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CC BY-NC-ND 4.0 · Sports Med Int Open 2017; 1(05): E160-E165
DOI: 10.1055/s-0043-115105
Clinical Sciences
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Upper Extremity Strength Imbalance after Mastectomy and the Effect of Resistance Training

Melissa J. Benton
1   University of Colorado Colorado Springs, Helen & Arthur E. Johnson Beth-El College of Nursing & Health Sciences, Colorado Springs, United States
,
Maura C. Schlairet
2   Mercer University, Georgia Baptist College of Nursing, Atlanta, United States
› Author Affiliations
Further Information

Publication History

received 14 April 2017
revised 15 June 2017

accepted 18 June 2017

Publication Date:
02 August 2017 (online)

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Abstract

The purpose of this non-randomized pre/post comparison trial was to explore the effect of resistance training (RT) on upper extremity strength imbalance in breast cancer survivors. Seventeen right-side dominant female breast cancer survivors (age: 58.2±2.7 years; BMI: 27.8±1.1 kg/m2) with right-sided (RSM) or left-sided (LSM) mastectomy completed strength testing (30-second arm curl) before and after an 8-week RT program. At baseline, LSM (n=8) had equal strength bilaterally (right=16.8±1.1 repetitions; left=16.4±1.4 repetitions), whereas RSM (n=9) had impaired strength on the right (16.7±1.3 repetitions) compared to the left (18.6±1.1 repetitions) side (p<0.01). After RT, RSM increased strength by 25% on the right (initially weaker) side and 19% on the left (initially stronger) side, which resolved the imbalance. By comparison LSM increased 19% on both sides that were initially equal in strength. Based on our findings, breast cancer survivors with dominant-side mastectomy are at risk for upper extremity strength imbalance that can be resolved with a relatively short-term RT program.

