Starting shoulder exercises early improves recovery

Starting shoulder exercises soon after surgery for breast cancer can result in a significant improvement in recovery of movement, according to Australian researchers.

They said upper-limb dysfunction was a common side effect of breast cancer surgery.

After reviewing 24 studies, they concluded starting exercises in the first three days after surgery resulted in better recovery of movement than delaying exercise, but added: “This approach may need to be carefully weighed against the potential for increases in wound drainage.” 

The following abstract summary of the study is taken from the Cochrane Collaboration.

Upper-limb dysfunction following breast cancer surgery:

The use of upper-limb stretching and strengthening exercises after breast cancer surgery have been shown to improve recovery of shoulder movement.

However, there are different views on what type of exercise is best and how soon exercises should be started following surgery. Moreover, it is not known if exercise is helpful in addressing upper-limb problems that persist following surgery and there is some concern that upper-limb exercise may increase the risk of developing lymphedema in the arm.

In this review, a total of 24 studies examined the benefit of exercise on upper-limb dysfunction. Ten studies examined whether it was better to start exercise early after surgery or to delay exercise by about one week. Six studies examined structured exercise programs compared to usual care (exercise pamphlet or no exercise) following surgery. Three studies examined exercise interventions carried out during cancer treatment and five studies examined exercise interventions carried out following cancer treatment.

Best estimate of the effect of upper-limb exercise for women with breast cancer:

1) This review found that upper-limb exercise (e.g. shoulder ROM and stretching) is helpful in recovering upper-limb movement following surgery for breast cancer. Starting exercise early after surgery (day 1 to day 3) may result in better shoulder movement in the short term; however, it may also result in more wound drainage and require the drains to be in place longer than if exercise is delayed by about one week.

2) This review showed that more structured exercise programs, such as physical therapy, delivered in the early weeks following surgery are beneficial to regain movement in, and use of the shoulder and arm for daily activities such as reaching overhead.

3) This review did not find any evidence that upper-limb exercise, whether carried out following surgery, or during/ following other cancer treatments, resulted in more patients developing arm lymphedema