title: Progressive resistance training and stretching following surgery for breast cancer: study protocol for a randomised controlled trial.
abstract: BACKGROUND
  Currently 1 in 11 women over the age of 60 in Australia are diagnosed with breast cancer. Following treatment, most breast cancer patients are left with shoulder and arm impairments which can impact significantly on quality of life and interfere substantially with activities of daily living. The primary aim of the proposed study is to determine whether upper limb impairments can be prevented by undertaking an exercise program of prolonged stretching and resistance training, commencing soon after surgery.
  
  
  METHODS
  We will recruit 180 women who have had surgery for early stage breast cancer to a multicenter single-blind randomized controlled trial. At 4 weeks post surgery, women will be randomly assigned to either an exercise group or a usual care (control) group. Women allocated to the exercise group will perform exercises daily, and will be supervised once a week for 8 weeks. At the end of the 8 weeks, women will be given a home-based training program to continue indefinitely. Women in the usual care group will receive the same care as is now typically provided, i.e. a visit by the physiotherapist and occupational therapist while an inpatient, and receipt of pamphlets. All subjects will be assessed at baseline, 8 weeks, and 6 months later. The primary measure is arm symptoms, derived from a breast cancer specific questionnaire (BR23). In addition, range of motion, strength, swelling, pain and quality of life will be assessed.
  
  
  CONCLUSIONS
  This study will determine whether exercise commencing soon after surgery can prevent secondary problems associated with treatment of breast cancer, and will thus provide the basis for successful rehabilitation and reduction in ongoing problems and health care use. Additionally, it will identify whether strengthening exercises reduce the incidence of arm swelling.
  
  
  BACKGROUND
  The protocol for this study is registered with the Australian Clinical Trials Registry (ACTRN012606000050550).
authors.affiliation: Faculty of Health Sciences, University of Sydney, Sydney, Australia. s.kilbreath@usyd.edu.au
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Kilbreath
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Refshauge
authors.forename: Jane M
authors.initials: JM
authors.lastname: Beith
authors.forename: Leigh C
authors.initials: LC
authors.lastname: Ward
authors.forename: Judy M
authors.initials: JM
authors.lastname: Simpson
authors.forename: Ross D
authors.initials: RD
authors.lastname: Hansen
mesh_terms: D001132:Arm / Q000502:physiology; D001943:Breast Neoplasms / Q000534:rehabilitation* / Q000601:surgery*; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008209:Lymphedema / Q000209:etiology / Q000517:prevention & control; D053580:Muscle Strength / Q000502:physiology; D052580:Muscle Stretching Exercises; D011182:Postoperative Care; D011788:Quality of Life; D016059:Range of Motion, Articular; D012782:Shoulder / Q000502:physiology; D016037:Single-Blind Method