Korean J Adult Nurs.  2019 Oct;31(5):461-478. 10.7475/kjan.2019.31.5.461.

Effects of Exercise on Breast Cancer-related Upper Extremity Lymphedema in Breast Cancer Survivors: A Systematic Review and Meta-analysis

• Park J
• Jung M

• KMID: 2461062
• DOI: http://doi.org/10.7475/kjan.2019.31.5.461

Abstract

PURPOSE
This systematic review and meta-analysis was performed to confirm the effects of exercise on Breast Cancer-Related Lymphedema (BCRL) in breast cancer survivors.
METHODS
Totally, 1,614 articles were retrieved from databases including PubMed, Ovid MEDLINE, Embase, Cochrane CENTRAL, CINAHL, Korea Med, Kmbase, KISS, NDSL, KiSTi, and academic journals related to nursing in Korea between June 17 and 18, 2019. Fifteen Randomized Controlled Trials (RCTs) were selected for the analysis from June 19 to July 12, 2019. Cochrane's Risk of Bias assessed the quality and risk of bias of selected articles. Review Manager version 5.3 was used for the meta-analysis.
RESULTS
Studies were published since 2006 including a total of 1,109 participants who were diagnosed with or at risk of BCRL or had undergone surgery for breast cancer treatment. Although exercises were found ineffective for reducing upper extremity edema (Z=0.37, 95% Confidence Interval [CI]=−0.06~0.04, p=.710), they significantly improved shoulder Range of Motion (ROM), especially flexion (Z=5.88, 95% CI=3.06~6.12, p<.001) and abduction (Z=3.41, 95% CI=2.71~10.06, p<.001), upper extremity function (Z=4.02, 95% CI=−12.09~−4.17, p<.001), and Quality of Life (QoL) (Z=3.00, 95% CI=0.13~0.61, p=.003). Egger's regression test assessed publication bias (Intercept=3.75, t=1.79, df=8, p=.111).
CONCLUSION
Results suggest that exercise is beneficial to BCRL management, especially improvement of shoulder ROM, upper extremity function, and QoL. However, exercise must be performed carefully to prevent side effects. Therefore, nurses should continuously observe signs and symptoms related to BCRL and educate breast cancer survivors on safely performing exercise.

MeSH Terms

Bias (Epidemiology)
Breast Neoplasms*
Breast*
Edema
Exercise
Humans
Korea
Lymphedema*
Nursing
Publication Bias
Quality of Life
Range of Motion, Articular
Shoulder
Survivors*
Upper Extremity*

Figure

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  Figure 1 Flow diagram for study selection.

• 

  Figure 2 The results of risk of bias.

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