Chan, D.N., Lui, L.Y., & So, W.K. (2010). Effectiveness of exercise programmes on shoulder mobility and lymphoedema after axillary lymph node dissection for breast cancer: Systematic review. Journal of Advanced Nursing, 66(9), 1902–1914.

To review the effectiveness of exercise programs on shoulder mobility and lymphoedema in patients with breast cancer after having axillary lymph node dissection as revealed by randomized controlled trials

Databases searched were CINAHL, Ovid Medline, the BritishNursing Index, Proquest, Science Direct, PubMed, Scopus, and the Cochrane Library. Search keywords were breast; cancer, malignancy, neoplasm, or tumour; modified radical mastectomy, radical mastectomy, breast conservation surgery, wide local excision, axillary lymph node dissection, or adjuvant therapy; exercise, training, weight training, stretching exercise, physical activity, rehabilitation or resistance training, aerobic training, strength training, or lifestyle or range of motion exercises; lymphoedema, arm circumference, arm swelling, oedema, range of motion or shoulder mobility, joint movement, or shoulder function. Studies were included in the study if they

• Were published in English
• Were randomized controlled trials
• Included women undergoing breast cancer treatment with axillary lymph node dissection
• Had treatment strategies defined as various types of exercise programs: weight training, aerobic and strengthening exercises, stretching and range of motion exercises.

Studies were excluded if they

• Targeted male participants
• Reported only decongestive therapy involving manual lymphatic drainage, compression garments, or skin care as interventions
• Dealt with patients undergoing sentinel lymph node biopsy.
   

The total number of studies initially reviewed was 325. A quantitative effectiveness review was used with levels of evidence defined by the Joanna Briggs Institute.

• Six studies were included in the report.
• The total sample size across studies was 429 female patients with a range of 27–205.
• Mean age of the sample was less than 60 years.
• Patients were from the United States, Sweden, the Netherlands, Turkey, Canada, and Australia.

Early rather than delayed onset of training did not affect the incidence of postoperative lymphoedema, but early introduction of exercises was valuable in avoiding deterioration in range of shoulder motion.

Nurses have an important role in educating and encouraging patients to practice these exercises to speed up recovery.