Key words

breast cancer - exercise training - arm curl
 

  • References

  • 1 Bemben MG, Murphy RE. Age related neural adaptation following short term resistance training in women. J Sports Med Phys Fitness 2001; 41: 291-299
    PubMedGoogle Scholar
  • 2 Benton MJ, Alexander JL. Validation of functional fitness tests as surrogates for strength measurement in frail, older adults with chronic obstructive pulmonary disease. Am J Phys Med Rehabil 2009; 88: 579-583
    CrossrefPubMedGoogle Scholar
  • 3 Benton MJ, Schlairet MC, Gibson DR. Change in quality of life among breast cancer survivors after resistance training: Is there an effect of age?. J Aging Phys Act 2014; 22: 178-185
    CrossrefPubMedGoogle Scholar
  • 4 Burnham RS, May L, Nelson E, Steadward R, Reid DC. Shoulder pain in wheelchair athletes. The role of muscle imbalance. Am J Sports Med 1993; 21: 238-242
    CrossrefPubMedGoogle Scholar
  • 5 Callaway CW, Chumlea WC, Bouchard C, Himes JH, Lohman TG, Martin AD, Mitchell CD. Circumferences. In: Lohman TG. ed. Anthropometric Standardization Reference Manual. Champaign, IL: Human Kinetics; 1988: 44-46
    Google Scholar
  • 6 Cheema BS, Kilbreath SL, Fahey PP, Delaney GP, Atlantis E. Safety and efficacy of progressive resistance training in breast cancer: A systematic review and meta-analysis. Breast Cancer Res Treat 2014; 148: 249-268
    CrossrefPubMedGoogle Scholar
  • 7 Costa E, Moreira A, Cavalcanti B, Krinski K, Aoki M. Effect of unilateral and bilateral resistance exercise on maximal voluntary strength, total volume of load lifted, and perceptual and metabolic responses. Biol Sport 2015; 32: 35-40
    PubMedGoogle Scholar
  • 8 Courneya KS, Segal RJ, Mackey JR, Gelmon K, Reid RD, Friedenreich CM, Ladha AB, Proulx C, Vallance JK, Lane K, Yasui Y, McKenzie DC. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: A multicenter randomized controlled trial. J Clin Oncol 2007; 25: 4396-4404
    CrossrefPubMedGoogle Scholar
  • 9 Croisier JL, Forthomme B, Namurois MH, Vanderthommen M, Crielaard JM. Hamstring muscle strain recurrence and strength performance disorders. Am J Sports Med 2002; 30: 199-203
    CrossrefPubMedGoogle Scholar
  • 10 Dasgupta S, Sanyal S, Sengupta SP. Transpectoral anterior approach to the axilla for lymph node dissection in association with mastectomy preserving both pectoral muscles and their neurovascular bundles. Tumori 1999; 85: 498-502
    PubMedGoogle Scholar
  • 11 Dragun AE, Huang B, Tucker TC, Spanos WJ. Increasing mastectomy rates among all age groups for early stage breast cancer: A 10-year study of surgical choice. Breast J 2012; 18: 318-325
    CrossrefPubMedGoogle Scholar
  • 12 Edouard P, Degache F, Oullion R, Plessis JY, Gleizes-Cervera S, Calmels P. Shoulder strength imbalances as injury risk in handball. Int J Sports Med 2013; 34: 654-660
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Fritz CO, Morris PE, Richler JJ. Effect size estimates: Current use, calculations, and interpretation. J Exp Psychol Gen 2012; 141: 2-18
    CrossrefPubMedGoogle Scholar
  • 14 Hagstrom AD, Shorter KA, Marshall PW. Changes in unilateral upper limb muscular strength and EMG activity following a 16 week strength training intervention survivors of breast cancer. J Strength Cond Res 2017; DOI: 10.1519/JSC.0000000000001890.
    CrossrefPubMedGoogle Scholar
  • 15 Harrington S, Padua D, Battaglini C, Michener LA, Giuliani C, Myers J, Groff D. Comparison of shoulder flexibility, strength, and function between breast cancer survivors and healthy participants. J Cancer Surviv 2011; 5: 167-174
    CrossrefPubMedGoogle Scholar
  • 16 Harriss DJ, Atkinson G. Ethical standards in sport and exercise science research: 2016 update. Int J Sports Med 2015; 36: 1121-1124
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Hayes S, Battistutta D, Newman B. Objective and subjective upper body function six months following diagnosis of breast cancer. Breast Cancer Res Treat 2005; 94: 1-10
    CrossrefPubMedGoogle Scholar
  • 18 Hayes SC, Battistutta D, Parker AW, Hirst C, Newman B. Assessing task "burden" of daily activities requiring upper body function among women following breast cancer treatment. Support Care Cancer 2005; 13: 255-265
    CrossrefPubMedGoogle Scholar
  • 19 Hubal MJ, Gordish-Dressman H, Thompson PD, Price TB, Hoffman EP, Angelopoulos TJ, Gordon PM, Moyna NM, Pescatello LS, Visich PS, Zoeller RF, Seip RL, Clarkson PM. Variability in muscle size and strength gain after unilateral resistance training. Med Sci Sports Exerc 2005; 37: 964-972
    PubMedGoogle Scholar
  • 20 Jacobs C, Uhl TL, Seeley M, Sterling W, Goodrich L. Strength and fatigability of the dominant and nondominant hip abductors. J Athl Train 2005; 40: 203-206
    PubMedGoogle Scholar
  • 21 Janzen CL, Chilibeck PD, Davison KS. The effect of unilateral and bilateral strength training on the bilateral deficit and lean tissue mass in post-menopausal women. Eur J Appl Physiol 2006; 97: 253-260
    CrossrefPubMedGoogle Scholar
  • 22 Jung H, Lee N, Park S. Interaction of ACTN3 gene polymorphism and muscle imbalance effects on kinematic efficiency in combat sports athletes. J Exerc Nutrition Biochem 2016; 20: 1-7
    PubMedGoogle Scholar
