McNeely, M.L., Parliament, M.B., Seikaly, H., Jha, N., Magee, D.J., Haykowsky, M.J., & Courneya, K.S. (2008). Effect of exercise on upper extremity pain and dysfunction in head and neck cancer survivors: A randomized controlled trial. Cancer, 113, 214–222.

To examine the effects of progressive resistance exercise training on upper extremity pain and dysfunction in postsurgical head and neck cancer survivors

Participants were randomly assigned to either standard therapeutic exercise or progressive resistance exercise training (PRET). All were asked to attend at least two supervised sessions per week for 12 weeks. Standard exercise involved active and passive range of motion and stretching, postural exercise, and strengthening with light weights (1–5 kg) and elastic resistance bands targeting specific muscle groups. The PRET group received the same exercises except that the strengthening was replaced with individualized exercise on the same muscle groups designed with the intent to provide progressive overload to those muscles. Outcomes were assessed at baseline and postintervention.

• The study reported on 52 head and neck cancer survivors.
• Mean participant age was 52 years (range = 32–76 years).
• The sample was 71% male and 29% female.
• To be eligible, participants had to have undergone surgical treatment, including radical neck dissection, modified radical neck dissection, or other variants of selective neck dissection; have a Karnofsky Performance Status score greater than 60%; have no evidence of residual cancer in the neck and no distant metastases; and have completed adjuvant treatment for head and neck cancer.
• All participants were required to present with symptoms of shoulder dysfunction attributed to spinal accessory nerve damage.

• Multisite
• Outpatient setting
• Cross Cancer Institute and University of Alberta in Edmonton, Canada

The study was a prospective randomized controlled trial.

• A block permutation procedure to generate the allocation sequence with each stratum Borg scale for rating of perceived exertion
• Training log
• Shoulder Pain and Disability Index (SPADI)
• Functional Assessment of Cancer Therapy–Anemia (FACT-An) scale for quality-of-life and fatigue assessment
• Neck Dissection Impairment Index (NDII)

The PRET program significantly reduced shoulder pain and disability (p = 0.001) and improved upper extremity muscular strength and endurance. Patients participating in the PRET program had a 52% reduction in pain. The effect size for change in pain was d = 0.84. PRET was better than the standard exercise for all strength endpoints measured, and endurance was more improved with PRET (p = 0.039).

Findings show that a program of individualized progressive resistance exercise in patients with specific shoulder dysfunction postsurgery for head and neck cancer as provided here can reduce pain and disability.

• Range of time from surgery varied widely among participants.
• Study results may have been limited by long-term survivors with deficits refractory to the exercise protocol that focused primarily on active and passive range-of-motion and basic strengthening exercises.
• The study did not differentiate between the location and type of pain in participants, nor did it differentiate involvement of the upper, middle, and lower trapezius, which may affect head and neck cancer survivors’ clinical presentation and response to treatment.

Survivors of head and neck cancer can be burdened with pain and loss of strength and function associated with damage to the spinal accessory nerve. It is important that nurses consider means that will help to minimize these residual effects. Exercise is a noninvasive tool that enables patients to actively participate in their recovery. This study shows that a PRET program had a beneficial effect, with reduction in pain of 52% in the PRET group. Improvement in pain was also associated with increases in upper extremity strength and endurance.