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Article

IMU-Based Assessment of Arm Movement in Breast Cancer Survivors: An Exploratory Study

by
Carlos Navarro-Martínez
1,
Diego Hernán Villarejo-García
1,*,
Rafael Carvajal-Espinosa
2,
Germán Cánovas-Ambit
3,
Boryi A. Becerra-Patiño
4 and
José Pino-Ortega
1
1
BioVetMed & SportSci Research Group, Faculty of Sport Sciences, University of Murcia, 30720 San Javier, Spain
2
School of Physical Education and Sports, University of Costa Rica, San José 11501-2060, Costa Rica
3
Research Group on Physiotherapy and Disability, Murcian Institute of Biomedical Research IMIB-Arrixaca, 30120 Murcia, Spain
4
Research Group on Management and Pedagogy of Physical Activity and Sport, Faculty of Physical Education, Pedagogical National University, Bogotá 110221, Colombia
*
Author to whom correspondence should be addressed.
Women 2025, 5(4), 41; https://doi.org/10.3390/women5040041
Submission received: 8 September 2025 / Revised: 31 October 2025 / Accepted: 3 November 2025 / Published: 6 November 2025
(This article belongs to the Special Issue Breast Cancer: Causes and Prevention)
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Abstract

Breast cancer (BC), despite its high survival rate, can cause significant functional sequelae in the scapulohumeral joint after surgery. This study evaluated angular velocity during a lateral reach test, comparing the operated arm with the non-operated arm as a possible indicator of functional asymmetry. This study employed an observational, comparative, cross-sectional design. Twenty-two women voluntarily participated in the study. The anthropometric characteristics were as follows: mean age, 55.95 ± 6.34 years; height, 1.63 ± 0.06 m; body weight, 65.37 ± 11.10 kg; and BMI, 24.73 ± 3.60 kg/m2. The participants, who were survivors of breast cancer and had undergone surgery on only one arm, regularly performed physical activity in the Department of Exercise, Education, and Cancer at the University of Murcia, BC. A lateral opening test was performed, measuring the angular velocity in both arms during 15 repetitions using the WIMU PRO™ inertial device. Results showed no significant main effects for arm (p = 0.369) or surgery side (p = 0.587) but a significant interaction (F = 29.44, p = 0.001), with lower velocity in the operated arm both for right-side surgery (right: 100.4 ± 31.1 vs. left: 111.7 ± 32.0 °/s) and left-side surgery (left: 92.1 ± 22.3 vs. right: 100.2 ± 20.2 °/s). Effect sizes were small to moderate (Hedges’ g = 0.35–0.36). This difference may suggest the presence of postoperative functional asymmetries, which may inform future research on therapeutic exercise approaches, though direct clinical applications cannot yet be established. These preliminary findings highlight the feasibility of using inertial devices to assess postoperative functional asymmetry in breast cancer survivors.

1. Introduction

Breast cancer remains one of the leading causes of death in women worldwide, accounting for 685,000 deaths in 2020 [1]. Advances in medicine and early detection have increased survival rates [2,3,4]; however, many survivors continue to experience postoperative functional sequelae that compromise quality of life, particularly in the shoulder joint [5,6,7,8]. Exercise interventions combining strength and aerobic components have demonstrated improvements in functional capacity, emotional health, fatigue, and overall quality of life [9,10,11,12]. However, despite these benefits, persistent deficits in strength, mobility, and neuromuscular coordination remain evident in women following treatment [5,13,14].
Functional impairments following breast cancer treatment stem from interrelated physiological and mechanical factors, including hormonal dysregulation [15], neuromuscular alterations [16], and musculoskeletal adaptations resulting from surgical and radiotherapy procedures [17,18,19]. These alterations lead to pain, stiffness, restricted range of motion, and disturbed scapulohumeral mechanics that compromise upper-limb function and daily activities [20,21,22,23]. Although such deficits may persist long after clinical recovery, current assessments largely rely on subjective or coarse clinical measures, underscoring the need for an objective kinematic evaluation in post-treatment functional analysis.
Traditional assessment methods—such as range of motion, strength testing, electromyography, or isokinetic analysis [24,25,26,27]—provide valuable yet incomplete insight into the dynamic execution of upper-limb movement. These approaches typically evaluate static or isolated conditions that do not fully represent everyday functional demands. Therefore, there is a growing need for objective, portable, and ecologically valid tools that can quantify shoulder performance under dynamic conditions.
In this context, inertial measurement units (IMUs), which integrate accelerometers, gyroscopes, and magnetometers, enable the precise recording of acceleration and angular velocity, offering a practical alternative for movement assessment in clinical and field settings [28,29]. IMU-based systems have demonstrated reliability and sensitivity in evaluating movement quality across different rehabilitation contexts [30]. Recent studies have extended their application to cancer rehabilitation, suggesting that IMUs can capture subtle motor deficits and monitor functional recovery [31,32,33]. However, their feasibility for unilateral functional assessment in breast cancer survivors remains scarcely explored, particularly regarding side-to-side asymmetries that may indicate residual deficits.
Accordingly, this exploratory study aimed to evaluate the feasibility of using IMUs to detect inter-limb differences in shoulder angular velocity during a unilateral functional task in breast cancer survivors. Given its exploratory nature, the study specifically hypothesized that the operated arm would exhibit lower angular velocity than the non-operated arm, reflecting potential functional asymmetry after surgery.

