Effect of exercise on upper extremity pain and dysfunction in head and neck cancer survivors

Abstract

BACKGROUND.Shoulder pain and disability are well recognized complications associated with surgery for head and neck cancer. This study was designed to examine the effects of progressive resistance exercise training (PRET) on upper extremity pain and dysfunction in postsurgical head and neck cancer survivors.METHODS.Fifty‐two head and neck cancer survivors were assigned randomly to PRET (n = 27) or a standardized therapeutic exercise protocol (TP) (n = 25) for 12 weeks. The primary endpoint was change in patient‐rated shoulder pain and disability from baseline to postintervention. Secondary endpoints were upper extremity strength and endurance, range of motion, fatigue, and quality of life.RESULTS.Follow‐up assessment for the primary outcome was 92%, and adherence to the supervised PRET and TP programs were 95% and 87%, respectively. On the basis of intention‐to‐treat analyses, PRET was superior to TP for improving shoulder pain and disability (−9.6; 95% confidence interval [95% CI], −16.4 to −4.5; P = .001), upper extremity strength (+10.8 kg; 95% CI, 5.4–16.2 kg; P < .001), and upper extremity endurance (+194 repetitions × kg; 95% CI, 10–378 repetitions × kg; P = .039). Changes in neck dissection impairment, fatigue, and quality of life favored the PRET group but did not reach statistical significance.CONCLUSIONS.The PRET program significantly reduced shoulder pain and disability and improved upper extremity muscular strength and endurance in head and neck cancer survivors who had shoulder dysfunction because of spinal accessory nerve damage. Clinicians should consider the addition of PRET in the rehabilitation of postsurgical head and neck cancer survivors. Cancer 2008. © 2008 American Cancer Society.

Sustainability of Outcomes after a Randomized Crossover Trial of Resistance Exercise for Shoulder Dysfunction in Survivors of Head and Neck Cancer

“…2,11 The results from our randomized controlled trial of upper extremity (UE) progressive resistance exercise training (PRET) demonstrated significant improvements in patient-rated shoulder pain and disability, UE strength and endurance, and range of motion in post-surgical HNC survivors. 12 All other outcomes, including fatigue, neck dissection impairment, and quality of life (QOL), favoured the PRET group at the end of the 12-week intervention but did not reach statistical significance. 12 In this article, we report the 12-month follow-up data from our randomized crossover trial comparing PRET with a standard therapeutic protocol (TP) in post-surgical HNC survivors.…”

“…12 All other outcomes, including fatigue, neck dissection impairment, and quality of life (QOL), favoured the PRET group at the end of the 12-week intervention but did not reach statistical significance. 12 In this article, we report the 12-month follow-up data from our randomized crossover trial comparing PRET with a standard therapeutic protocol (TP) in post-surgical HNC survivors. Our study is one of the first to provide follow-up data on a resistance exercise intervention for shoulder pain and dysfunction after neck dissection in HNC survivors.…”

“…Because the study methods have previously been reported, 12 here we briefly review the methods, with additional information pertaining to the 12-month follow-up assessment.…”

Predictors of adherence to an exercise program for shoulder pain and dysfunction in head and neck cancer survivors

“…The PRET protocol, however, was tailored to each survivor based on baseline testing results and consisted of two sets of [10][11][12][13][14][15] repetitions, starting at 25-30% of their 1 repetition maximum (1-RM) strength, slowly progressing to 60-70% of their 1-RM by the end of the intervention period. Details of the PRET protocol have been published previously [5,12,13]. To summarize, participants in the TP arm of the trial performed a low-intensity resistance exercise program, while participants in the PRET arm performed a moderateintensity resistance exercise program.…”

“…We previously reported that PRET was superior to TP for reducing shoulder pain and disability and improving upper extremity muscular strength and upper extremity muscular endurance [5]. The purpose of the present trial was to identify the key predictors of exercise adherence during the trial.…”