National Cancer Control Institute, National Cancer Center, Goyang-si, South Korea.
Department of Sport Industry Sciences, Yonsei University, Seoul, South Korea.
JAMA Surg. 2024 Aug 1;159(8):872-880. doi: 10.1001/jamasurg.2024.1633.
Recovery of shoulder function following breast cancer surgery is crucial for physical functioning and quality of life. While early implementation of shoulder rehabilitation exercises may enhance recovery, the optimal timing and exercise program remain unclear.
To investigate whether an early exercise intervention, initiated 1 day postsurgery and continued for 1 month through subsequent visits, could improve shoulder range of motion (ROM) and strength in patients with breast cancer.
DESIGN, SETTING, AND PARTICIPANTS: A parallel-group, 2-arm randomized clinical trial was conducted between June 2020 and October 2021 at the Breast Cancer Center in Seoul, South Korea. Fifty-six patients (of 119 screened) with early-stage breast cancer who were scheduled for partial or total mastectomy were randomized into a tailored resistance exercise group (n = 28) or a usual care group (n = 28). Data were analyzed from November 2021 to June 2022.
The exercise intervention commenced 1 day postsurgery and consisted of 4 supervised exercise education sessions corresponding with surgeon visits and daily home-based exercises for the first postoperative month. Tailored programs, including stretching and strength exercises, were adjusted based on individual shoulder function recovery status.
Primary end points were shoulder ROM and strength at 1 and 6 months postsurgery. Physical activity, body composition, and quality of life were assessed at 6 months.
Of 56 patients randomized (mean [SD] age, 50.3 [6.6] years), 54 completed the trial (96%), with 100% and 97% compliance to supervised and home-based exercise sessions, respectively. At 1 month postsurgery, 19 (67.9%) in the exercise group had fully recovered shoulder strength compared to 1 (3.6%) in the usual care group (P < .001). At 6 months, 22 (78.6%) in the exercise group had fully recovered shoulder ROM and 24 (85.7%) had fully recovered strength compared to 6 (21.4%) and 5 (17.9%), respectively, in the usual care group (P < .001). The exercise group exhibited less loss in muscle mass and improved physical activity and quality of life compared to the usual care group.
In this trial, 1-month tailored exercise program, initiated immediately after breast cancer surgery and supplemented with supervised sessions coinciding with surgeon visits, significantly improved shoulder function in patients with breast cancer.
WHO International Clinical Trials Registry identifier: KCT0006997.
乳腺癌手术后肩部功能的恢复对于身体功能和生活质量至关重要。虽然早期实施肩部康复锻炼可能会促进恢复，但最佳时机和锻炼方案仍不清楚。
研究在乳腺癌患者中，术后第 1 天开始并持续 1 个月通过后续就诊进行的早期运动干预是否可以改善肩部活动范围（ROM）和力量。
设计、设置和参与者：这是一项在韩国首尔乳腺癌中心进行的 2020 年 6 月至 2021 年 10 月期间进行的平行分组、2 臂随机临床试验。共有 56 名（119 名筛查者中）早期乳腺癌患者被随机分为定制阻力运动组（n = 28）或常规护理组（n = 28）。数据于 2021 年 11 月至 2022 年 6 月进行分析。
运动干预于术后第 1 天开始，包括 4 次与外科医生就诊相对应的监督运动教育课程和术后第 1 个月的每日家庭锻炼。根据个体肩部功能恢复情况，调整了包括伸展和力量练习在内的定制方案。
主要终点为术后 1 个月和 6 个月的肩部 ROM 和力量。在 6 个月时评估身体活动、身体成分和生活质量。
在随机分组的 56 名患者中（平均[标准差]年龄，50.3[6.6]岁），54 名患者完成了试验（96%），监督和家庭锻炼的依从性分别为 100%和 97%。术后 1 个月，运动组有 19 名（67.9%）患者完全恢复肩部力量，而常规护理组有 1 名（3.6%）患者（P < .001）。术后 6 个月，运动组有 22 名（78.6%）患者完全恢复肩部 ROM，24 名（85.7%）患者完全恢复肩部力量，而常规护理组分别有 6 名（21.4%）和 5 名（17.9%）患者（P < .001）。与常规护理组相比，运动组的肌肉质量损失较少，身体活动和生活质量得到改善。
在这项试验中，乳腺癌手术后立即开始的为期 1 个月的定制运动方案，并辅以与外科医生就诊时间相吻合的监督课程，显著改善了乳腺癌患者的肩部功能。
世界卫生组织国际临床试验注册平台标识符：KCT0006997。