2. Results

For the residuals of right mean velocity, the Kolmogorov–Smirnov test yielded D(22) = 0.122, p = 0.200, and the Shapiro–Wilk test yielded W(22)= 0.967, p = 0.637. For the residuals of left mean velocity, the Kolmogorov–Smirnov test yielded D(22) = 0.176, p = 0.075, and the Shapiro–Wilk test yielded W(22) = 0.925, p = 0.095. In all cases, significance values were above the critical level of α = 0.05, indicating that the assumption of residual normality was met. For right arm velocity, the result was F(1,20) = 2.007, p = 0.172, and for left arm velocity, F(1,20) = 2.94, p = 0.102. In both cases, the values were not statistically significant (p > 0.05), indicating that the assumption of homogeneity of variances required for the application of the ANOVA model was met.

2.1. Descriptive Results

First, the clinical characteristics of the participants were described. Table 1 presents the distribution of variables related to surgical side, time since treatment, adjuvant therapy, and musculoskeletal injuries.
For the mean angular velocity values (degrees/second), Table 2 shows the values obtained during the lateral opening test, differentiating between the evaluated limb and the side of the surgical intervention. Both measurements reflect small-to-moderate magnitudes.

2.2. Inferential Analysis and Interaction Effects

A two-way repeated-measures ANOVA was performed to examine the potential interaction between the evaluated limb and the operated side. The results are summarized in Table 3.
No significant main effects were observed for either the evaluated limb (F = 0.845, p = 0.369) or the side of surgery (F = 0.305, p = 0.587). In contrast, a significant interaction between these variables was identified (F = 29.437, p = 0.001), indicating that the effect of the evaluated limb on mean angular velocity depends on the side of the surgery.
Effect size analysis for the differences between the operated and non-operated arms yielded Hedges’ g = 0.35 for participants who underwent right-side surgery and g = 0.36 for those who underwent left-side surgery, both representing small to moderate effects according to Cohen’s benchmarks.
Figure 1 illustrates this interaction, showing that women who underwent right-sided surgery exhibited lower angular velocity in the right arm compared to the left arm. Conversely, among those who underwent left-side surgery, the left arm demonstrated lower angular velocity. This reversal in patterns confirms the presence of a significant interaction, suggesting that inter-limb differences are not uniform but vary according to the side of mastectomy.
In women who underwent right-sided surgery, the right arm exhibited lower angular velocity than the left arm. Conversely, in those who underwent left-sided surgery, the left arm demonstrated lower angular velocity. This inversion of the pattern between groups reveals a significant interaction, indicating that inter-limb differences in movement speed are not uniform but vary according to the side of the surgical intervention.
A post hoc power analysis of the 2 × 2 repeated-measures within–between interaction was performed using G*Power (α = 0.05, groups = 2, measurements = 2, ε = 1, assumed correlation among repeated measures = 0.5). Based on the observed effect (F(1,20) = 29.437), the analysis yielded a critical F = 4.35, a noncentrality parameter λ = 130.97, and an achieved power of 1.00, indicating very high sensitivity for the primary interaction.

