We included 24 studies involving 2132 participants. Ten of the 24 were considered of adequate methodological quality.
Ten studies examined the effect of early versus delayed implementation of post-operative exercise. Implementing early exercise was
more effective than delayed exercise in the short term recovery of shoulder flexion ROM (Weighted Mean Difference (WMD): 10.6
degrees; 95%Confidence Interval (CI): 4.51 to 16.6); however, early exercise also resulted in a statistically significant increase in wound
drainage volume (Standardized Mean Difference (SMD) 0.31; 95% CI: 0.13 to 0.49) and duration (WMD: 1.15 days; 95% CI: 0.65
to 1.65).
Fourteen studies examined the effect of structured exercise compared to usual care/comparison. Of these, six were post-operative, three
during adjuvant treatment and five following cancer treatment. Structured exercise programs in the post-operative period significantly
improved shoulder flexion ROMin the short-term(WMD: 12.92 degrees; 95%CI: 0.69 to 25.16). Physical therapy treatment yielded
additional benefit for shoulder function post-intervention (SMD: 0.77; 95% CI: 0.33 to 1.21) and at six-month follow-up (SMD:
0.75; 95% CI: 0.32 to 1.19). There was no evidence of increased risk of lymphedema from exercise at any time point.
Authors’ conclusions
Exercise can result in a significant and clinically meaningful improvement in shoulder ROMin women with breast cancer. In the postoperative
period, consideration should be given to early implementation of exercises, although this approach may need to be carefully
weighed against the potential for increases in wound drainage volume and duration. High quality research studies that closely monitor
exercise prescription factors (e.g. intensity), and address persistent upper-limb dysfunction are needed.