Investigation of the exercise therapy efficiency during radiotherapy after breast cancer surgery

. The aim of this study was to investigate the effectiveness of supervised exercise training during post surgery radiotherapy period on range of motion, grip strength, scapular dyskinesia, lymphedema, upper extremity functionality, fear of movement, quality of life, pain and sensory symptoms. Thirtyseven patients who underwent unilateral breast and axilla surgery and referred to axillary radiotherapy were allocated in two groups as exercise (n = 19) and control (n = 18) by simple random method. The patients in exercise group received, range of motion, stretching, strengthening, breathing, neural mobilization exercises and manuel therapy applications, 3 days a week for 7 weeks. The patients in the control group didn't receive any exercise training as in routine radiotherapy period. The patients in both groups were evaluated before and after radiotherapy period for shoulder range of motion with universal goniometer, grip strength with Jamar hand dynamometer, scapular dyskinesia with Lateral Scapular Slide Test, lymphedema with circumferencial measurement, functionality with Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) and Shoulder Pain and Disability Index (SPADI), fear of movement with TAMPA Kinesiophobia Scale , quality of life with European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 and BR23 (EORTC QLQ C30 and BR23), pain and sensory symptoms with McGill Pain Questionnaire and the Visual Analogue Scale (VAS). According to our results; while shoulder ROM increased in all directions in exercise group (p<0.05), the only change in control group was a decrease in the flexion degree (p<0.05). The grip strength was increased in exercise group (p <0.05) and decreased in control group (p<0.05). The number of patients with positive scapular dyskinesia and lymph edema severity did not change in either group. Functional status improved in exercise group for both DASH and SPADI findings (p<0.05) and control group results decreased for both measures (p<0.05). Fear of movement improved in exercise group (p<0.05) and no change was observed in control group (p>0.05). For quality of life subscale results; breast symptoms increased in both groups (p<0.05). In exercise group all the other subscale parameters improved except cognitive function did not chance (p<0.05). In control group while no change was obtained in body image, emotional function, cognitive functions and general health level (p>0.05), all the other quality of life parameters was decreased (p<0.05). For pain results; Mcgill and VAS values recovered in exercise group (p<0.05) and worsened in the control group (p<0.05). In conclusion, upper extremity acute complications were prevented and recovered with supervised exercise training during post surgery radiotherapy. The exercise protocol used in this study is recommended to be applied in breast cancer radiotherapy patients. Studies investigating the longterm effectiveness of exercise therapy in axillary radiotherapy patients are needed. Keywords: Breast cancer, adjuvant radiotherapy, exercise training, upper extremity, quality of life