Content area
Full Text
Abstract-Lymphedema is a debilitating complication following mastectomy, affecting the arm functions and quality of life (QOL) of breast cancer patients. Studies have shown the beneficial effects of upper-limb exercises on lymphedema in clinical settings. However, there is a dearth of evidence regarding the effect of home-based exercises on lymphedema; therefore, we examined the effect of a home-based exercise program on lymphedema and QOL in postmastectomy patients. Thirty-two female postmastectomy lymphedema patients participated in an individualized home-based exercise program for 8 weeks. Arm circumference, arm volume, and QOL (36-Item Short Form Health Survey) were measured before and after the program. Data were analyzed with the use of paired t-tests for circumferential and volumetric measures and Wilcoxon signed ranks tests for QOL. Significance level was set at p < 0.01 with Bonferroni correction (alpha/n = 0.05/5 = 0.01). Analysis showed a statistically significant improvement in the affected upper-limb circumference and volume (~122 mL reduction, p < 0.001) and in the QOL scores (p < 0.001) at the end of the home-based exercise program. The individualized home-based exercise program led to improvement in affected upper-limb volume and circumference and QOL of postmastectomy lymphedema patients.
Key words: breast cancer, home-based exercise program, mastectomy, physiotherapy, postmastectomy lymphedema, progressive resistance exercise, quality of life, rehabilitation, upper-limb exercise, Wilcoxon signed rank test.
Abbreviations: QOL = quality of life, SF-36 = 36-Item Short Form Health Survey.
INTRODUCTION
Lymphedema is a chronic, debilitating complication that breast cancer survivors face after breast cancer treatment [1-8]. Incidence of secondary arm lymphedema varies from 5 to 56 percent [4,7-12]. About 60 percent of patients who undergo axillary lymph node resection and irradiation will eventually develop lymphedema [13].
Lymphedema develops when the lymphatic flow is impaired and excess fluid and protein accumulate in the interstitial space. The hemodynamic factors at the site of lymphedema may also play a role in its development [1]. Affected women can experience pain, swelling, arm tightness, heaviness of the arm, and recurrent skin infections. If left untreated, lymphedema may predispose the affected limb to the development of other secondary complications like recurrent bouts of cellulitis or lymphangitis, axillary vein thrombosis, severe functional impairment, cosmetic embracement, and lymphangiosarcoma [9]. Breast cancer survivors may find lymphedema more distressing than mastectomy, because hiding the physiological...