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Effectiveness of three exercise programs and intensive follow-up in improving quality of life, pain, and lymphedema among breast cancer survivors: a randomized, controlled 6-month trial

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Abstract

Purpose

Postoperative complications of breast cancer (BC) seriously affect the quality of life (QOL) of survivors. Physical activity is related to prevention of complications and improvement of QOL. Follow-up can keep patients motivated to exercise. This study aimed to (1) compare the effect of three exercise programs on lymphedema, pain, and QOL in BC patients and (2) explore the effect of intensive follow-up on the outcomes of exercise programs.

Methods

A single-blind randomized parallel controlled trial with a 6-month intervention was carried out in China in 2021. The study sample included 200 women with BC. The patients were randomly divided into 4 groups. G0 (control group) was joint mobility exercise (JME) group; G1 was joint mobility exercise + intensive follow-up (IF) group; G2 was JME + aerobic exercise (AE) + IF group; and G3 was JME + progressive resistance exercise (PRE) + IF group. Outcome measures were evaluated at baseline (T1), 3 months post-intervention (T2), and 6 months post-intervention (T3). The following instruments and measurements were administered before and after the intervention: the Functional Assessment of Cancer Therapy-Breast (FACT-B) instrument, the numerical rating scale (NRS), and the relative volume change (RVC). Verificating aim 1 is by comparing the results of G1, G2, and G3, and verificating aim 2 is achieved by comparing G0 and G1. Differences before and after the intervention were determined by analysis of variance of repeated measures and Kruskal–Wallis nonparametric analysis of variance.

Results

Among the exercise programs, JME + PRE + IF resulted in the best improvement in QOL (T2: ΔG3-G0 = 13.032, P = 0.008; T2: ΔG3-G1 = 13.066, P < 0.001; ΔG3-G0 = 17.379, P < 0.001). For pain relief, JME + AE + IF had the best improvement (T3: ΔG2-G1 =  − 0.931, P = 0.010; ΔG2-G0 =  − 1.577, P < 0.001). For the prevention of lymphedema, JME + AE + IF (Z = 2.651, P = 0.048) and JME + PRE + IF (Z = 3.277, P = 0.006) had the similar effect, but JME + PRE + IF is better than JME + AE + IF.

Conclusion

JME + PRE have the best effect in improving the QOL and preventing lymphedema after surgery. In improving pain, the effect of JME + AE appears earlier, and the overall effect of JME + PRE is better. In addition, long-term and planned monitoring and follow-up are also important.

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Data availability

All data and materials are available.

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Abbreviations

BC:

Breast cancer

JME:

Joint mobility exercise

IF:

Intensive follow-up

AE:

Aerobic exercise

PRE:

Progressive resistance exercise

T1 :

Baseline

T2 :

3 Months after the intervention

T3 :

6 Months after the intervention

FACT-B:

The Functional Assessment of Cancer Therapy-Breast instrument

QOL:

Quality of life

NRS:

The numerical rating scale

RVC:

The relative volume change

CONSORT:

Consolidated Standards of Reporting Trials

ANOVA:

Analysis of variance

ICBN:

The intercostobrachial nerve

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Acknowledgements

The authors also appreciate all the volunteers for participating in the study. The authors thank AiMi Academic Services (www.aimieditor.com) for the English language editing and review services.

Funding

The research was supported by the Shaanxi Key R & D projects (no. 2022SF-371).

Author information

Author notes

  1. Yawei Lin, Chao Wu and Chunyan He contributed equally to this work.

Authors and Affiliations

  1. Department of Clinical Nursing, School of Nursing, Air Force Medical University, 169 Changle West Avenue, New Urban District, Xi’an, 710000, Shaanxi, China

    Yawei Lin, Chao Wu, Chunyan He, Jiaran Yan, Li Gao & Baohua Cao

  2. 956Th Hospital of the Chinese People’s Liberation Army, Nyingchi, Tibet, China

    Yawei Lin

  3. Unit 66029 of the Chinese People’s Liberation Army, Xilinguole League, Inner Mongolia Autonomous Region, Hohhot, China

    Yi Chen

  4. College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, 28 Fuxing Road, Beijing, China

    Rongrong Liu

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  1. Yawei Lin
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Lin Yawei, Wu Chao, He Chunyan, Yan Jiaran, Chen Yi, Gao Li, Liu Rongrong, and Cao Baohua. The first draft of the manuscript was written by Lin Yawei, Wu Chao, and He Chunyan, and all authors commented on the previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Baohua Cao.

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Lin, Y., Wu, C., He, C. et al. Effectiveness of three exercise programs and intensive follow-up in improving quality of life, pain, and lymphedema among breast cancer survivors: a randomized, controlled 6-month trial. Support Care Cancer 31, 9 (2023). https://doi.org/10.1007/s00520-022-07494-5

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