***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: The purpose of this study was to determine whether 20 patients who received an early postmastectomy rehabilitation treatment program  showed more improvement in range of shoulder motion and functional activities than 13 patients who received instruction for exercise only .  Data were obtained at preoperatively , three days after operation , at discharge and at postdischarge one month for each patient on parameters such as range of motion of the ipsilateral shoulder joint , upper extremity circumferential measurements , as well as 10 elements of shoulder function . Postoperatively , both groups showed an increased range of motion of the shoulder joint and improved functional activities , but the group that received postoperative rehabilitation management had a better range of shoulder motion and less difficulty in five items for functional assessment . This study also showed that an early rehabilitation program did not increase postoperative complications . We concluded that an early rehabilitation program or intensive instruction program only by a well-trained physical therapist or physiatrist was beneficial to postmastectomy patients in regaining the function and range of shoulder motion , and significantly better in a rehabilitation group Aims and Background We attempted to determine the best method of performing the exercises in rehabilitation after breast cancer surgery and their influence on postoperative complications . Currently , there are no guidelines for these exercises . The scope of this study was to evaluate the effect of two schemes of physiotherapy exercises ( directed or free ) on shoulder function and lymphatic disturbance in postoperative rehabilitation . Subjects Sixty women who underwent a modified radical mastectomy or quadrantectomy with axillary dissection were r and omized into two groups . Methods The physiotherapy technique used was kinesiothera-py . The directed group performed physiotherapy following a regimen of 19 exercises . The free group performed the exercises following the biomechanical physiological movements of the shoulder without a previously defined sequence or number of repetitions . Results The averages of the flexion , abduction and external rotational movements of the shoulder showed better recovery with statistical significance in the directed group compared to the free group . There was no significant difference between the groups in lymphatic disturbance . Conclusion At the end of 42 days of follow-up , the movements of flexion , extension , abduction and external rotation of the shoulder were better rehabilitated in the directed group . The two schemes of exercises were not different with regard to lymphatic disturbance Breast cancer treatment often results in impaired shoulder function , in particular , decrements in muscular endurance and range of motion , which may lead to decreased quality of life . The purpose of this investigation was to determine the effects of walking pole use on shoulder function in female breast cancer survivors . Participants had previously been treated with 1 or a combination of the following : mastectomy , breast conservation therapy , axillary lymph node dissection , chemotherapy , or radiation . Participants were r and omly placed in experimental ( n = 6 ) and control ( n = 6 ) groups and met with a cancer exercise specialist 2 times each week for 8 weeks . The experimental group used walking poles during the 20-minute aerobic portion of their workout , whereas the control group did not use walking poles but performed 20 minutes of aerobic exercise per workout session . Both groups participated in similar resistance training programs . Testing was done pre- and postexercise intervention to determine upper body muscular endurance and active range of motion at the glenohumeral joint . Repeated- measures analysis of variance ( ANOVA ) revealed significant improvements in muscular endurance as measured by the bench press ( P = .046 ) and lat pull down ( P = .013 ) in the walking pole group . No within-group improvements were found in the group that did not use walking poles . The data suggest that using a walking pole exercise routine for 8 weeks significantly improved muscular endurance of the upper body , which would clearly be beneficial in helping breast cancer survivors perform activities of daily living and regain an independent lifestyle Sixty-seven patients undergoing level three axillary node clearance were studied to ascertain the benefit of collar and cuff shoulder immobilization in reducing the incidence of axillary seroma formation . During this period the patients ' views were obtained on this aspect of post-operative care . Although daily drainage volume decreased more rapidly in those patients whose shoulders were immobilized this did not result in a significant decrease in seroma formation following drain removal on the fifth post-operative day ( 31 % vs 43 % , P>0.05 ) . Patient interviews revealed that they found the collar and cuff incapacitating , felt it delayed their return to normal activity and made personal