title: Effectiveness of exercise programmes on shoulder mobility and lymphoedema after axillary lymph node dissection for breast cancer: systematic review.
abstract: OBJECTIVE
  This article is a report of a review of the effectiveness of exercise programmes on shoulder mobility and lymphoedema in postoperative patients with breast cancer having axillary lymph node dissection, as revealed by randomized controlled trials.
  
  
  BACKGROUND
  Breast cancer is the most common malignancy in women. After surgery, the most common postoperative complications are reduced range of motion in the shoulder, muscle weakness in the upper extremities, lymphoedema, pain and numbness. To reduce these impairments, shoulder exercises are usually prescribed. However, conflicting results regarding the effect and timing of such exercises have been reported. Data sources. Studies were retrieved from a systematic search of published works over the period 2000-2009 indexed in the Cumulative Index to Nursing and Allied Health Literature, Ovid Medline, the British Nursing Index, Proquest, Science Direct, Pubmed, Scopus and the Cochrane Library, using the combined search terms 'breast cancer', 'breast cancer surgery', 'exercise', 'lymphoedema', 'shoulder mobility' and 'randomized controlled trials'.
  
  
  METHODS
  A quantitative review of effectiveness was carried out. Studies were critically appraised by three independent reviewers, and categorized according to levels of evidence defined by the Joanna Briggs Institute.
  
  
  RESULTS
  Six studies were included in the review. Early rather than delayed onset of training did not affect the incidence of postoperative lymphoedema, but early introduction of exercises was valuable in avoiding deterioration in range of shoulder motion.
  
  
  CONCLUSIONS
  Further studies are required to investigate the optimal time for starting arm exercises after this surgery. Nurses have an important role in educating and encouraging patients to practise these exercises to speed up recovery.
authors.affiliation: Department of Surgery, Ruttonjee and Tang Shiu Kin Hospital, Hong Kong SAR, China.
authors.forename: Dorothy N S
authors.initials: DN
authors.lastname: Chan
authors.forename: Liza Y Y
authors.initials: LY
authors.lastname: Lui
authors.forename: Winnie K W
authors.initials: WK
authors.lastname: So
mesh_terms: D001132:Arm / Q000473:pathology; D001365:Axilla; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000601:surgery*; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008209:Lymphedema / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D008875:Middle Aged; D018908:Muscle Weakness / Q000209:etiology / Q000534:rehabilitation; D016032:Randomized Controlled Trials as Topic; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012720:Severity of Illness Index; D012785:Shoulder Joint / Q000502:physiology*; D013997:Time Factors; D016896:Treatment Outcome