Effectiveness of aerobic exercise on upper limb function following breast cancer treatment: a systematic review and meta-analysis

Abstract

Background: Aerobic exercise is currently considered to be an effective method of rehabilitation in breast cancer patients. Studies have shown that aerobic exercise after breast cancer surgery can improve upper limb function, cardiopulmonary function, and quality of life. Breast cancer rehabilitation guidelines encourage patients to actively participate in aerobic exercise to promote rehabilitation, the current study is to evaluate the effectiveness of aerobic exercise on upper limb muscle strength and range of motion (ROM) following breast cancer treatment.

Methods: Electronic databases (Cochrane Library, PubMed, Web of Science, EBSCO and Embase) were searched for randomized controlled trials (RCTs) published before September 1, 2019, using the search terms "aerobic exercise", "exercise", "breast cancer", "muscle strength", "strength", "flexibility" and "function". Grip strength and shoulder joint ROM were used to evaluate upper limb strength and upper limb flexibility respectively. All statistical tests were performed using RevMan5.3 software.

Results: Nine RCTs (421 patients) were included for analysis, with JBI scores ranging from 19 to 23, and bias grade B for all studies among which, there were six studies reported change in grip strength, and five studies reported change in shoulder joint ROM. Meta-analysis showed a statistically significant difference in shoulder flexion ROM (MD =4.97, 95% CI: 0.47-9.46, P=0.03), shoulder abduction ROM (MD =8.95, 95% CI: 0.99-16.91, P=0.03), shoulder internal rotation ROM (MD =3.45, 95% CI: 1.80-5.09, P<0.0001), shoulder external rotation ROM (MD =7.69, 95% CI: 0.06-15.32, P=0.05) between the intervention and control groups following completion of the aerobic exercise intervention, while there were no significant improvement with respect to grip strength and shoulder extension ROM (P>0.05).

Conclusions: Aerobic exercise could improve shoulder joint ROM in breast cancer survivors, but shows no obvious effect on the improvement of upper limb strength.

Keywords: Breast cancer; aerobic exercise; meta-analysis; muscle strength; range of motion (ROM).