This systematic review aimed to evaluate the effectiveness of therapeutic exercise in recovering range of motion after radical mastectomy due to limited information on physiotherapy's role in addressing musculoskeletal sequelae.
A search was conducted using PubMed, Scopus, and BVS databases with Medical Subject Headings (MeSH) terms: “Breast Cancer”, “Mastectomy”, “Exercise Therapy”, “Physical Therapy”, and “Range of Motion.”Inclusion criteria were established based on the PICO framework: P (Population): women aged 18 to 60 years with post-mastectomy breast cancer; I (Intervention): therapeutic exercise aimed at increasing shoulder range of motion; C (Comparison): not applicable; O (Outcome): effectiveness of therapeutic exercise in recovering shoulder range of motion. Exclusion criteria included history of lymphedema, systematic reviews, meta-analyses, publications older than five years, and male patients. Methodological quality was assessed using the Physiotherapy Evidence Data (PEDro) scale.
Of 423 studies identified, 6 were included in the final analysis where they used muscle strengthening exercises, graduated with thera-band, scapular stabilization, and muscle relaxation as treatment after surgery. These studies showed significant improvements in range of motion (ROM), pain, and quality of life following early rehabilitation interventions. Five studies evaluated ROM of flexion, extension, abduction, adduction, internal rotation, and external rotation using goniometry. Only flexion and abduction were considered, as they were common across all studies. Majed et al., (2022) reported an increase in flexion of 34.17° and abduction of 23.53° in the intervention group. Mohite et al., (2023) showed increases of 64.17° in flexion and 56.05° in abduction. Aboelnour et al., (2023) reported increases of 61.43° in flexion and 48.08° in abduction. The Rizzi et al., (2020) trial observed increases of 43.3° in flexion and 58.1° in abduction. Namadev et al., (2024) achieved increases of 41.5° in flexion and 13.7° in abduction. Zhou et al., (2019) used the Constant-Murley Score (CMS), ranging from 0 to 100 points, with higher scores indicating better shoulder function. An increase of 23.75 points was observed between baseline and six-month scores.
Additionally, improvements in quality of life were reported, with significant differences in physical, psychological, and social well-being. Patients also experienced increased muscle strength, and lower functional disability. These results align with previous studies, confirming the role of early rehabilitation in improving ROM and reducing pain.
The evidence underscores the global relevance of incorporating therapeutic exercise in post-mastectomy care to enhance recovery and quality of life. However, larger, multicenter trials are needed to further substantiate these findings across diverse populations.
This systematic review highlights the impact of therapeutic exercise on shoulder ROM recovery post-mastectomy and underscores the importance of preoperative and postoperative treatment for better postoperative outcomes. Enhanced shoulder ROM positively affects strength and quality of life.
radical mastectomy
exercise therapy