3. Discussion

This exploratory study evaluated the feasibility of using inertial sensors to detect inter-limb differences in shoulder angular velocity in women following breast cancer surgery. The results confirmed the initial hypothesis, showing reduced angular velocity in the operated arm compared to the contralateral limb, which reflects potential postoperative functional limitations.
The magnitude of the observed asymmetries was ES: 0.35 and 0.36 (classified as small to moderate according to Cohen’s criteria [34]). The observed small to moderate effect sizes suggest possible functional differences worth exploring in future studies of populations at risk of neuromuscular imbalance. However, given the exploratory nature of this study, direct clinical or prescriptive implications cannot be inferred at this time. Nevertheless, caution is warranted in interpreting these results due to the limited sample size and statistical power.
Participants consistently performed the lateral opening movement more slowly with the operated arm, irrespective of laterality, indicating residual functional asymmetry that may persist after surgery and impact upper-limb performance. One of the principal contributions of this study is demonstrating that angular velocity, captured through inertial sensors, can detect subtle deficits that may not be evident in traditional assessments, such as strength or range of motion. Similar evidence from sports biomechanics indicates that velocity-based measures provide a more dynamic reflection of neuromuscular status than static indicators [28]. Applying this concept to clinical populations could enhance rehabilitation monitoring, though further validation is needed.
The systematic review by Miguel-Andrés et al. [35] highlights the heterogeneity and lack of standardization in upper-limb assessment protocols post-breast cancer treatment. The present study addresses this gap by providing a replicable, sensor-based, unilateral protocol that enables independent and symmetrical comparison of both arms, overcoming the methodological limitations of bilateral assessments. For example, Franco-López et al. [36] examined the load–velocity relationship during a bilateral bench press and found no significant intergroup differences. However, the bilateral design limited the ability to detect side-to-side discrepancies. In contrast, the unilateral approach employed here isolates each arm’s performance, providing greater sensitivity for detecting functional asymmetry.
Other studies have also reported persistent upper-limb alterations in this population. Maciukiewicz et al. [37] documented reductions in strength and range of motion, while Liu et al. [38] observed progressive structural asymmetry following unilateral mastectomy, manifested as changes in scapular position and shoulder height that could influence overall biomechanics. Lang et al. [39] identified reduced upward scapular rotation and limited external rotation, and Prieto-Gómez et al. [40] described altered activation of the serratus anterior, trapezius, and deltoid muscles. Together, these findings support the hypothesis that structural and neuromuscular adaptations may underlie the differences in angular velocity observed.
Despite these promising insights, interpretation of the results requires caution. The clinical applicability of inertial measurement units (IMUs) in oncological rehabilitation is still evolving. While IMUs offer advantages in portability, precision, and ecological validity, their diagnostic thresholds and longitudinal responsiveness are not fully standardized. Previous investigations have identified persistent asymmetries between the operated and non-operated sides during both isokinetic [25] and dynamic functional tasks [41], as well as variations related to the intrinsic capacity for postoperative improvement [28]. To the best of the authors’ knowledge, no prior studies have assessed unilateral angular velocity using IMUs in this population, limiting direct benchmarking. Consequently, the asymmetry indices observed here (8–10%) should be interpreted in a contextual manner, as their clinical relevance remains uncertain. Establishing minimal clinically important differences (MCID) for angular velocity will be essential for meaningful clinical integration.
A symmetry index was calculated based on the percentage difference in angular velocity between arms. Participants with right-sided surgery exhibited an index of 10.17%, while those with left-sided surgery showed an index of 8.06%, indicating small-to-moderate asymmetry magnitudes consistent with prior research [29]. These preliminary findings highlight the methodological feasibility of unilateral angular velocity assessment for identifying postoperative functional differences. Further research is required before any clinical or prescriptive applications can be considered.
This study also contributes to filling the methodological gap identified by Miguel-Andrés et al. [35], providing a standardized, sensor-based unilateral protocol for evaluating functional asymmetry in breast cancer survivors. The absence of a control group limits the possibility that the recorded observations could be pathological, as natural differences between limbs can also occur in the general population. The results should therefore be viewed as relative, not absolute, indicators. This particular design prioritizes internal control, limiting the external validity of the findings. Future studies should include controls with participants who are age- and fitness-matched to confirm that these asymmetries exceed normal ranges. However, limitations include the small sample size, lack of stratification by type of surgery, and omission of pain and fatigue measures, which restrict generalizability. Longitudinal studies are needed to determine whether these asymmetries persist and respond to targeted interventions. Despite the very high achieved power for the primary interaction, the study remains underpowered to detect small effects in simple within-subject contrasts, so ancillary estimates should be interpreted cautiously.
In summary, this exploratory study advances the understanding of post-surgical functional asymmetry by introducing angular velocity as a sensitive and feasible measure for unilateral assessment. These preliminary findings support further exploration of velocity-based functional testing in oncological rehabilitation research, with an emphasis on methodological feasibility rather than immediate clinical translation. Future research should expand sample sizes, include subgroup analyses by surgery type and recovery stage, and incorporate complementary evaluations such as electromyography, patient-reported outcomes, and comparisons with age- and physically matched healthy women. Moreover, integrating IMU-based monitoring with digital rehabilitation platforms or remote supervision systems could enable continuous assessment of upper-limb function in real-world settings and enhance individualized follow-up. In the clinical context, such approaches could help tailor rehabilitation programs to each patient’s motor profile and enable earlier identification of persistent or emerging movement impairments.

4. Materials and Methods

4.1. Study Design

A comparative cross-sectional observational study was conducted [42], in which each participant served as her own control by comparing the operated arm with the non-operated arm. This design enabled the analysis of potential functional asymmetries in breast cancer survivors through a single evaluation session using inertial devices, without the need for any intervention.
This study was designed as a between-subjects comparison to minimize interindividual variability. Each participant acted as their own control, allowing for the detection of asymmetries attributable specifically to patients undergoing surgery versus those without surgery in relation to the arm rather than differences in age, physical condition, or body composition. Given the exploratory nature of this study, the design was considered more appropriate for establishing preliminary evidence to inform future controlled studies. This within-subject design strengthens internal validity by reducing confounding factors and allowing direct attribution of observed asymmetries to the surgical intervention.

