A systematic review and meta-analysis of trials involving the use of range-of-motion (ROM) exercises in women after breast cancer surgery has found that the timing of initiating exercise may affect flexion ROM, but it did not appear to affect wound outcomes. Results of this analysis were reported in the journal Clinical Breast Cancer.

ROM exercises are frequently prescribed after breast cancer surgery to preserve upper limb function, but the ideal timing for these exercises has been complicated by mixed outcomes. Prior research has suggested that performing ROM exercises earlier may be better for maintaining ROM. However, delaying ROM exercises, or limiting their use, may lead to fewer wound complications.

In this analysis, several databases were searched for randomized controlled trials evaluating effects with early ROM exercises in comparison with delayed ROM exercises or usual care in women who underwent surgery for breast cancer. Early ROM exercise was defined as beginning within 3 days after the surgical procedure.

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The study investigators examined the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, CINAHL, and PEDro databases for records from dates of inception until February 15, 2021. The researchers primarily explored outcomes related to shoulder range, wound outcomes, and lymphedema incidence.

There were 20 trials that met inclusion criteria for analysis, and in total these trials included 2442 participants. Patients were mean age 56.24 years (SD, 4.72). Early ROM exercise was compared to delayed ROM exercise in 15 trials, and early ROM exercise was compared to usual care, activity restriction, or no intervention in 6 trials.

Results from trials evaluating ROM suggested that early ROM exercise was associated with better flexion ROM in the intermediate term (mean difference, 24.5°; 95% CI, 15.8°-33.2°), but no differences were based on timing of ROM exercise in other time periods. Early ROM exercise appeared associated with better flexion ROM in the short term compared with usual care. The timing of ROM exercise did not appear associated with significant differences in abduction ROM.

The researchers found that total drainage time was significantly longer with early ROM exercise compared with delayed ROM exercise (weighted mean difference, 1.2 days; 95% CI, 0.7-1.7). Hematoma incidence also appeared to be higher with early vs delayed ROM exercise (risk ratio [RR], 1.6; 95% CI, 1.1-2.3). However, analyses restricted to reports published after the year 2000 showed no significant differences between early and delayed ROM exercise for these outcomes. Outcomes of total drainage volume, seroma, wound infection, and delayed wound healing also appeared to be similar between treatment groups.

Early ROM exercise was associated with a higher incidence of lymphedema than was delayed ROM exercise (RR, 3.7; 95% CI, 1.3-10.9) in the short term. One study suggested lymphedema posed a higher risk in the long term with early vs late ROM exercise (RR, 2.67; 95% CI, 1.12-6.33).

“These results suggest that the timing of postoperative exercises should be determined using shared decision-making in conjunction with the patient,” the researchers concluded in their report.


Redemski T, Hamilton DG, Schuler S, Liang R, Michaleff ZA. Rehabilitation for women undergoing breast cancer surgery: a systematic review and meta-analysis of the effectiveness of early, unrestricted exercise programs on upper limb function. Clin Breast Cancer. 2022;22(7):650-665. doi:10.1016/j.clbc.2022.06.001