The effects of BOSU ball balance exercises added to complete decongestive therapy on static and dynamic balance in breast cancer-related lymphedema

The aim of our study was to investigate the effects of balance exercises using a BOSU ball, added to complex decongestive therapy (CDT), on both static and dynamic balance in patients with breast cancer-related lymphedema (BCRL). A total of 38 patients diagnosed with unilateral BCRL, according to the 2020 diagnostic criteria of the International Society of Lymphology, were included in the study at Pamukkale University Hospital. Participants were randomized into two groups. Both groups received a total of 15 treatment sessions over three weeks, five days a week. The first group received the CDT program consisting of manual lymphatic drainage (MLD), multi-layered bandaging, skin/nail care, and exercise therapy, and balance exercises performed on a BOSU ball. The second group received only the CDT program. The demographic and clinical data of the patients were recorded. Before treatment and at the end of 3 weeks of treatment, the patients' arm circumference and volume measurements, static and dynamic balance measurements with the TecnoBody Prokin 252 system, Fall Efficacy Scale (FES), Tampa Scale for Kinesiophobia (TSK), Fullerton Advanced Balance (FAB) scale, Timed Up and Go test (TUG), ULL-27 quality of life questionnaire, and Hospital Anxiety and Depression Scale (HADS) scores were recorded. 38 patients with a mean age of 56.21 ± 7.30 years were participated. No statistically significant differences were found between the groups in terms of sociodemographic and clinical characteristics. Both groups showed improvements in upper extremity circumference and volume, FES, FAB scale, global and all subparameters of the ULL-27, and the anxiety subscale of HADS. Additionally, the intervention group showed improvements in the forward-backward standard deviation and average forward-backward speed with eyes open, the medium-lateral standard deviation and ellipse area with eyes closed, stabilite index, average track error, TKS, and depression section of the HADS. Compared to the active control group, the intervention group showed statistically significant improvement in the forward-backward standard deviation and average forward-backward speed with eyes open, the stability index, TSK, and FAB. As a result, in our study, it was observed that BOSU ball balance exercises added to CDT increased static and dynamic balance and provided improvement in kinesiophobia. Keywords: Breast cancer-related lymphedema, balance, BOSU ball, complete decongestive therapy.