hygiene difficult to maintain . In view of these results shoulder immobilization should not be employed in the routine post-operative care of these patients Surgery and radiotherapy commonly cause adverse musculoskeletal problems , particularly loss of strength and range of motion , in the upper quadrant of breast cancer patients . Few well- design ed studies have investigated whether these impairments can be prevented . Stretching is an effective technique for increasing range of motion , hence the aim of this study was to investigate whether a stretching program reduced acute musculoskeletal impairments in patients undergoing radiotherapy for breast cancer . Sixty-four women were recruited prior to commencement of radiotherapy following breast cancer surgery . Participants were r and omised to either a control or stretch group . Participants in both groups were review ed by the physical therapist on a weekly basis for approximately 6 weeks , and were given general information about skin care and lymphedema . The control group received no advice about exercise . The stretch group received instruction on low-load , prolonged pectoral stretches , which were to be performed daily and were checked at weekly visits . Shoulder range of motion , strength , arm circumference , and quality of life measurements were taken prior to , and at completion of radiotherapy , and at 7 months after radiotherapy . There was no difference in any outcome between groups . Breast symptoms increased for both groups during radiotherapy , without loss of strength or range of movement . The incidence of lymphedema during the study was low for both groups and did not differ between groups . The pectoral stretching program did not influence the outcomes measured because the symptoms reported by patients were not a consequence of contracture Purpose Postoperative radiotherapy for breast cancer has a number of associated complications . This study examined whether supervised moderate-intensity exercise could mitigate the complications that occur during radiotherapy . Patients and Methods Forty women were r and omized before radiotherapy after various operations for breast cancer . Seventeen patients who were assigned to the exercise group performed supervised moderate-intensity exercise therapy for 50 min 3 times per week for 5 weeks . Twenty-three patients in the  control group were asked to perform self-shoulder stretching exercise . The World Health Organization Quality of Life-BREF ( WHOQOL-BREF ) , brief fatigue inventory ( BFI ) , range of motion ( ROM ) of the shoulder , and pain score were assessed before and after radiotherapy . Results There were no significant differences noted at baseline between groups . In the exercise group , there was an increase in the WHOQOL-BREF and shoulder ROM and decrease in BFI and pain score after radiotherapy . On the other h and , patients in the control group showed decrease in the WHOQOL-BREF and shoulder ROM and increase in BFI and pain score after radiotherapy . There were statistically significant differences in the changes in the WHOQOL , BFI , shoulder ROM , and pain score between the groups . Conclusion Patients receiving radiotherapy for breast cancer may benefit in physical and psychological aspects from supervised moderate-intensity exercise therapy Abstract Background : Seromas and impaired shoulder function are well-known complications after modified radical mastectomy for breast cancer . Early postoperative physiotherapy is a common treatment to avoid shoulder dysfunction . The aim of this study was to evaluate if the frequency of postoperative seromas could be reduced , without increasing shoulder dysfunction , by delayed postoperative shoulder exercises . Methods : In a prospect i ve study 163 patients with breast cancer undergoing modified radical mastectomy  were r and omized to physiotherapy starting on postoperative day 1 or day 7 . Patients were seen by the surgeons and the physiotherapists during hospital stay and in the outpatient department . Seromas and other complications were registered by the surgeons . The physiotherapists instructed the patients pre- and postoperatively and assessed shoulder function . Results : There was a significantly higher incidence of postoperative seromas in the group of patients that started physiotherapy postoperative day 1 ( 38 % ) compared to the group that started physiotherapy postoperative day 7 ( 22 % ) ( p<0.05 ) . There was no significant difference between the groups in the late outcome of shoulder function . Conclusion : The incidence of seromas after modified radical mastectomy for breast cancer is reduced by delaying shoulder exercises one week postoperatively . Earlier postoperative physiotherapy is not necessary to avoid impaired shoulder function Objective This pilot study examined the effects of a self-administered , home-based exercise ( HBE ) rehabilitation programme design ed to help women regain shoulder mobility immediately following surgery for a modified radical mastectomy and axillary node dissection . Methods Twenty-seven women who were scheduled for surgery were r and