Therapeutic effect of home-based rehabilitation exercise on postoperative lymphedema in breast cancer patients

doi:10.3877/cma.j.issn.1674-0785.2022.04.013

Abstract

Abstract:

Objective

To explore the therapeutic effect of home-based rehabilitation exercise on postoperative lymphedema in patients with breast cancer.

Methods

Eighty breast cancer patients with postoperative lymphedema at Department of Cancer Chemotherapy, Haikou Hospital, Xiangya School of Medicine, Central South University from October 2021 to April 2019 were selected and randomly divided into either a control group or an exercise group. The control group was subjected to usual self-care, and the exercise group underwent home-based rehabilitation exercise on the basis of usual self-care. The therapeutic effect of rehabilitation exercise on lymphedema was evaluated by measuring the size of arm circumference, volume difference between affected limbs, range of motion of the shoulder joint, arm muscle strength, quality of life, and other indicators.

Results

After at least 6 weeks of intervention and rehabilitation, compared with the control group, the arm circumference size and arm volume decreased significantly in the exercise group (P＜0.05). The recovery of shoulder motion range in the exercise group was significantly better than that of the control group (P＜0.05). In addition, the muscle strength levels of the flexor, abductor, external pronator, internal pronator, and horizontal adductor were significantly increased in the exercise group (P＜0.05). The exercise group had improved quality of life in all dimensions, according to Functional Assessment of Cancer Therapy-Breast assessment.

Conclusion

Rehabilitation exercise is safe and effective in the treatment of postoperative lymphedema in breast cancer patients, which provides a reference for home-based rehabilitation exercise in the treatment of lymphedema after breast cancer surgery.

Key words: Home-based rehabilitation and exercise, Breast cancer patients, Lymphedema, Postoperative

Xiaoling Chen, Lemei Sun, Jiping Wu, Cui Gui, Yuji Mo. Therapeutic effect of home-based rehabilitation exercise on postoperative lymphedema in breast cancer patients[J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(04): 362-367.

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URL: https://zhlcyszz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0785.2022.04.013

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Figures/Tables 5

项目	对照组（40例）	锻炼组（40例）	t/χ²值	P值
年龄（岁， $x ¯$ ±s）	49.82±5.13	51.42±4.39	1.499	0.138
体重指数（kg/m²， $x ¯$ ±s）	24.6±3.9	23.8±4.9	0.713	0.478
淋巴水肿时长（年， $x ¯$ ±s）	4.5±1.4	4.9±1.7	1.149	0.254
术后时长（年， $x ¯$ ±s）	1.3±0.3	1.4±0.4	1.265	0.210
乳腺癌手术［例（%）］			1.317	0.251
块状切除术	18（45.0）	13（32.5）
乳房切除术	22（55.0）	27（67.5）
淋巴清扫类型［例（%）］			0.392	0.531
前哨节点	5（12.5）	7（17.5）
腋窝间隙	35（87.5）	33（82.5）
乳腺癌分期［例（%）］			1.348	0.965
DCIS	1（2.5）	3（7.5）
1	9（22.5）	7（17.5）
2	24（60.0）	23（57.5）
3	6（15.0）	7（17.5）
治疗效果［例（%）］
化疗	18（46）	19（48）	0.050	0.823
有效化疗	17（42）	18（46）	0.051	0.822
放射治疗	22（54）	21（52）	0.050	0.823
有效放射治疗	20（50）	19（48）	0.050	0.823
最常见的放射治疗领域［例（%）］			1.410	0.494
胸部	25（62.5）	27（67.5）
腋窝	5（12.5）	7（17.5）
腋下和胸部	10（25.0）	6（15.0）

项目	对照组（40例）	锻炼组（40例）	t/χ²值	P值
年龄（岁， $x ¯$ ±s）	49.82±5.13	51.42±4.39	1.499	0.138
体重指数（kg/m²， $x ¯$ ±s）	24.6±3.9	23.8±4.9	0.713	0.478
淋巴水肿时长（年， $x ¯$ ±s）	4.5±1.4	4.9±1.7	1.149	0.254
术后时长（年， $x ¯$ ±s）	1.3±0.3	1.4±0.4	1.265	0.210
乳腺癌手术［例（%）］			1.317	0.251
块状切除术	18（45.0）	13（32.5）
乳房切除术	22（55.0）	27（67.5）
淋巴清扫类型［例（%）］			0.392	0.531
前哨节点	5（12.5）	7（17.5）
腋窝间隙	35（87.5）	33（82.5）
乳腺癌分期［例（%）］			1.348	0.965
DCIS	1（2.5）	3（7.5）
1	9（22.5）	7（17.5）
2	24（60.0）	23（57.5）
3	6（15.0）	7（17.5）
治疗效果［例（%）］
化疗	18（46）	19（48）	0.050	0.823
有效化疗	17（42）	18（46）	0.051	0.822
放射治疗	22（54）	21（52）	0.050	0.823
有效放射治疗	20（50）	19（48）	0.050	0.823
最常见的放射治疗领域［例（%）］			1.410	0.494
胸部	25（62.5）	27（67.5）
腋窝	5（12.5）	7（17.5）
腋下和胸部	10（25.0）	6（15.0）

