Effects of progressive physical exercises combined with equipment-assisted training on postoperative rehabilitation of breast cancer patients underwent same-day surgery with axillary dissection
Authors: Huang Meiling , Wang Yang , Wang Ting , Guo Sijin 
Published: July 2023

Background
It is well known that postoperative exercise was good for the life quality of breast cancer patients. But it is important to design a exercise with flexibility and mobility for breast cancer survivors. Here we provide an effective postoperative rehabilitation strategy for breast cancer patients with desirable efficacy.
Methods
In this retrospective study, breast cancer patients between 2018.01 and 2022.08 were enrolled. Based on the different rehabilitation methods, patients were separated into control group (2018.01-2020.12) or intervention group (2021.01-2022.08). The patients in the control group were mainly told by oral education to move their upper limbs step by step according to the actual situation. The patients in the intervention group were fully informed of the timing, location, and precautions for postoperative rehabilitation exercise through oral education, video data, one-on-one guidance in combination with rehabilitation exercise equipment. The assessments include postoperative rest, diet and defecation, upper extremity edema and function, postoperative drainage volume, pain, quality of life, anxiety and depression.
Results
Finally, 838 participants were enrolled, including 337 cases in control group and 501 cases in intervention group. Three days after the operation, and the sleep status of the intervention group was significantly better than that of the control group. Compared with the control group, the axillary and chest wall drainage volumes in the intervention group were significantly reduced 3 days and 2 weeks after operation. Meanwhile, the extubation rates between two groups was statistically significant. There was a significant statistical difference in the mean pain scores between the two groups at postoperative day 3 (0.78 ± 0.84 vs 0.69 ± 0.73, P = 0.03) and postoperative two weeks (0.46 ± 0.69 vs 0.38 ± 0.54, P<0.001). The wound healing rate was 90.8% vs 94.5% with statistically significance. Two weeks after surgery (3.6% vs 1.4%, P = 0.04) and 1 month after surgery (2.4% vs 0.6%, P = 0.03 ), the rate of upper limb edema in the intervention group was significantly reduced. In addition, the mobility of the affected limbs of patients in the intervention group was better than that in the control group. Postoperative ROM in convention group was better than control group. The height of the finger wall were relatively larger. DASH score of two groups were 22.50 ± 2.71 and 46.72 ± 3.11, P = 0.03. The anxiety level of patients in the intervention group was significantly lower than that in the control group 3 days after operation and 6 months after surgery. For depression analysis, the proportion of patients with different degrees of depression in the intervention group was significantly lower than that in the control group at 3 days after operation. Finally, significant improvement in the cognitive function, emotional function and physical function was found in intervention group 6 months after surgery.
Conclusions
Progressive physical exercises combined with equipment-assisted training had positive effects on improving postoperative rehabilitation, physical functioning, shoulder ROM, and decreasing patients' anxiety and depression symptoms, consequently enhancing the quality of life.