Early exercise may facilitate recovery after breast cancer surgery: A groundbreaking randomized clinical trial

The findings, published in JAMA Surgery, revealed the effectiveness of an early tailored home-based exercise intervention supplemented with supervised sessions during surgical visits immediately after breast cancer surgery. 

"In the study, significantly more participants in the exercise group regained 95% of their shoulder strength after 1 and 6 months postsurgery versus the usual care group," the researchers reported.

Shoulder function recovery following breast cancer surgery is important for quality of life and physical functioning. The early implementation of shoulder rehabilitation exercises may enhance recovery, however, there is no clarity on the optimal timing and exercise program. Considering this, Jihee Min, National Cancer Control Institute, National Cancer Center, Goyang-si, South Korea, and colleagues aimed to investigate whether an early exercise intervention, initiated 1 day postsurgery and continued for one month through subsequent visits, could improve shoulder range of motion (ROM) and strength in breast cancer patients.

For this purpose, the researchers conducted a parallel-group, 2-arm randomized clinical trial between 2020 and 2021 at the Breast Cancer Center in Seoul, South Korea. It included fifty-six patients (of 119 screened) with early-stage breast cancer who were scheduled for total or partial mastectomy. They were randomized into a tailored resistance exercise group (n = 28) or a usual care group (n = 28).

The exercise intervention commenced 1-day post-surgery and comprised four supervised exercise education sessions corresponding with surgeon visits and daily home-based exercises for the first postoperative month. Tailored programs, including strength exercises and stretching, were adjusted based on the recovery status of individual shoulder function.

Primary endpoints included shoulder ROM and strength at 1 and 6 months post-surgery. At six months, physical activity, quality of life, and body composition were assessed.

The study led to the following findings:

• Of 56 patients randomized (mean age, 50.3 years), 54 completed the trial, with 100% and 97% compliance with supervised and home-based exercise sessions, respectively.
• At 1 month post-surgery, 67.9% in the exercise group had fully recovered shoulder strength compared to 3.6% in the usual care group.
• At six months, 78.6% in the exercise group had fully recovered shoulder ROM, and 85.7% had fully recovered strength compared to 21.4% and 17.9%, respectively, in the usual care group.
• The exercise group exhibited less loss in muscle mass and improved physical activity and quality of life compared to the usual care group.

The findings showed that the early intervention-tailored exercise programming immediately after surgery for breast cancer improved shoulder function and other health parameters.

"In the future, multinational and multicenter trials should be performed to test the external validity of the combined supervised and home-based exercise program we developed and implemented in this study," the researchers wrote.

Reference:

Min J, Kim JY, Ryu J, et al. Early Implementation of Exercise to Facilitate Recovery After Breast Cancer Surgery: A Randomized Clinical Trial. JAMA Surg. Published online June 05, 2024. doi:10.1001/jamasurg.2024.1633