Lymphology. 2005;38(4):167–180.
    1. Schmitz KH, Ahmed RL, Troxel A, et al. Weight lifting in women with breast-cancer–related lymphedema. N. Engl. J. Med. 2009;361(7):664–673. doi: 10.1056/NEJMoa0810118.
    1. Ahmed RL, Thomas W, Yee D, et al. Randomized controlled trial of weight training and lymphedema in breast cancer survivors. J. Clin. Oncol. 2006;24(18):2765–2772. doi: 10.1200/JCO.2005.03.6749.
    1. Aydogan F, Belli AK, Baghaki S, Karabulut K, Tahan G, Uras C. Axillary web syndrome after sentinel node biopsy. Breast Care (Basel). 2008;3(4):277–278. doi: 10.1159/000145384.
    1. Fukushima KFP, Carmo LA, Borinelli AC, et al. Frequency and associated factors of axillary web syndrome in women who had undergone breast cancer surgery: A transversal and retrospective study. Springerplus. 2015;4(1):112. doi: 10.1186/s40064-015-0889-7.
    1. Jacob T, Bracha J. Identification of signs and symptoms of axillary web syndrome and breast seroma during a course of physical therapy 7 months after lumpectomy: A case report. Phys Ther. 2019;99(2):229–239. doi: 10.1093/ptj/pzy110.
    1. Hunt WTN, Porter R, Lucke T. Axillary web syndrome induced by physical exertion. Clin. Exp. Dermatol. 2020;45(3):382–384. doi: 10.1111/ced.14089.
    1. Fukushima KF, Carmo LA, Borinelli AC, Ferreira CW. Frequency and associated factors of axillary web syndrome in women who had undergone breast cancer surgery: A transversal and retrospective study. Springerplus. 2015;4:112. doi: 10.1186/s40064-015-0889-7.
    1. Poleshuck EL, Katz J, Andrus CH, Hogan LA, Jung BF, Kulick DI, Dworkin RH. Risk factors for chronic pain following breast cancer surgery: A prospective study. J. Pain. 2006;7(9):626–634. doi: 10.1016/j.jpain.2006.02.007.
    1. Forsythe LP, Alfano CM, George SM, et al. Pain in long-term breast cancer survivors: The role of body mass index, physical activity, and sedentary behavior. Breast Cancer Res. Treat. 2013;137(2):617–630. doi: 10.1007/s10549-012-2335-7.
    1. Galiano-Castillo N, Cantarero-Villanueva I, Fernández-Lao C, et al. Telehealth system: A randomized controlled trial evaluating the impact of an internet-based exercise intervention on quality of life, pain, muscle strength, and fatigue in breast cancer survivors. Cancer. 2016;122(20):3166–3174. doi: 10.1002/cncr.30172.

Source: PubMed

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