Teaching of Independent Exercises for Prehabilitation in Breast Cancer

Abstract

We attempted to determine the feasibility of studying prehabilitation exercises to improve shoulder pain and abduction range of motion (ROM) after breast cancer surgery. We evaluated methods of exercise teaching and assessed effect on postsurgical seroma formation. This was a feasibility study with two non-blinded groups of subjects randomized by timing of appointment. This single-site study was performed at an academic tertiary medical center. Sixty cancer patients were randomly assigned to either group 1, in-person teaching arm, n = 36, or group 2, video-only teaching arm, n = 24. Forty-five patients completed the study. Shoulder exercises were assigned to both groups 1 month prior to surgery during evaluation. Group 1 received in-person instruction on exercises, plus an information sheet with exercises and a link to an online video. Group 2 received only the information sheet with exercises and a link to the online video. The primary outcomes considered are as follows: exercise compliance, shoulder pain (via visual analog scale), shoulder abduction ROM (via goniometer), and presence or absence of seroma. Seventy-six percent of study patients chose to exercise. There was no difference in exercise compliance between in-person teaching versus video teaching (75 %, 24/32 vs. 77 %, 10/13, OR = 1.03). Sixty-six of patients (20/30) lost greater than 10° shoulder abduction ROM at 1 month post surgery. Twenty-nine of patients (9/31) had worse shoulder pain than baseline at 1 month post surgery (24 %, 6/25 exercisers, and 50 %, 3/6 non-exercisers). Fifteen percent of patients (4/27) had worse shoulder pain than baseline at 3 months post surgery (8 %, 2/23 exercisers, and 100 %, 2/2 non-exercisers). Prehabilitation exercise program inferred no additional risk of seroma formation (Exercisers 21 %, 7/33 vs. non-exercisers 22 %, 2/9, OR = 0.94). Our subjects were able to perform three exercises independently in the preoperative period. A high-quality randomized controlled trial is necessary to assess the appropriate timing and efficacy of this intervention.

Prehabilitation for adults diagnosed with cancer: A systematic review of long‐term physical function, nutrition and patient‐reported outcomes

“…These interventions were all compared to usual or supportive care. Adherence to the intervention was not always reported in the observational studies with attrition 25%–52% respectively (Baima et al, ) (Jones et al, ).…”

“…Three studies reported favourable effects of home‐based pelvic floor training on post‐operative urinary continence outcomes in prostate cancer patients undergoing radical prostatectomy up to 12 months of follow‐up (Burgio et al, ; Centemero et al, ; Sueppel et al, ), and a fourth study (Bales et al, ) showed no urinary continence benefits of including biofeedback training. Similarly, a study of female breast cancer patients reported no additional post‐operative benefits when home‐based shoulder exercise prehabilitation included an in‐person teaching session versus video‐based instruction (Baima et al, ). Supervised exercise prehabilitation programmes in lung cancer patients have generally been more intensive than home‐based programmes and have resulted in improvements in pre‐operative cardiopulmonary fitness measures, including six‐minute walk test (6 MWT) (Jones et al, ) and peak VO 2 (Jones et al, ; Stefanelli et al, ).…”

“…Studies were primarily feasibility studies, and participant numbers were small, ranging from 35 to 87 with a total of 289 participants. Studies included individuals with breast cancer (Baima et al, 2015), lung cancer (Jones et al, 2007;Peddle et al, 2009;Sekine et al, 2005), colorectal cancer (Li et al, 2013) and prostate cancer (Sueppel, Kreder, & See, 2001).…”

“…These exercises were performed on 5-7 days per week and included incentive spirometry, abdominal breathing, huffing and coughing, and respiratory exercises on a bench, mattress pad and wall bars. Finally, a study in breast cancer patients investigated the feasibility of therapeutic shoulder mobility exercises in the 2-4 weeks before surgery, comparing in-person teaching with video-only teaching (Baima et al, 2015). Both methods were shown to be feasible with high adherence (≥75%).…”

“…Studies involving a psychoeducation modality as part of prehabilitation programmes have focused primarily on anxiety and stress reduction (Cheville et al, 2015;Garssen et al, 2013;Parker et al, 2009;Schmidt et al, 2015), patient education and lifestyle advice (Baima et al, 2015;Barlési et al, 2008) (Jensen et al, 2015) and/ or counselling (Parker et al, 2009) as part of the intervention; however, few studies report any detail of the therapeutic components of the intervention. Psychoeducational prehabilitation strategies have been studied as single mode counselling interventions (Barlési et al, 2008;Cheville et al, 2015) or by comparing a variety of psychological and educational approaches prior to cancer treatment (Parker et al, 2009).…”