Effect of Aqua Therapy Exercises on Postmastectomy Lymphedema: A Prospective Randomized Controlled Trial. (2021)

PICO

Patient/Population

Female post-mastectomy lymphedema (mild to moderate degree or stage I–II) (n=50)

Intervention

  • Aqua therapy resistance exercise

Comparison

  • Land-based exercise

Outcomes

  • Limb volume (circumference)
  • ROM
  • VAS

Translatability   (3/3) Easy                                 

Comments: Aqua therapy resistance exercise decreases limb volume and pain increases the ROM of the shoulder joint.

Limitations: no long-term follow-up, no psychological status evaluation,  for maximum reliability different measurement tools might be useful.

Appraisals:

PEDro Scale  – (6/10) Concealed allocation: No; Blind subjects: No; Blind therapists: No; Blind assessors: No. (by PEDro – confirmed)

CEBMa CAT – The study contains no serious weaknesses. Based on this result you should conclude that the trustworthiness of the study is high (90%). This means there is a 10% chance that alternative explanations for the effect found are possible. The effect size was large and no CI were reported.  (by CAT for RCTS)

Metrics and
Journal Details:
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BTB

Intervention – 1

  • Aqua therapy resistance exercise

Dose

Periodicity

  • 3 sessions per week,  for 8 consecutive weeks.

Local/Technic:

Same land-based exercise + diaphragmatic breathing, submerged to their necks in water at 30°C–32°C. 

    Intervention – 2

    • Land-based exercise

    Dose

    • 60 minutes per session
    • 55% to 65% of 1RM with a maximum of 15–20 repetitions for 1 to 2 sets per exercise.  Weekly increments of 5%–10% for progressive resistance, if the participants were able to perform more repetitions than the RM specified during 3 consecutive with no increase in arm symptoms.

    Periodicity

    • 3 sessions per week,  for 8 consecutive weeks.

    Local/Technic:

    All the upper limb muscles or movements can be affected.

    1 – 10 minutes of warm-up exercises (for improving the mobility and overall fitness) – small soft-ball, fit-ball, mobility and stretching exercises (to target the upper arm muscles), horizontal extension, arm abduction to 135°, shoulder flexion involving elevation of the arm in the sagittal plane, and maintaining the stretching for 2 to 3 minutes.

    2 – 30–40 minutes for muscle strength – dumbbells with free weights, for all the upper limb muscles, dumbbells side rise for the abduction movement, and arm elevation. Biceps curls, elbow extension, external/internal rotations, protraction/retraction of the shoulder blades, wrist curls, ball pressing, and movement of the intrinsic muscles.

    3 –  last 10 minutes of cooling down + stretching exercises.

    4 – Diaphragmatic breathing exercises during the exercise program – “belly” breathing before starting the exercise program.

    Citation:

    Ali, K. M., El Gammal, E. R., & Eladl, H. M. (2021). Effect of Aqua Therapy Exercises on Postmastectomy Lymphedema: A Prospective Randomized Controlled Trial. Annals of rehabilitation medicine, 45(2), 131–140. https://doi.org/10.5535/arm.20127

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