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Aerobic and resistance exercise improves shoulder function in women who are overweight or obese and have breast cancer: randomized, controlled trial
Sweeney FC, Demark-Wahnefried W, Courneya KS, Sami N, Lee K, Tripathy D, Yamada K, Buchanan TA, Spicer DV, Bernstein L, Mortimer JE, Dieli-Conwright CM
Physical Therapy 2019;99(10):1334-1345
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Adverse upper limb musculoskeletal effects occur after breast cancer surgery and radiotherapy and may interfere with activities of daily living. OBJECTIVE: The objective of this study was to examine the effects of a 16-week exercise intervention on shoulder function in women who are overweight or obese and have breast cancer. DESIGN: This study was a randomized, controlled trial. SETTING: The study was performed at the Division of Biokinesiology and Physical Therapy at the University of Southern California. PARTICIPANTS: A total of 100 women with breast cancer were randomized to exercise or usual-care groups. The mean age of the women was 53.5 (SD 10.4) years, 55% were Hispanic white, and their body mass index was 33.5 (SD 5.5) kg/m2. INTERVENTION: The 16-week exercise intervention consisted of supervised, progressive, moderate to vigorous aerobic and resistance exercise 3 times per week. MEASUREMENTS: Shoulder active range of motion, isometric muscular strength, and patient-reported outcome measures (including Disabilities of the Arm, Shoulder, and Hand and the Penn Shoulder Scale) were assessed at baseline, after the intervention, and at the 3-month follow-up (exercise group only). Differences in mean changes for outcomes were evaluated using mixed-model repeated-measures analysis. RESULTS: Compared with the usual-care group, the exercise group experienced significant increases in shoulder active range of motion (the mean between-group differences and 95% confidence intervals were as follows: shoulder flexion 36.6 degrees (95% CI 55.2 to 20.7), external rotation at 0 degrees 23.4 degrees (95% CI 31.1 to 12.5), and external rotation at 90 degrees 34.3 degrees (95% CI 45.9 to 26.2)), improved upper extremity isometric strength, and improved Disabilities of the Arm, Shoulder, and Hand and Penn Shoulder Scale scores. LIMITATIONS: Limitations include a lack of masking of assessors after the intervention, an attention control group, and statistical robustness (shoulder function was a secondary endpoint). CONCLUSIONS: A 16-week exercise intervention effectively improved shoulder function following breast cancer treatment in women who were overweight or obese, who were ethnically diverse, and who had breast cancer.

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