Discussion
®, lymphatic congestion, breast, ovarian, uterine, or cervical cancer, breast cancer
FEMALE BREAST CANCER, LYMPHEDEMA, BREAST CANCER
The purpose of this study was to investigate the effects of combined exercises on shoulder mobility and strength of the upper extremities in breast cancer rehabilitation. To our knowledge, this is the first study showing significant improvement in these outcomes with combined device-supported strength and mobility training (FIVE®, MILON®) in a sample of female breast cancer patients shortly after treatment. Previous studies examined the effects of aerobic and resistance training in breast cancer patients, but did not analyze the results of a combined mobility and resistance training on devices in breast cancer patients in rehabilitation [As a first consequence, we can conclude that both methods show small to large (practical) exercise effects for patients in breast cancer rehabilitation in each dependent variable. In detail and with reference to our statistical analyses, we could observe that Bonferroni corrected t-tests for matched pairs revealed that only the intervention group achieved statistically significant improvements in shoulder mobility, although repeated measures ANOVA showed no interaction effects with respect to all dependent variables. Additionally, only the treatment type “irradiation” had a significant influence on the mobility in the sagittal plane on the right side. This may be due to the fact that the lymph nodes are also treated during irradiation, which increases the risk of lymphatic congestion (lymphedema) in the chest or arm and can severely limit the patient’s mobility [In contrast, both groups improved their strength performance after a three-week combined strength and mobility training on FIVE® devices, respectively device-supported training. Because of the specificity of the two approaches, these results are in accordance with our initial theoretical assumptions, and they support and complement previous results concerning aerobic capacity, lower and upper limb strength, and agility [Nevertheless, reasons for the lack of interaction effects in all outcomes require closer consideration: First, the short duration of this intervention may have been insufficient to promote significant differences in training methods; as we know from training science, it takes at least 5 to 6 weeks for measurable training effects [Another and third issue to be considered is the varying amount of training lessons, which do not affect the dependant variables. The fact that there is a training effect although some patients completed just five training lessons may be explained by their participation in further therapy programs (e.g., pilates, water aerobics, cancer-specific group training, Nordic walking). These interventions aimed at treating gynecologic patients with breast, ovarian, uterine, or cervical cancer.It is important to note that these therapies were designed for all gynecologic patients with different emphases such as relaxation and functional exercise. However, they were not specifically planned to treat the side effects associated with breast cancer. Therefore, the potential impact of these therapies on the study results should be considered as rather small. For ethical reasons, patients had to be allowed to participate in further therapy programs in order to enable a plenary therapeutic success, which may have led to some bias. Statistical analysis is needed to examine whether there is a bias caused by participation in other therapy programs and how these variables might have influenced the therapy success. Due to the large variety of complementary therapy programs, the influence of individual variables could not be statistically determined in this study [In the current study, baseline levels of the dependent variables did not differ except the variable strength. Thus, the irregularity of the variable strength may be explained by a highly diverse fitness level of the patients due to different exercise habits and treatment options.The different treatment options may have influenced the mobility results in the pre- and postintervention assessments as well. Patients indicated different results of the left and right shoulder mobility at baseline and postintervention. This may be illustrated by the fact that either the left or the right side was treated. The abovementioned improvement of the outcome strength might be attributed to the inclusion of women within a short period after breast cancer treatment and the physically inactive nature of the participants upon enrolment. Previous studies utilizing a combined aerobic and resistance exercise intervention showed significant improvements in strength performance, yet to a greater degree than our results [There are a few limitations to this intervention that demand discussion. First, this study has a small sample size, which results in issues such as reduced statistical power to identify signficant difference in training methods. In addition, in the current study, there was an uneven group assignment as well as a short duration of intenvention, which may have affected the statistical results in terms of effect size. Moreover, adherence to the exercise program is challenging, thus the amount of training lessons varies greatly. Strengths of our study include the focus on device-supported mobility training, the randomized controlled trial design, and the use of laser technology to objectively measure ROM in the shoulder joint.