omly assigned to either a  post-surgical experimental HBE rehabilitation group  ( n = 16 ) or a  usual care group  ( UC ; n = 11 ) . Women assigned to the HBE group followed an 11 day ( days 3–14 post-surgery ) , home-based rehabilitation programme consisting of shoulder flexibility and stretching exercises that were described on videotape . The videotape programme was modelled after the exercises and guidelines described in a brochure produced by the Canadian Cancer Society . Results As a result of the exercise programme intervention , there was a time × group interaction indicating that the HBE group demonstrated a significantly greater increase in shoulder flexion range of motion ( ROM ) ( p = 0.003 ) and abduction ROM ( p = 0.036 ) when compared to the UC . There were no statistical differences in shoulder strength between groups over time . External rotation ( p = 0.036 ) and grip strength ( p = 0.001 ) significantly increased in both groups during the intervention period but there were no interaction effects . With respect to the forearm circumferences , there was a significant decrease over time ( p < 0.001 ) but no interaction between groups . Conclusion This HBE rehabilitation programme is an effective way to improve shoulder mobility and ROM during the immediate 2-week recovery period following surgery Objectives To determine functional and psychological benefits of a 12 week supervised group exercise programme during treatment for early stage breast cancer , with six month follow-up . Design Pragmatic r and omised controlled prospect i ve open trial . Setting Three National Health Service oncology clinics in Scotl and and community exercise facilities . Participants 203 women entered the study ; 177 completed the six month follow-up . Interventions Supervised 12 week group exercise programme in addition to usual care , compared with usual care . Main outcome measures Functional assessment of cancer therapy ( FACT ) question naire , Beck depression inventory , positive and negative affect scale , body mass index , seven day recall of physical activity , 12 minute walk test , and assessment of shoulder mobility . Results Mixed effects models with adjustment for baseline values , study site , treatment at baseline , and age gave intervention effect estimates ( intervention minus control ) at 12 weeks of 129 ( 95 % confidence interval 83 to 176 ) for metres walked in 12 minutes , 182 ( 75 to 289 ) for minutes of moderate intensity activity reported in a week , 2.6 ( 1.6 to 3.7 ) for shoulder mobility , 2.5 ( 1.0 to 3.9 ) for breast cancer specific subscale of quality of life , and 4.0 ( 1.8 to 6.3 ) for positive mood . No significant effect was seen for general quality of life ( FACT-G ) , which was the primary outcome . At the six month follow-up , most of these effects were maintained and an intervention effect for breast cancer specific quality of life emerged . No adverse effects were noted . Conclusion Supervised group exercise provided functional and psychological benefit after a 12 week intervention and six months later . Clinicians should encourage activity for their patients . Policy makers should consider the inclusion of exercise opportunities in cancer rehabilitation services . Trial registration Current controlled trials IS RCT N12587864 PURPOSE Breast cancer chemotherapy  may cause unfavorable changes in physical functioning , body composition , psychosocial functioning , and quality of life ( QOL ) . We evaluated the relative merits of aerobic and resistance exercise in blunting these effects . PATIENTS AND METHODS We conducted a multicenter r and omized controlled trial in Canada between 2003 and 2005 that r and omly assigned 242 breast cancer patients initiating adjuvant chemotherapy to usual care ( n = 82 ) , supervised resistance exercise  ( n = 82 ) , or supervised aerobic exercise  ( n = 78 ) for the duration of their chemotherapy ( median , 17 weeks ; 95 % CI , 9 to 24 weeks ) . Our primary end point was cancer-specific QOL assessed by the Functional Assessment of Cancer Therapy-Anemia scale . Secondary end points were fatigue , psychosocial functioning , physical fitness , body composition , chemotherapy completion rate , and lymphedema . RESULTS The follow-up assessment rate for our primary end point was 92.1 % , and adherence to the supervised exercise was 70.2 % . Unadjusted and adjusted mixed-model analyses indicated that aerobic exercise was superior to usual care for improving self-esteem ( P = .015 ) , aerobic fitness ( P = .006 ) , and percent body fat ( adjusted P = .076 ) . Resistance exercise was superior to usual care for improving self-esteem ( P = .018 ) , muscular strength ( P < .001 ) , lean body mass ( P = .015 ) , and chemotherapy completion rate ( P = .033 ) . Changes in cancer-specific QOL , fatigue , depression , and anxiety favored the exercise groups but did not reach statistical significance . Exercise did not cause lymphedema or adverse events . CONCLUSION Neither aerob 
    Output:
    
Exercise can result in a significant and clinical ly meaningful improvement in shoulder ROM in women with breast cancer .