The impact of exercise prehabilitation on upper extremity range of motions, functionality and quality of life in breast cancer survivors: a prospective clinical trial

BACKGROUND: Aim of this trial is to evaluate the long-term effects of an individualized exercise prehabilitation program on shoulder range of motions (ROM), functionality, pain, and quality of life (QoL) in women with breast cancer (BC). METHODS: Prospective single-center longitudinal prehabilitation trial was conducted with thirty women with BC, completed chemotherapy and scheduled for surgery. Participants who completed 12 months of follow-up were included in the final analysis. A structured, individualized exercise program included postural correction, aerobic and respiratory, stretching and strengthening exercises of muscles adjacent to shoulder and upper extremity, scapulothoracic mobilization via periscapular stretching and strengthening. Adjustments were made according to days of surgery, radiation therapy (RT) and individual tolerance. Range of motion (ROM), pain intensity via Visual Analog Scale (VAS), inter-limb volume difference and patient-reported outcome measures (PROM) such as European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30), Upper Extremity Functional Index-15 (UEFI-15), and Fatigue Severity Scale (FSS) were assessed at baseline and at 1, 3, 6, and 12 months. RESULTS: Pain intensity increased significantly in the early postoperative period but declined progressively by month 12. Shoulder ROM improved gradually, with flexion and abduction recovering by month 3, internal rotation by month 6, and external rotation by month 12. PROMs demonstrated significant improvements, while inter-limb volume differences remained nonsignificant. Patients undergoing RT exhibited temporary mobility limitation, which improved with continued exercise participation. CONCLUSIONS: Prehabilitation and maintaining structured exercise is safe and effective for functionality and QoL in women with BC. Incorporating scapulothoracic mobilization and strengthening may further mitigate RT-related dysfunction. These findings support integrating individualized prehabilitation into standard oncologic rehabilitation protocols. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT07240584, Release Date: November 16, 2025. The trial is retrospectively registered to the Clinical Trials.gov, Protocol Registration and Results System.