Effects of Progressive Upper Limb Exercises and Muscle Relaxation Training on Upper Limb Function and Health-Related Quality of Life Following Surgery in Women with Breast Cancer: A Clinical Randomized Controlled Trial

  • Kaina Zhou
  • Wen Wang
  • Jinghua An
  • Minjie Li
  • Jin Li
  • Xiaomei LiEmail author
Breast Oncology



The aim of this study was to examine the effects of progressive upper limb exercises and muscle relaxation training (PULE-MRT) on upper limb function and health-related quality of life (HRQoL) following surgery in Chinese mainland women with breast cancer (BC).


Overall, 102 patients following surgery (i.e. mastectomy or breast-conserving surgery, with sentinel lymph node biopsy or axillary lymph node dissection) were randomly allocated to the intervention (n = 51) or control (n = 51) groups. The former received PULE-MRT plus routine nursing care, whereas the latter received only routine nursing care for 6 months. Upper limb function and HRQoL were measured at baseline and 1, 3, and 6 months using Constant–Murley scores (CMS) and Functional Assessment of Cancer Therapy-Breast version 4.0 (FACT-Bv4.0), respectively.


All patients in the intervention group completed the exercises and training, with 100% compliance and no adverse events. The intervention group had significantly higher total CMS and FACT-Bv4.0 scores at 1-, 3-, and 6-month follow-up than the control group. The significant effects in total CMS comparisons were group (F = 25.30, p < 0.001), time (F = 18.02, p < 0.001), and group-by-time interaction (F = 9.95, p < 0.001), and, in FACT-Bv4.0, total score comparisons were group (F = 15.87, p < 0.001), time (F = 17.92, p < 0.001), and group-by-time interaction (F = 7.88, p < 0.001). Similar results were observed for the scale scores of CMS and FACT-Bv4.0.


PULE-MRT had positive effects on improving upper limb function and HRQoL following surgery in women with BC and could be used as an optional rehabilitation management strategy in post-surgery BC patient populations.

Trial Registration ChiCTR-IOR-16008253 (; 9 April 2016).



We thank the Breast Cancer Surgical Department of the First Affiliated Hospital of Xi’an Jiaotong University for their support.


This study was funded by the National Natural Science Foundation of China (Grant Number 81502700) to KZ. No other authors received any grants related to this manuscript.

Compliance with Ethical Standards


The authors declare that they have no conflicts of interest.

Ethical Standards

All procedures were performed 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. The study protocol received ethical approval from the Biomedical Ethics Committee of Xi’an Jiaotong University Health Science Center (reference 2015-170).

Informed Consent

Written informed consent was obtained from all patients included in the study, prior to data collection.

Supplementary material

10434_2019_7305_MOESM1_ESM.tiff (1.3 mb)
Participant selection process (TIFF 1285 kb)
10434_2019_7305_MOESM2_ESM.eps (193 kb)
Changes in the Constant–Murley scores from baseline to 6 months after surgery. ADL activities of daily living, ROM range of motion (EPS 192 kb)
10434_2019_7305_MOESM3_ESM.eps (218 kb)
Changes in the FACT-Bv4.0 scores from baseline to 6 months after surgery. FACT-Bv4.0 Functional Assessment of Cancer Therapy-Breast version 4.0 (EPS 217 kb)


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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  1. 1.School of NursingXi’an Jiaotong University Health Science CentreXi’anChina

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