Sample Size Rationale and Sensitivity Analysis

A post hoc power and sensitivity analysis was conducted using G*Power (version 3.1, Heinrich Heine University, Düsseldorf, Germany) to assess the adequacy of the sample size and to determine the minimum detectable effect under the parameters of the repeated-measures design.

4.2. Participants

The sample selection was intentional to enable adaptation to the research objectives, thereby improving the rigor of the study and the reliability of the data and results [43]. Twenty-two women voluntarily participated in the study. The anthropometric characteristics were as follows: mean age, 55.95 ± 6.34 years; height, 1.63 ± 0.06 m; body weight, 65.37 ± 11.10 kg; and BMI, 24.73 ± 3.60 kg/m2.
The inclusion criteria were (a) BC survivors who had undergone unilateral surgery; (b) being able to perform moderate physical exercise [44]; and (c) not having any chronic diseases that would affect performance. The exclusion criteria were (a) metastatic diagnosis, advanced lymphedema; (b) injuries to either arm that impaired movement, and (c) use of medication that affected the neuromuscular system. During the recruitment process, one woman was excluded because she had undergone bilateral surgery, which made it impossible to perform the intended comparison between the operated and non-operated sides. Therefore, the final sample consisted of 22 participants who met the inclusion criteria and completed the functional evaluation.
The study was approved by the Ethics Committee of the University of Murcia (reference M10/2024/495), and written informed consent was obtained from all participants. The study was conducted in accordance with the Declaration of Helsinki [45].

4.3. Instruments

To analyze the influence of the operated side on the angular velocity of movement execution in female BC survivors, the lateral opening test [46] was used to identify possible functional asymmetries between the surgically operated arm and the non-operated arm. The measurement was performed by recording the angular velocity in degrees per second (°/s) simultaneously in both arms.
WIMU PROTM inertial devices (RealTrack Systems, Almería, Spain) were used, which had been previously validated in the scientific literature as valid and reliable tools for recording different movements [47,48]. Reported reliability values for this system are high, with intraclass correlation coefficients (ICC) ranging from 0.81 to 0.97 and coefficients of variation (CV) between 2.6% and 17%, depending on the movement assessed [47].
Each device was placed independently on the outer side of the forearm, over the area of the long and short radial extensor muscles of the carpus, in order to ensure accurate movement capture without joint interference. The devices were secured using adjustable elastic straps, and placement was supervised and calibrated by qualified personnel in the Department of Physical Activity and Sports Sciences, in accordance with the manufacturer’s protocols.
Before each recording session, the WIMU PRO devices were calibrated according to the manufacturer’s WIMUNET protocol, which includes static six-face calibration of the accelerometer, gyroscope drift correction during 30 s of rest, and magnetometer compensation through controlled figure-eight movements to minimize magnetic interference.
Both limbs were tested simultaneously, and post-processing synchronization was achieved using a soft synchronization criterion based on the zero-crossing event (negative slope) of the Y-axis angular velocity during the second movement cycle. This event-based alignment ensured temporal consistency between sensors without requiring hardware triggering.
Data were quality-checked following the manufacturer’s (RealTrack Systems, Almería, Spain) recommendations. Noisy or incomplete IMU signals (<1% data loss) were smoothed and interpolated using a moving-window filter.
The sampling frequency was 1000 Hz. The data were analyzed using SPRO software (version 989, RealTrack Systems, Almería, Spain).