项目	对照组（40例）	锻炼组（40例）	t值	P值
淋巴水肿大小检测（cm²， $x ¯$ ±s）
第0周	6.51±0.51	6.38±1.65	0.402	0.689
第1~3周	6.52±0.68	6.16±0.67	2.385	0.020
第4~5周	6.43±0.52	6.01±0.45^a	3.863	＜0.001
第6周以后	6.21±0.69^ab	5.74±0.86^ab	2.696	0.009
手臂体积测量（ml， $x ¯$ ±s）
第0周	184.61±27.57	185.51±26.29	0.149	0.882
第1~3周	185.47±27.54	172.64±27.73^a	2.076	0.041
第4~5周	185.14±25.26	168.15±24.34^a	3.063	0.003
第6周以后	185.48±26.19	164.59±27.49^a	3.480	0.001

项目	对照组（40例）	锻炼组（40例）	t值	P值
淋巴水肿大小检测（cm²， $x ¯$ ±s）
第0周	6.51±0.51	6.38±1.65	0.402	0.689
第1~3周	6.52±0.68	6.16±0.67	2.385	0.020
第4~5周	6.43±0.52	6.01±0.45^a	3.863	＜0.001
第6周以后	6.21±0.69^ab	5.74±0.86^ab	2.696	0.009
手臂体积测量（ml， $x ¯$ ±s）
第0周	184.61±27.57	185.51±26.29	0.149	0.882
第1~3周	185.47±27.54	172.64±27.73^a	2.076	0.041
第4~5周	185.14±25.26	168.15±24.34^a	3.063	0.003
第6周以后	185.48±26.19	164.59±27.49^a	3.480	0.001

肩部运动范围（°）	对照组		t值	P值	锻炼组		t值	P值
肩部运动范围（°）	第0周	6周以后	t值	P值	第0周	6周以后	t值	P值
前屈	165.46±10.34	170.26±9.67	2.144	0.035	164.59±11.26	175.44±10.26^a	4.505	＜0.001
后伸	50.27±7.12	54.22±6.17	2.652	0.010	50.48±7.37	57.82±6.48^a	4.730	＜0.001
内收	36.21±7.36	41.61±7.25	3.306	0.002	36.02±7.44	43.54±7.56^a	4.484	＜0.001
外展	148.26±16.38	157.21±15.26	2.528	0.014	149.54±15.49	168.05±17.15^b	5.066	＜0.001

项目	对照组		t值	P值	锻炼组		t值	P值
项目	第0周	6周以后	t值	P值	第0周	6周以后	t值	P值
屈曲肌	3.35±0.26	3.41±0.35	0.870	0.387	3.48±0.40	3.81±0.49^b	3.230	0.002
外展肌	3.21±0.24	3.15±0.30	0.988	0.326	3.16±0.56	3.58±0.33^b	4.087	＜0.001
外旋肌	3.04±0.59	3.01±0.36	0.275	0.784	3.09±0.51	3.37±0.52^a	2.431	0.017
内旋肌	3.36±0.26	3.27±0.43	1.133	0.261	3.34±0.68	4.15±0.86^b	4.673	＜0.001
水平内收肌	3.18±0.34	3.26±0.26	1.182	0.241	3.20±0.25	3.72±0.28^a	8.761	＜0.001

生活质量	对照组（40例）		t值	P值	锻炼组（40例）		t值	P值
生活质量	第0周	6周以后	t值	P值	第0周	6周以后	t值	P值
身体健康	10.60±2.01	11.93±1.89	3.049	0.003	10.92±1.85	13.28±2.09^a	7.702	0.003
家庭/社会情况	12.56±2.28	13.54±2.11	1.995	0.049	12.47±2.21	14.57±2.30^a	5.348	0.040
情感状况	11.67±1.53	12.87±1.95	3.062	0.003	12.03±1.98	15.02±2.12^a	4.164	＜0.001
功能状况	11.28±1.79	12.59±2.15	2.962	0.004	11.91±1.87	15.34±2.04^a	6.519	＜0.001
附加状况	10.75±2.07	12.03±2.34	2.591	0.011	11.24±2.20	13.15±1.96^a	4.100	＜0.001
总计	56.86±6.38	62.96±7.24	3.998	＜0.001	58.57±7.01	71.36±7.82^a	7.702	＜0.001

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