Time course of upper limb function and return-to-work post-radiotherapy in young adults with breast cancer: a pilot randomized control trial on effects of targeted exercise program



Breast cancer (BC) diagnosis in young adults (YA) is rising, and both disease and treatments are aggressive in this population. Evidence supports the use of physical activity in reducing shoulder dysfunction, which is common among BC survivors. A pilot randomized clinical trial was performed to determine the effectiveness of a 12-week post-radiation exercise program in minimizing upper extremity dysfunction in YA with BC.


Participants were randomized to either an exercise arm or a control arm receiving standard care. Data was collected over six time points using: the Disability of Arm, Shoulder, and Hand (DASH); the Metabolic Equivalent of Task-hours per week (MET-hours/week), and a post hoc questionnaire on return to work.


In total, 59 young women participated in the study (n = 29 exercise; n = 30 control). No statistically significant differences were found in overall DASH results between groups; however, those who underwent total mastectomy had residual upper limb dysfunction (p < 0.05). Both groups returned to pre-diagnosis activity levels by 18 months. Final evaluation showed that 86% of the women returned to work, and 89% resumed prior work activities with a decrease of 8.5 h/week.


Although the short-term targeted exercise program had no effect on long-term upper limb function post-radiation, timing and program specificity may require consideration of tissue healing post-radiation and surgery type. The majority of participants returned to work, however not returning to pre-diagnosis work hours.

Implications for Cancer Survivors

Exercise interventions alone may not reverse the long-term sequelae of breast cancer treatment and allow young adult patients to return to work.

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The authors wish to thank Hope & Cope, the CURE Foundation, and the Jewish General Hospital Foundation /Weekend to End Breast Cancer for providing the financial resources needed to sustain this research study. We thank the McGill Adolescent and Young Adult (AYA) program for their continued support.

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Corresponding author

Correspondence to Mary-Ann Dalzell.

Ethics declarations

Conflict of interest

Marize Ibrahim declares that she has no conflict of interest. Theirry Muanza declares that he has no conflict of interest. Nadia Smirnow declares that she has no conflict of interest. Warren Sateren declares that he has no conflict of interest. Beatrice Fournier declares that she has no conflict of interest. Warren Sateren declares that he has no conflict of interest. Petr Kavan declares that she has no conflict of interest. Michael Palumbo declares that he has no conflict of interest. Richard Dalfen declares that he has no conflict of interest. Mary-Ann Dalzell declares that she has no conflict of interest.

Human and animal rights

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 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

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

Research performed at the following institution

The Segal Cancer Center and the Department of Radiation Oncology at the Jewish General Hospital, Montreal, Quebec, Canada.

Previous presentation of research

Patient demographics have previously been reported in presentation and abstracts (Abstract Presented: Muanza, T. M., et al. “Randomized Clinical Trial of a Progressive Exercise Program for Young Women with Breast Cancer Undergoing Radiation Therapy.” International Journal of Radiation Oncology• Biology• Physics 93.3 (2015): S35-S36).

Ibrahim, M. Randomized Clinical Trial of a Post-Radiation Therapy Exercise Program for Young Women with Breast Cancer Hope & Cope, Jewish General Hospital; Dept. of Oncology, Faculty of Medicine, McGill University; Segal Cancer Centre, Jewish General Hospital. Canada. Canadian Cancer Research Conference 2015, Montreal QC. URL file:///E:/BREAST%20CANCER/Presentations-Submissions/Draft%20Marize%20Poster%202015-10-23.pdf


This study was funded by Hope & Cope, a grant from the CURE foundation, as well as grants from the Jewish General Hospitals’ Weekend to End Breast Cancer.

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Ibrahim, M., Muanza, T., Smirnow, N. et al. Time course of upper limb function and return-to-work post-radiotherapy in young adults with breast cancer: a pilot randomized control trial on effects of targeted exercise program. J Cancer Surviv 11, 791–799 (2017). https://doi.org/10.1007/s11764-017-0617-0

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  • Radiation therapy
  • Exercise
  • Physical therapy
  • Breast cancer
  • Young adult
  • Rehabilitation