4.4. Procedure

The procedure followed in this study was outlined based on previous studies that had performed strength exercises in similar populations, focusing on the upper body, especially those that used an incline bench [49,50,51].
The lateral opening test is a bilateral horizontal abduction movement with light dumbbells on a 45° inclined bench. Although performed simultaneously with both arms, each arm was independently monitored with an inertial device, enabling unilateral measurement and preventing compensations between sides.
Data collection was conducted in a single session, held first thing in the morning, to minimize the impact of accumulated fatigue from the previous day [50,51]. The procedure was conducted at the Chair of Exercise, Education, and Cancer at the University of Murcia, where all women who regularly attended supervised exercise sessions were invited to participate. Those who met the inclusion criteria took part in the study.
Briefly, a standardized 5-min warm-up was performed, focusing on shoulder and elbow joint mobility, which included active exercises such as shoulder circles, elbow flexion and extension, and horizontal arm opening and closing at a moderate pace. Next, two sets of five repetitions of the lateral opening test were performed with the same load (2 kg dumbbells), but at a submaximal speed (approximately 50% of the expected execution speed). Two additional sets at maximum speed followed this to familiarize the participants with the movement and the devices. After the warm-up, a 3-min rest period was allowed before the main test was performed.
The test was conducted on a bench inclined at 45 degrees, an angle described in the literature as optimal for specifically engaging the clavicular portion of the pectoralis major and the anterior deltoid, key muscles involved in shoulder joint mobility and stability [50,51]. The participants adopted a supine position, holding 2 kg dumbbells. Care was taken to ensure that the head, upper back, and buttocks remained in constant contact with the bench, and the feet were firmly on the ground, following a standard five-point support position similar to that used in bench protocols [49].
The starting position consisted of keeping the arms extended in front and upwards, with a slight bend in the elbows (~10–15°), and the wrists in a neutral position. The shoulders remained slightly abducted (~30–45°), and the plane of movement was performed at a transverse/horizontal angle, avoiding excessive lowering of the elbows to protect the glenohumeral joint. From this starting position, a controlled opening (eccentric phase) was performed until the arms formed a cross, i.e., until they reached approximately 90° of horizontal abduction from the trunk, with the dumbbells aligned in a plane parallel to the sternum, avoiding lowering them below the level of the bench so as not to strain the anterior shoulder capsule [50]. Subsequently, the closure was performed at maximum speed (concentric phase) until the dumbbells were brought back together over the chest, returning to the initial position.
The verbal instruction “as fast as you can!” was given just before each repetition to encourage maximum effort in the concentric phase, following recommendations from studies on kinematic measurements with verbal feedback [36,51]. The 15 repetitions were performed consecutively and continuously, without intermediate breaks, except in cases of discomfort or pain, at which point the test was stopped for safety reasons. At all times, the test was supervised by personnel specialized in Physical Activity and Sports Sciences, and a second person was present to ensure the safety and motivation of the participants (see Figure 2).
All participants performed the movement tasks in a standardized environment under controlled lighting, temperature, and spatial conditions. Testing procedures were consistent across participants, including the same posture and task instructions, to ensure reproducibility and minimize measurement variability.
The primary outcome variable was mean angular velocity (°/s) during the concentric phase of the lateral opening test. These data were obtained from the gyroscope of the WIMU PRO™ inertial devices, recorded at a sampling frequency of 1000 Hz. The raw data were first processed with SPRO software (version 989, RealTrack Systems, Almería, Spain) and then exported to Microsoft Excel to generate the database used for subsequent statistical analysis.

4.5. Data Availability

The data used for statistical analysis and the results of this work are publicly available in the Research Data Repository (DIGITUM) under the following Digital Object Identifier (DOI): http://hdl.handle.net/10201/157560 (accessed on 7 September 2025).

4.6. Statistical Analysis

Descriptive statistics (mean and standard deviation) were calculated for the variable of mean angular velocity (degrees/second). The assumptions of normality and homogeneity of variances, necessary to ensure the validity of the statistical model, were verified. The normality of the residuals for the dependent variable (angular velocity) was assessed using the Kolmogorov–Smirnov and Shapiro–Wilk tests. The results did not show significant deviations from normality in any case. Levene’s test was applied to assess the homogeneity of variances between groups. A factorial repeated-measures analysis of variance (2 × 2 ANOVA) was performed to assess the potential interaction between the arm evaluated (right or left) and the operated side (surgery on the right or left side). Effect size was calculated using Hedges’ g for comparisons between the operated and non-operated arm within each surgical laterality subgroup. The values of Hedges’ g were interpreted according to Cohen’s guidelines, where a value of 0.20 is considered a small effect, 0.50 a moderate effect, and 0.80 a large effect [34]. Data analysis was performed using SPSS software (version 29.0, IBM Corp., Armonk, NY, USA).
Data analysis was conducted using a per-protocol approach, including only participants with complete IMU recordings for both limbs.

5. Conclusions

This exploratory study suggests the presence of functional asymmetry in female BC survivors who had undergone unilateral surgery, as indicated by lower angular velocity in the operated arm during the lateral opening test. Although the effect sizes observed were small to moderate, these differences may reflect subtle biomechanical and neuromuscular sequelae that can persist after treatment and potentially impact movement quality.
The findings also support the relevance of incorporating functional assessments that evaluate not only strength and range of motion but also dynamic variables such as execution speed. These preliminary results underline the feasibility of using inertial devices as a sensitive tool for detecting asymmetries and guiding the design of individualized rehabilitation programs. Future studies with larger samples are warranted to confirm and expand these observations.

Author Contributions

Conceptualization, C.N.-M. and J.P.-O.; methodology, C.N.-M. and J.P.-O.; software, C.N.-M.; validation, D.H.V.-G., G.C.-A. and B.A.B.-P.; formal analysis, C.N.-M.; investigation, C.N.-M. and J.P.-O.; resources, R.C.-E.; data curation, C.N.-M.; writing—original draft preparation, C.N.-M. and J.P.-O.; writing—review and editing, D.H.V.-G., G.C.-A., B.A.B.-P. and R.C.-E.; visualization, C.N.-M.; supervision, J.P.-O.; project administration, J.P.-O. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the University of Murcia (protocol code M10/2024/495; date of approval: 2024).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study. Written informed consent has been obtained from the patient(s) to publish this paper.

