Supportive Care in Cancer

, Volume 26, Issue 2, pp 329–332 | Cite as

Longitudinal assessment of the impact of adapted physical activity on upper limb disability and quality of life in breast cancer survivors from an Italian cohort

  • Daniela Mirandola
  • Guido Miccinesi
  • Maria Grazia Muraca
  • Stefania Belardi
  • Roberta Giuggioli
  • Eleonora Sgambati
  • Mirko Manetti
  • Marco Monaci
  • Mirca MariniEmail author



The purpose of this study was to evaluate the effectiveness of a specific adapted physical activity (APA) protocol on upper limb disability and quality of life in breast cancer survivors and to assess longitudinally the possible role of APA on long-term benefits.


Breast cancer survivors from an Italian cohort were assessed by fitness tests (shoulder-arm mobility, range of motion, and back flexibility) before and after 8-week APA. Quality of life and back and surgical shoulder pain intensity were evaluated by Short Form-12 and numerical rating scale questionnaires, respectively. At 1.5-year post-APA follow-up, survivors were evaluated as at baseline/post-APA to assess long-term effects.


A statistically significant improvement in shoulder-arm mobility, pain perception, and quality of life was observed in breast cancer survivors after APA intervention. Longitudinal analyses indicated an overall decrease in the achieved benefits at 1.5-year post-APA.


The survivorship phase of breast cancer requires a multidisciplinary collaboration involving either the cancer-care medical team or APA professionals to manage psychophysical outcomes. A specific APA protocol may represent an effective countermeasure to reduce post-treatment upper limb disability and improve the quality of life in breast cancer survivors. Participation in structured APA protocols should be maintained over time to preserve the achieved benefits.


Adapted physical activity Breast cancer Survivorship Physical function Quality of life 



