Motor Exercises Effect on Improving Shoulders Functioning, Functional Ability, Quality of Life, Depression and Anxiety For Women With Breast Cancer

Published:August 02, 2022DOI:



      This research aimed to study the effects of motor exercises on improving shoulder functioning, functional ability, quality of life, depression, and anxiety in patients.

      Patients and Methods

      A randomized clinical trial in which 70 eligible patients referred to the oncology ward participated in two intervention and control groups. The intervention group (N=35) had been doing motor exercises for five weeks. Before the surgery, two days, and five weeks after surgery, shoulder Range Of Motion (ROM) was measured with a goniometer, and the functional capacity level was measured by the 6-Minute-Walk-Test. Quality of life, depression, and anxiety were measured using the EORTC QLQ-C30 and QLQ-BR23; and HADS questionnaires, respectively, at baseline and five weeks after surgery. Descriptive statistics, the T-test, and the Chi-Square t-hotelling model were used to analyze the data.


      The results showed that motor exercises had a significant statistical increase in the distance of 6MWT (P<.001) and ROM (P≤.001) compared to the control group. Moreover, there were significant differences in dimensions of patients’ quality of life, depression, and anxiety in the intervention group, compared to the control group (P<.05).


      Motor exercises had positive effects on improving physical functioning, shoulder ROM, and decreasing patients’ anxiety and depression symptoms, consequently enhancing the quality of life.


