Abstract
BACKGROUND: Breast cancer-related lymphedema (BCRL) is a chronic complication of axillary lymph node dissection (ALND) that impairs mobility and quality of life (QoL). This study evaluated the impact of early systematic exercise on BCRL incidence, severity, and functional recovery. METHODS: A retrospective cohort study analyzed 136 patients who underwent ALND between 2020 and 2024. The intervention group (n=70) participated in a therapist-guided, phased exercise program initiated within two weeks post-surgery. The control group (n=66) received conventional health education. The primary outcome was BCRL incidence within 12 months (defined as ≥10% or ≥200 mL volume increase). Secondary outcomes included shoulder range of motion (ROM), [Disabilities of the Arm, Shoulder, and Hand (DASH) score] scores, pain [Visual Analog Scale (VAS) score], and QoL [European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and breast cancer module (EORTC QLQ-C30/BR23)]. RESULTS: The overall BCRL incidence was 25.0%. The intervention group showed a significantly lower incidence compared to controls (17.1% vs. 33.3%, P=0.03). Multivariate analysis confirmed early exercise as an independent protective factor [odds ratio (OR) =0.42, 95% confidence interval (CI): 0.20-0.88, P=0.02] and significantly delayed the time to BCRL onset [hazard ratio (HR) =0.52, P=0.04]. In the intervention group, patients experienced significantly reduced severity of lymphedema, characterized by smaller limb volume differences (95±120 vs. 165±140 mL, P=0.01) and a lower proportion of moderate-to-severe cases (5.7% vs. 18.2%). These patients also demonstrated superior functional recovery, with greater shoulder flexion and abduction ROM (P<0.01) and lower DASH scores (12.4±8.6 vs. 18.1±10.3, P=0.002), alongside enhanced well-being evidenced by lower median pain scores (VAS 1 vs. 2, P=0.02) and higher QLQ-C30 QoL scores (78.5±12.0 vs. 72.0±13.5, P=0.008). Subgroup analysis revealed the greatest benefits for high-risk patients [radiotherapy, high body mass index (BMI), ≥15 lymph nodes dissected]. No serious exercise-related adverse events occurred. CONCLUSIONS: Early, systematic exercise intervention after ALND is a safe and effective strategy to reduce BCRL risk and severity. It significantly enhances physical function and QoL, particularly in high-risk populations. These findings support integrating individualized exercise programs into routine postoperative rehabilitation pathways.