Data Availability Statement

The data supporting the findings of this study are openly available in the Research Data Repository DIGITUM at the University of Murcia, under the following Digital Object Identifier (DOI): http://hdl.handle.net/10201/157560 (accessed on 7 September 2025).

Acknowledgments

The authors wish to express their deepest gratitude to all the women who participated in this study for their valuable collaboration, commitment, and willingness to contribute to advancing scientific knowledge in the field of physical exercise and breast cancer. The authors also acknowledge the institutional support and resources provided by the Chair of Exercise, Education, and Cancer at the University of Murcia, whose involvement was essential for the execution and development of this research.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Abbreviations

The following abbreviations are used in this manuscript:
BCBreast Cancer
ROMRange of Motion
BMIBody Mass Index
IMUInertial Measurement Unit
SPSSStatistical Package for the Social Sciences
ANOVAAnalysis of Variance
SDStandard Deviation

References

  1. Sung, H.; Ferlay, J.; Siegel, R.L.; Laversanne, M.; Soerjomataram, I.; Jemal, A.; Bray, F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA A Cancer J. Clin. 2021, 71, 209–249. [Google Scholar] [CrossRef]
  2. American Cancer Society. Cancer Facts & Figures 2022; American Cancer Society: Atlanta, GA, USA, 2022. [Google Scholar]
  3. Hewitt, M.; Rowland, J.H.; Yancik, R. Cancer Survivors in the United States: Age, Health, and Disability. J. Gerontol. Ser. A Biol. Sci. Med. Sci. 2003, 58, 82–91. [Google Scholar] [CrossRef]
  4. Nardin, S.; Mora, E.; Varughese, F.M.; D’Avanzo, F.; Vachanaram, A.R.; Rossi, V.; Saggia, C.; Rubinelli, S.; Gennari, A. Breast Cancer Survivorship, Quality of Life, and Late Toxicities. Front. Oncol. 2020, 10, 864. [Google Scholar] [CrossRef]
  5. Penttinen, H.M.; Saarto, T.; Kellokumpu-Lehtinen, P.; Blomqvist, C.; Huovinen, R.; Kautiainen, H.; Järvenpää, S.; Nikander, R.; Idman, I.; Luoto, R.; et al. Quality of Life and Physical Performance and Activity of Breast Cancer Patients after Adjuvant Treatments. Psychooncology 2011, 20, 1211–1220. [Google Scholar] [CrossRef]
  6. Brown, J.C.; Harhay, M.O.; Harhay, M.N. Physical Function as a Prognostic Biomarker among Cancer Survivors. Br. J. Cancer 2015, 112, 194–198. [Google Scholar] [CrossRef]
  7. Seol, K.H.; Bong, S.H.; Kang, D.H.; Kim, J.W. Factors Associated with the Quality of Life of Patients with Cancer Undergoing Radiotherapy. Psychiatry Investig. 2021, 18, 80–87. [Google Scholar] [CrossRef]
  8. Ferrara, P.E.; Gatto, D.M.; Codazza, S.; Zordan, P.; Stefinlongo, G.; Ariani, M.; Coraci, D.; Ronconi, G. An Update on Rehabilitative Treatment of Shoulder Disease after Breast Cancer Care. Musculoskelet. Surg. 2024, 108, 31–45. [Google Scholar] [CrossRef]
  9. Dieli-Conwright, C.M.; Courneya, K.S.; Demark-Wahnefried, W.; Sami, N.; Lee, K.; Buchanan, T.A.; Spicer, D.V.; Tripathy, D.; Bernstein, L.; Mortimer, J.E. Effects of Aerobic and Resistance Exercise on Metabolic Syndrome, Sarcopenic Obesity, and Circulating Biomarkers in Overweight or Obese Survivors of Breast Cancer: A Randomized Controlled Trial. J. Clin. Oncol. 2018, 36, 875–883. [Google Scholar] [CrossRef]
  10. Joaquim, A.; Leão, I.; Antunes, P.; Capela, A.; Viamonte, S.; Alves, A.J.; Helguero, L.A.; Macedo, A. Impact of Physical Exercise Programs in Breast Cancer Survivors on Health-Related Quality of Life, Physical Fitness, and Body Composition: Evidence from Systematic Reviews and Meta-Analyses. Front. Oncol. 2022, 12, 955505. [Google Scholar] [CrossRef]