The authors are deeply grateful to all the women who participated in this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the Helsinki declaration.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Short CE, James EL, Girgis A, McElduff P, Plotnikoff RC (2012) Move more for life: the protocol for a randomised efficacy trial of a tailored-print physical activity intervention for post-treatment breast cancer survivors. BMC Cancer 12:172. CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Dunne M, Keenan K (2016) CE: late and long-term sequelae of breast cancer treatment. Am J Nurs 116:36–45. CrossRefPubMedGoogle Scholar
  3. 3.
    Khan F, Amatya B, Pallant JF, Rajapaksa I (2012) Factors associated with long-term functional outcomes and psychological sequelae in women after breast cancer. Breast 21:314–320. CrossRefPubMedGoogle Scholar
  4. 4.
    Schmidt ME, Chang-Claude J, Vrieling A, Heinz J, Flesch-Janys D, Steindorf K (2012) Fatigue and quality of life in breast cancer survivors: temporal courses and long-term pattern. J Cancer Surviv 6:11–19. CrossRefPubMedGoogle Scholar
  5. 5.
    Loprinzi PD, Cardinal BJ (2012) Effects of physical activity on common side effects of breast cancer treatment. Breast Cancer 19:4–10. CrossRefPubMedGoogle Scholar
  6. 6.
    Short CE, James EL, Plotnikoff RC (2013) Theory-and evidence-based development and process evaluation of the Move More for Life program: a tailored-print intervention designed to promote physical activity among post-treatment breast cancer survivors. Int J Behav Nutr Phys Act 10:124. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Bränström R, Petersson LM, Saboonchi F, Wennman-Larsen A, Alexanderson K (2015) Physical activity following a breast cancer diagnosis: implications for self-rated health and cancer-related symptoms. Eur J Oncol Nurs 19:680–685. CrossRefPubMedGoogle Scholar
  8. 8.
    Mirandola D, Miccinesi G, Muraca MG, Sgambati E, Monaci M, Marini M (2014) Evidence for adapted physical activity as an effective intervention for upper limb mobility and quality of life in breast cancer survivors. J Phys Act Health 11:814–822. CrossRefPubMedGoogle Scholar
  9. 9.
    Rasinaho M, Hirvensalo M, Törmäkangas T, Leinonen R, Lintunen T, Rantanen T (2012) Effect of physical activity counseling on physical activity of older people in Finland (ISRCTN 07330512). Health Promot Int 27:463–474. CrossRefPubMedGoogle Scholar
  10. 10.
    Rhodes A, Spinazzola J, van der Kolk B (2016) Yoga for adult women with chronic PTSD: a long-term follow-up study. J Altern Complement Med 22:189–196. CrossRefPubMedGoogle Scholar
  11. 11.
    Buffart LM, Galvão DA, Brug J, Chinapaw MJ, Newton RU (2014) Evidence-based physical activity guidelines for cancer survivors: current guidelines, knowledge gaps and future research directions. Cancer Treat Rev 40:327–340. CrossRefPubMedGoogle Scholar
  12. 12.
    Kampshoff CS, Jansen F, van Mechelen W, May AM, Brug J, Chinapaw MJ, Buffart LM (2014) Determinants of exercise adherence and maintenance among cancer survivors: a systematic review. Int J Behav Nutr Phys Act 11:80. CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Neuzillet C, Vergnault M, Bonnetain F, Hammel P (2016) Rationale and design of the Adapted Physical Activity in advanced Pancreatic Cancer patients (APACaP) GERCOR (Groupe Coopérateur Multidisciplinaire en Oncologie) trial: study protocol for a randomized controlled trial. Trials 16:454. CrossRefGoogle Scholar
  14. 14.
    Desnoyers A, Riesco E, Fülöp T, Pavic M (2016) Physical activity and cancer: update and literature review. Rev Med Interne 37:399–405. CrossRefPubMedGoogle Scholar
  15. 15.
    Haddad CA, Saad M, Perez Mdel C, Miranda Júnior F (2013) Assessment of posture and joint movements of the upper limbs of patients after mastectomy and lymphadenectomy. Einstein (Sao Paulo) 11:426–434. CrossRefGoogle Scholar
  16. 16.
    Johansen S, Fosså K, Nesvold IL, Malinen E, Fosså SD (2014) Arm and shoulder morbidity following surgery and radiotherapy for breast cancer. Acta Oncol 53:521–529. CrossRefPubMedGoogle Scholar
  17. 17.
    Senkus-Konefka E, Jassem J (2006) Complications of breast-cancer radiotherapy. Clin Oncol (R Coll Radiol) 18:229–235CrossRefGoogle Scholar
  18. 18.
    Borstad JD, Szucs KA (2012) Three-dimensional scapula kinematics and shoulder function examined before and after surgical treatment for breast cancer. Hum Mov Sci 31:408–418. CrossRefPubMedGoogle Scholar
  19. 19.
    Listing M, Reisshauer A, Krohn M, Voigt B, Tjahono G, Becker J, Klapp BF, Rauchfuss M (2009) Massage therapy reduces physical discomfort and improves mood disturbances in women with breast cancer. Psychooncology 18:1290–1299. CrossRefPubMedGoogle Scholar
  20. 20.
    Khadilkar L, MacDermid JC, Sinden KE, Jenkyn TR, Birmingham TB, Athwal GS (2014) An analysis of functional shoulder movements during task performance using Dartfish movement analysis software. Int J Shoulder Surg 8:1–9. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Daniela Mirandola
    • 1
  • Guido Miccinesi
    • 2
  • Maria Grazia Muraca
    • 3
  • Stefania Belardi
    • 4
  • Roberta Giuggioli
    • 4
  • Eleonora Sgambati
    • 5
  • Mirko Manetti
    • 4
  • Marco Monaci
    • 4
  • Mirca Marini
    • 4
    Email author
  1. 1.Italian League Against Tumors (LILT)Cancer Rehabilitation Center (Ce.Ri.On.)FlorenceItaly
  2. 2.Clinical Epidemiology UnitCancer Prevention and Research Institute (ISPO)FlorenceItaly
  3. 3.Cancer Rehabilitation Center (Ce.Ri.On.)Cancer Prevention and Research Institute (ISPO)FlorenceItaly
  4. 4.Department of Experimental and Clinical Medicine, Section of Anatomy and HistologyUniversity of FlorenceFlorenceItaly
  5. 5.Department of Biosciences and TerritoryUniversity of MolisePescheItaly

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