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        • Awatef M.
        • Olfa G.
        • Rim C.
        • Asma K.
        • Kacem M.
        • Makram H.
        • Slim B.A.
        Physical activity reduces breast cancer risk: A case–control study in Tunisia.
        Cancer epidemiology. 2011; 35: 540-544
        • Bendz I.
        • Olsén M.F.
        Evaluation of immediate versus delayed shoulder exercises after breast cancer surgery including lymph node dissection–A randomised controlled trial.
        The Breast. 2002; 11: 241-248
        • Bonnie A.
        Psychological Intervention and health outcomes among Women treated for breast cancer.
        BRAIN, BEHAVIOR, AND IMMUNITY. 2009; 23: 159-166
        • de Oliveira C.
        • Weir S.
        • Rangrej J.
        • Krahn M.D.
        • Mittmann N.
        • Hoch J.S.
        • Peacock S.
        The economic burden of cancer care in Canada: a population-based cost study.
        CMAJ open. 2018; 6: E1
        • Fu M.R.
        • Axelrod D.
        • Guth A.A.
        • Cleland C.M.
        • Ryan C.E.
        • Weaver K.R.
        • Palamar J.J.
        Comorbidities and quality of life among breast cancer survivors: a prospective study.
        Journal of personalized medicine. 2015; 5: 229-242
        • Ghiasvand R.
        • Adami H.-O.
        • Harirchi I.
        • Akrami R.
        • Zendehdel K.
        Higher incidence of premenopausal breast cancer in less developed countries; myth or truth?.
        BMC cancer. 2014; 14: 1-8
        • Harirchi I.
        • Kolahdoozan S.
        • Karbakhsh M.
        • Chegini N.
        • Mohseni S.
        • Montazeri A.
        • Ebrahimi M.
        Twenty years of breast cancer in Iran: downstaging without a formal screening program.
        Annals of oncology. 2011; 22: 93-97
        • Hayes S.C.
        • Rye S.
        • DiSipio T.
        • Yates P.
        • Bashford J.
        • Pyke C.
        • Eakin E.
        Exercise for health: a randomized, controlled trial evaluating the impact of a pragmatic, translational exercise intervention on the quality of life, function and treatment-related side effects following breast cancer.
        Breast cancer research and treatment. 2013; 137: 175-186
        • Irwin M.L.
        • Medicine A.C.o.S.
        ACSM's guide to exercise and cancer survivorship.
        Human Kinetics, 2012
        • Jazayeri S.
        • Saadat S.
        • Ramezani R.
        • Kaviani A.
        Incidence of primary breast cancer in Iran: Ten-year national cancer registry data report.
        Cancer epidemiology. 2015; 39: 519-527
        • Johansen S.
        • Fosså K.
        • Nesvold I.L.
        • Malinen E.
        • Fosså S.D.
        Arm and shoulder morbidity following surgery and radiotherapy for breast cancer.
        Acta oncologica. 2014; 53: 521-529
        • Kilbreath S.L.
        • Refshauge K.M.
        • Beith J.M.
        • Ward L.C.
        • Lee M.
        • Simpson J.M.
        • Hansen R.
        Upper limb progressive resistance training and stretching exercises following surgery for early breast cancer: a randomized controlled trial.
        Breast cancer research and treatment. 2012; 133: 667-676
        • Knobel H.
        • Loge J.H.
        • Brenne E.
        • Fayers P.
        • Hjermstad M.J.
        • Kaasa S.
        The validity of EORTC QLQ-C30 fatigue scale in advanced cancer patients and cancer survivors.
        Palliative medicine. 2003; 17: 664-672
        • A.C.O.P.S.F.C.P.F. Laboratories. 
        ATS statement: guidelines for the six-minute walk test.
        Am J Respir Crit Care Med. 2002; 166: 111-117
        • Lahart I.
        • Metsios G.
        • Nevill A.
        • Carmichael A.
        Physical activity for women with breast cancer after adjuvant therapy.
        Cochrane Database of Systematic Reviews. 2018;
        • Liguori G.
        • Medicine A.C.o.S.
        ACSM's guidelines for exercise testing and prescription.
        Eleventh ed. Lippincott Williams & Wilkins, 2020
        • Maass S.W.
        • Roorda C.
        • Berendsen A.J.
        • Verhaak P.F.
        • de Bock G.H.
        The prevalence of long-term symptoms of depression and anxiety after breast cancer treatment: a systematic review.
        Maturitas. 2015; 82: 100-108
        • Mazor M.
        • Lee J.Q.
        • Peled A.
        • Zerzan S.
        • Irwin C.
        • Chesney M.A.
        • Sacks D.
        The effect of yoga on arm volume, strength, and range of motion in women at risk for breast cancer-related lymphedema.
        The Journal of Alternative and Complementary Medicine. 2018; 24: 154-160
        • Mehnert A.
        • Brähler E.
        • Faller H.
        • Härter M.
        • Keller M.
        • Schulz H.
        • Hund B.
        Four-week prevalence of mental disorders in patients with cancer across major tumor entities.
        Journal of Clinical Oncology. 2014; 32: 3540-3546
        • Ng C.G.
        • Mohamed S.
        • Kaur K.
        • Sulaiman A.H.
        • Zainal N.Z.
        • Taib N.A.
        • group M.S.
        Perceived distress and its association with depression and anxiety in breast cancer patients.
        PLoS One. 2017; 12e0172975
        • Norkin C.C.
        • White D.J.
        Measurement of joint motion: a guide to goniometry.
        FA Davis, 2016
        • Park J.-H.
        The effects of complex exercise on shoulder range of motion and pain for women with breast cancer-related lymphedema: a single-blind, randomized controlled trial.
        Breast Cancer. 2017; 24: 608-614
        • Reis A.D.
        • Pereira P.T.V.T.
        • Diniz R.R.
        • de Castro Filha J.G.L.
        • Dos Santos A.M.
        • Ramallo B.T.
        • Garcia J.B.S.
        Effect of exercise on pain and functional capacity in breast cancer patients.
        Health and quality of life outcomes. 2018; 16: 1-10
        • Rogers L.Q.
        • Courneya K.S.
        • Anton P.M.
        • Verhulst S.
        • Vicari S.K.
        • Robbs R.S.
        • McAuley E.
        Effects of a multicomponent physical activity behavior change intervention on fatigue, anxiety, and depressive symptomatology in breast cancer survivors: randomized trial.
        Psycho-oncology. 2017; 26: 1901-1906
        • Rohani C.
        • Abedi H.-A.
        • Omranipour R.
        • Langius-Eklöf A.
        Health-related quality of life and the predictive role of sense of coherence, spirituality and religious coping in a sample of Iranian women with breast cancer: a prospective study with comparative design.
        Health and quality of life outcomes. 2015; 13: 1-14
        • Roshandel G.
        • Ghanbari-Motlagh A.
        • Partovipour E.
        • Salavati F.
        • Hasanpour-Heidari S.
        • Mohammadi G.
        • Tavangar S.-M.
        Cancer incidence in Iran in 2014: results of the Iranian National Population-based Cancer Registry.
        Cancer epidemiology. 2019; 61: 50-58
        • Sabaghi Kenari M.
        • Hadadnezhad M.
        • Karimi M.
        Effect of Callisthenic Exercises on Shoulder Range of Motion, Pain and Quality of Life on Female Breast Cancer Survivals.
        Iranian Quarterly Journal of Breast Disease. 2017; 9: 60-70
      1. SAMA. (2020). Sama Tashkhis Aria-Iran.