  11. Sánchez Calderón, R.; Pulgar, S.; Lago Fuentes, C. Beneficios del ejercicio físico en mujeres diagnosticadas de cáncer de seno invasivo. Una revisión sistemática. MLS Sport Res. 2023, 3, 2. [Google Scholar] [CrossRef]
  12. Wen, C.P.; Wai, J.P.M.; Tsai, M.K.; Yang, Y.C.; Cheng, T.Y.D.; Lee, M.C.; Chan, H.T.; Tsao, C.K.; Tsai, S.P.; Wu, X. Minimum Amount of Physical Activity for Reduced Mortality and Extended Life Expectancy: A Prospective Cohort Study. Lancet 2011, 378, 1244–1253. [Google Scholar] [CrossRef]
  13. De Groef, A.; Geraerts, I.; Demeyer, H.; Van der Gucht, E.; Dams, L.; de Kinkelder, C.; Dukers-van Althuis, S.; Van Kampen, M.; Devoogdt, N. Physical Activity Levels after Treatment for Breast Cancer: Two-Year Follow-Up. Breast 2018, 40, 23–28. [Google Scholar] [CrossRef]
  14. Irwin, M.L.; McTiernan, A.; Manson, J.E.; Thomson, C.A.; Sternfeld, B.; Stefanick, M.L.; Wactawski-Wende, J.; Craft, L.; Lane, D.; Martin, L.W.; et al. Physical Activity and Survival in Postmenopausal Women with Breast Cancer: Results from the Women’s Health Initiative. Cancer Prev. Res. 2011, 4, 522–529. [Google Scholar] [CrossRef]
  15. Dieli-Conwright, C.M.; Wong, L.; Waliany, S.; Bernstein, L.; Salehian, B.; Mortimer, J.E. An Observational Study to Examine Changes in Metabolic Syndrome Components in Patients with Breast Cancer Receiving Neoadjuvant or Adjuvant Chemotherapy. Cancer 2016, 122, 2646–2653. [Google Scholar] [CrossRef]
  16. Lacourt, T.E.; Heijnen, C.J. Mechanisms of Neurotoxic Symptoms as a Result of Breast Cancer and Its Treatment: Considerations on the Contribution of Stress, Inflammation, and Cellular Bioenergetics. Curr. Breast Cancer Rep. 2017, 9, 70–81. [Google Scholar] [CrossRef]
  17. Slominski, R.M.; Raman, C.; Chen, J.Y.; Slominski, A.T. How Cancer Hijacks the Body’s Homeostasis through the Neuroendocrine System. Trends Neurosci. 2023, 46, 263–275. [Google Scholar] [CrossRef]
  18. Taillibert, S.; Le Rhun, E.; Chamberlain, M.C. Chemotherapy-Related Neurotoxicity. Curr. Neurol. Neurosci. Rep. 2016, 16, 81. [Google Scholar] [CrossRef]
  19. Ferrucci, L.; Cooper, R.; Shardell, M.; Simonsick, E.M.; Schrack, J.A.; Kuh, D. Age-Related Change in Mobility: Perspectives from Life Course Epidemiology and Geroscience. J. Gerontol. Ser. A Biomed. Sci. Med. Sci. 2016, 71, 1184–1194. [Google Scholar] [CrossRef]
  20. Tsai, R.J.; Dennis, L.K.; Lynch, C.F.; Snetselaar, L.G.; Zamba, G.K.; Scott-Conner, C. The Risk of Developing Arm Lymphedema among Breast Cancer Survivors: A Meta-Analysis of Treatment Factors. Ann. Surg. Oncol. 2009, 16, 1959–1972. [Google Scholar] [CrossRef]
  21. Hidding, J.T.; Beurskens, C.H.; van der Wees, P.J.; van Laarhoven, H.W.; Nijhuis-van der Sanden, M.W. Treatment Related Impairments in Arm and Shoulder in Patients with Breast Cancer: A Systematic Review. PLoS ONE 2014, 9, e96748. [Google Scholar] [CrossRef]
  22. Johansen, S.; Fosså, K.; Nesvold, I.L.; Malinen, E.; Fosså, S.D. Arm and Shoulder Morbidity Following Surgery and Radiotherapy for Breast Cancer. Acta Oncol. 2014, 53, 521–529. [Google Scholar] [CrossRef]
  23. Leonardis, J.M.; Lulic-Kuryllo, T.; Lipps, D.B. The Impact of Local Therapies for Breast Cancer on Shoulder Muscle Health and Function. Crit. Rev. Oncol. Hematol. 2022, 177, 103759. [Google Scholar] [CrossRef] [PubMed]
  24. Akoochakian, M.; Davari, H.A.; Alizadeh, M.H.; Rahnama, N. Evaluation of Shoulder Girdle Strength More Than 12 Months after Modified Radical Mastectomy and Axillary Nodes Dissection. J. Res. Med. Sci. 2017, 22, 81. [Google Scholar] [CrossRef]
  25. Liszka, M.; Samborski, W. Assessment of Biomechanical Parameters of the Shoulder Joint at the Operated Side versus Non-Operated Side in Patients Treated Surgically for Breast Cancer. Rep. Pract. Oncol. Radiother. 2018, 23, 378–383. [Google Scholar] [CrossRef]
