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

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.

Keywords: Breast cancer; Exercise; Lymphedema; Pain; Quality of life.