        • Schmidt M.E.
        • Wiskemann J.
        • Armbrust P.
        • Schneeweiss A.
        • Ulrich C.M.
        • Steindorf K.
        Effects of resistance exercise on fatigue and quality of life in breast cancer patients undergoing adjuvant chemotherapy: a randomized controlled trial.
        International journal of cancer. 2015; 137: 471-480
        • Schmitz K.H.
        • Courneya K.S.
        • Matthews C.
        • Demark-Wahnefried W.
        • Galvão D.A.
        • Pinto B.M.
        • Lucia A.
        American College of Sports Medicine roundtable on exercise guidelines for cancer survivors.
        Medicine & Science in Sports & Exercise. 2010; 42: 1409-1426
        • Servick K.
        Breast cancer: a world of differences. 2014; 343: 1452-1453
        • Smoot B.
        • Wong J.
        • Cooper B.
        • Wanek L.
        • Topp K.
        • Byl N.
        • Dodd M.
        Upper extremity impairments in women with or without lymphedema following breast cancer treatment.
        Journal of cancer survivorship. 2010; 4: 167-178
        • Spei M.-E.
        • Samoli E.
        • Bravi F.
        • La Vecchia C.
        • Bamia C.
        • Benetou V.
        Physical activity in breast cancer survivors: A systematic review and meta-analysis on overall and breast cancer survival.
        The Breast. 2019; 44: 144-152
        • Stark D.P.H.
        • House A.
        Anxiety in cancer patients.
        British journal of cancer. 2000; 83: 1261-1267
        • Vardar Yağlı N.
        • Şener G.
        • Arıkan H.
        • Sağlam M.
        • İnal İnce D.
        • Savcı S.
        • Kutluk T.
        Do yoga and aerobic exercise training have impact on functional capacity, fatigue, peripheral muscle strength, and quality of life in breast cancer survivors?.
        Integrative cancer therapies. 2015; 14: 125-132
      2. WHO. (2020a). Breast cancer: prevention and control.

      3. WHO. (2020b). Cancer. Fact sheet n. 297. Updated September, 2018.

      4. WHO. (2020). Cancer. Fact sheet n. 297. Updated September, 2018.

      5. William E. Prentice, P., PT, ATC, FNATA (2020). Rehabilitation techniques for sports medicine and athletic training 2020 (seventh ed.): Slack Incorporated; Seventh edition (March 1, 2020).

        • Wilson D.J.
        Exercise for the patient after breast cancer surgery.
        Seminars in oncology nursing. 2017; 33: 98-105
        • Winters-Stone K.M.
        • Dobek J.
        • Bennett J.A.
        • Nail L.M.
        • Leo M.C.
        • Schwartz A.
        The effect of resistance training on muscle strength and physical function in older, postmenopausal breast cancer survivors: a randomized controlled trial.
        Journal of cancer survivorship. 2012; 6: 189-199
        • Yun Y.H.
        • Bae S.H.
        • Kang I.O.
        • Shin K.H.
        • Lee R.
        • Im Kwon S.
        • Lee E.S.
        Cross-cultural application of the Korean version of the European Organization for Research and Treatment of Cancer (EORTC) breast-cancer-specific quality of life questionnaire (EORTC QLQ-BR23).
        Supportive Care in Cancer. 2004; 12: 441-445
        • Zhu G.
        • Zhang X.
        • Wang Y.
        • Xiong H.
        • Zhao Y.
        • Sun F.
        Effects of exercise intervention in breast cancer survivors: a meta-analysis of 33 randomized controlled trails.
        OncoTargets and therapy. 2016; 9: 2153
        • Zigmond A.S.
        • Snaith R.P.
        The hospital anxiety and depression scale.
        Acta psychiatrica scandinavica. 1983; 67: 361-370