  • 23 Knapik JJ, Bauman CL, Jones BH, Harris JM, Vaughan L. Preseason strength and flexibility imbalances associated with athletic injuries in female collegiate athletes. Am J Sports Med 1991; 19: 76-81
    CrossrefPubMedGoogle Scholar
  • 24 Lee M, Carroll TJ. Cross education: Possible mechanisms for the contralateral effects of unilateral resistance training. Sports Med 2007; 37: 1-14
    CrossrefPubMedGoogle Scholar
  • 25 Lin JJ, Wu YT, Wang SF, Chen SY. Trapezius muscle imbalance in individuals suffering from frozen shoulder syndrome. Clin Rheumatol 2005; 24: 569-575
    CrossrefPubMedGoogle Scholar
  • 26 Lucado AM, Kolber MJ, Cheng MS, Echternach Sr JL. Upper extremity strength characteristics in female recreational tennis players with and without lateral epicondylalgia. J Orthop Sports Phys Ther 2012; 42: 1025-1031
    CrossrefPubMedGoogle Scholar
  • 27 Luk HY, Winter C, O'Neill E, Thompson BA. Comparison of muscle strength imbalance in powerlifters and jumpers. J Strength Cond Res 2014; 28: 23-27
    CrossrefPubMedGoogle Scholar
  • 28 Merchant CR, Chapman T, Kilbreath SL, Refshauge KM, Krupa K. Decreased muscle strength following management of breast cancer. Disabil Rehabil 2008; 30: 1098-1105
    CrossrefPubMedGoogle Scholar
  • 29 Milne HM, Wallman KE, Gordon S, Courneya KS. Effects of a combined aerobic and resistance exercise program in breast cancer survivors: a randomized controlled trial. Breast Cancer Res Treat 2008; 108: 279-288
    CrossrefPubMedGoogle Scholar
  • 30 Munn J, Herbert RD, Gandevia SC. Contralateral effects of unilateral resistance training: a meta-analysis. J Appl Physiol 2004; 96: 1861-1866
    CrossrefPubMedGoogle Scholar
  • 31 Munn J, Herbert RD, Hancock MJ, Gandevia SC. Training with unilateral resistance exercise increases contralateral strength. J Appl Physiol 2005; 99: 1880-1884
    CrossrefPubMedGoogle Scholar
  • 32 Nickols-Richardson SM, Miller LE, Wootten DF, Ramp WK, Herbert WG. Concentric and eccentric isokinetic resistance training similarly increases muscular strength, fat-free soft tissue mass, and specific bone mineral measurements in young women. Osteoporos Int 2007; 18: 789-796
    CrossrefPubMedGoogle Scholar
  • 33 Niederbracht Y, Shim AL, Sloniger MA, Paternostro-Bayles M, Short TH. Effects of a shoulder injury prevention strength training program on eccentric external rotator muscle strength and glenohumeral joint imbalance in female overhead activity athletes. J Strength Cond Res 2008; 22: 140-145
    CrossrefPubMedGoogle Scholar
  • 34 Noffal GJ. Isokinetic eccentric-to-concentric strength ratios of the shoulder rotator muscles in throwers and nonthrowers. Am J Sports Med 2003; 31: 537-541
    CrossrefPubMedGoogle Scholar
  • 35 Rikli RE, Jones CJ. Development and validation of a functional fitness test for community-residing older adults. J Aging Phys Act 1999; 7: 127-159
    PubMedGoogle Scholar
  • 36 Schmitz KH. Balancing lymphedema risk: Exercise versus deconditioning for breast cancer survivors. Exerc Sport Sci Rev 2010; 38: 17-24
    CrossrefPubMedGoogle Scholar
  • 37 Schmitz KH, Ahmed RL, Troxel A, Cheville A, Smith R, Lewis-Grant L, Bryan CJ, Williams-Smith CT, Greene QP. Weight lifting in women with breast-cancer-related lymphedema. N Engl J Med 2009; 361: 664-673
    CrossrefPubMedGoogle Scholar
  • 38 Sclafani LM, Baron RH. Sentinel lymph node biopsy and axillary dissection: added morbidity of the arm, shoulder and chest wall after mastectomy and reconstruction. Cancer J 2008; 14: 216-222
    CrossrefPubMedGoogle Scholar
  • 39 Shamley DR, Srinanaganathan R, Weatherall R, Oskrochi R, Watson M, Ostlere S, Sugden E. Changes in shoulder muscle size and activity following treatment for breast cancer. Breast Cancer Res Treat 2007; 106: 19-27
    CrossrefPubMedGoogle Scholar
  • 40 Unyo C, Chaler J, Rojas-Martinez M, Pujol E, Muller B, Garreta R, Mananas MA. A cross-sectional study comparing strength profile of dorsal and palmar flexor muscles of the wrist in epicondylitis and healthy men. Eur J Phys Rehabil Med 2013; 49: 507-515
    PubMedGoogle Scholar
  • 41 van Delden AE, Peper CE, Beek PJ, Kwakkel G. Unilateral versus bilateral upper limb exercise therapy after stroke: a systematic review. J Rehabil Med 2012; 44: 106-117
    CrossrefPubMedGoogle Scholar
  • 42 van Huizum MA, Hoornweg MJ, de Ruiter N, Oudenhoven E, Hage JJ, Veeger DJ. Effect of latissimus dorsi flap breast reconstruction on the strength profile of the upper extremity. J Plast Surg Hand Surg 2016; 1-6
    PubMedGoogle Scholar
  • 43 Wang HK, Cochrane T. Mobility impairment, muscle imbalance, muscle weakness, scapular asymmetry and shoulder injury in elite volleyball athletes. J Sports Med Phys Fitness 2001; 41: 403-410
    PubMedGoogle Scholar
  • 44 Winters-Stone KM, Dobek J, Bennett JA, Nail LM, Leo MC, Schwartz A. The effect of resistance training on muscle strength and physical function in older, postmenopausal breast cancer survivors: a randomized controlled trial. J Cancer Surviv 2012; 6: 189-199
    CrossrefPubMedGoogle Scholar
  • 45 Winters-Stone KM, Dobek J, Nail LM, Bennett JA, Leo MC, Torgrimson-Ojerio B, Luoh SW, Schwartz A. Impact + resistance training improves bone health and body composition in prematurely menopausal breast cancer survivors: a randomized controlled trial. Osteoporos Int 2013; 24: 1637-1646
    CrossrefPubMedGoogle Scholar