Effect of ERAS and Upper Limb Exercise on LoS After Modified Radical Mastectomy

The Effect of Enhanced Recovery After Surgery and Upper Limb Exercise on Length of Stay After Modified Radical Mastectomy

The goal of this clinical trial is to learn if Enhanced Recovery After Surgery (ERAS) protocol and upper limb exercise shorten the length of stay (LoS) in adults after modified radical mastectomy (MRM) surgery. The main questions it aims to answer are:

• Do ERAS protocol and upper limb exercise shorten the LoS after modified radical mastectomy (MRM)? Researchers will compare the ERAS protocol and upper limb exercise intervention to standard care to determine whether these interventions reduce LoS.

Four weeks before surgery, participants in intervention group will do:

• Aerobic exercise by walking for 30 minutes at moderate intensity (Borg scale 12-14) with frequency twice a week and by cycling for 30 minutes at moderate intensity (40-60% HRR / 64-76% HRmax/RPE 12-14) with frequency three times a week.
• Strengthening exercise of lower limbs three times a week, intensity 60-80% 1RM, 3 set, 10 repetition, rest 60 seconds between sets by machine pulley.
• Strengthening exercise of upper limbs at intensity 60-80% 1RM, frequency three times a week, 10 repetition, rest 60 seconds by bench press and cable front raise.
• Stretching exercise of upper limbs and range of motion exercise frequency three times a week, hold 10 seconds, by static stretching.

After surgery, both groups will do:

• Mobilization, ambulation, and shoulder range of motion exercise in first 24 hours after surgery.

Inclusion Criteria:

1. Women aged 30-65 years
2. Diagnosed with breast cancer by histopathological examination and will undergo the first MRM surgery
3. Planned to undergo neoadjuvant chemotherapy
4. Hemodynamically stable (assessed by vital signs)
5. Mini Mental State Examination (MMSE) score > 25
6. Comorbid diseases are controlled
7. Corrected nutritional status
8. No balance or coordination disorders
9. Normal or corrected vision function
10. Normal hearing function as tested by whisper test
11. Willing and agree to participate in the study until completion and sign informed consent

Exclusion Criteria:

1. Presence of distant metastasis
2. Presence of lymphedema
3. Limited joint range of motion
4. Other cardiovascular conditions that contraindicate physical exercise according to the American College of Sports Medicine (ACSM) guidelines