  26. Min, J.; Kim, J.Y.; Yeon, S.; Ryu, J.; Min, J.J.; Park, S.; Kim, S.I.; Jeon, J.Y. Change in Shoulder Function in the Early Recovery Phase after Breast Cancer Surgery: A Prospective Observational Study. J. Clin. Med. 2021, 10, 3416. [Google Scholar] [CrossRef]
  27. Rasmussen, G.H.F.; Madeleine, P.; Arroyo-Morales, M.; Voigt, M.; Kristiansen, M. Pain Sensitivity and Shoulder Function among Breast Cancer Survivors Compared to Matched Controls: A Case-Control Study. J. Cancer Surviv. 2023, 17, 150–159. [Google Scholar] [CrossRef] [PubMed]
  28. Kolber, M.J.; Stull, K.R.; Cheatham, S.W.; Hanney, W.J. The Influence of Hip Muscle Impairments on Squat Performance. Strength Cond. J. 2017, 39, 66–73. [Google Scholar] [CrossRef]
  29. Skiba, M.B.; Harker, G.; Guidarelli, C.; El-Gohary, M.; Horak, F.; Roeland, E.J.; Silbermann, R.; Hayes-Lattin, B.; Winters-Stone, K. Using Wearable Inertial Sensors to Assess Mobility of Patients with Hematologic Cancer and Associations with Chemotherapy-Related Symptoms Before Autologous Hematopoietic Stem Cell Transplant: Cross-sectional Study. JMIR Cancer 2022, 8, e39271. [Google Scholar] [CrossRef] [PubMed]
  30. Smoot, B.; Paul, S.M.; Aouizerat, B.E.; Dunn, L.; Elboim, C.; Schmidt, B.; Hamolsky, D.; Levine, J.D.; Abrams, G.; Mastick, J.; et al. Predictors of Altered Upper Extremity Function during the First Year after Breast Cancer Treatment. Am. J. Phys. Med. Rehabil. 2016, 95, 639–655. [Google Scholar] [CrossRef]
  31. Vets, N.; De Groef, A.; Verbeelen, K.; Devoogdt, N.; Smeets, A.; Van Assche, D.; Emmerzaal, J.; De Baets, L. Assessing Upper Limb Function in Breast Cancer Survivors Using Wearable Sensors and Machine Learning in a Free-Living Environment. Sensors 2023, 23, 6100. [Google Scholar] [CrossRef]
  32. Emmerzaal, J.; Filtjens, B.; Vets, N.; Vanrumste, B.; Smeets, A.; De Groef, A.; De Baets, L. A Data-Driven Approach to Detect Upper Limb Functional Use during Daily Life in Breast Cancer Survivors Using Wrist-Worn Sensors. Sci. Rep. 2024, 14, 18165. [Google Scholar] [CrossRef]
  33. Bongiorno, G.; Tomasi, A.; Vigni, G.; Rizzardo, A.; Biancuzzi, H.; Dal Mas, F.; Miceli, L. Case Report: Movement Analysis in Oncological Rehabilitation—Proposal of a Kinematic and Surface Electromyographic Protocol in Breast Oncology. Front. Hum. Neurosci. 2024, 17, 1272027. [Google Scholar] [CrossRef]
  34. Cohen, J. Statistical Power Analysis for the Behavioral Sciences, 2nd ed.; Lawrence Erlbaum Associates: Hillsdale, NJ, USA, 1988. [Google Scholar]
  35. Miguel-Andrés, I.; Huerta-Franco, M.R.; García-González, S.B.; León-Rodríguez, M.; Barrera-Beltrán, K.; Ortiz-Lango, L.A. The Importance of the Kinematic Evaluation Methods of the Upper Limbs in Women with Breast Cancer Mastectomy: A Literature Review. Healthcare 2023, 11, 2064. [Google Scholar] [CrossRef]
  36. Franco-López, F.; Pérez-Caballero, C.; Buendía-Romero, Á.; Borrego, E.R.; Martínez-Cava, A.; Pallarés, J.G.; Hernández-Belmonte, A. Load-Velocity Relationship of the Bench Press Exercise Is Not Affected by Breast Cancer Surgery and Adjuvant Therapy. Int. J. Sports Med. 2024, 45, 110–115. [Google Scholar] [CrossRef]
  37. Maciukiewicz, J.M.; Hussein, A.T.S.; Mourtzakis, M.; Dickerson, C.R. An Evaluation of Upper Limb Strength and Range of Motion of Breast Cancer Survivors Immediately Following Treatment. Clin. Biomech. 2022, 96, 105666. [Google Scholar] [CrossRef]
  38. Liu, R.; Xie, H.; Wang, Y.; Wang, Q.; Xie, X.; Zhang, X. Impact of Unilateral Mastectomy on Body Posture: A Prospective Longitudinal Observational Study. Asia-Pac. J. Oncol. Nurs. 2024, 11, 100336. [Google Scholar] [CrossRef] [PubMed]
  39. Lang, A.E.; Milosavljevic, S.; Dickerson, C.R.; Trask, C.M.; Kim, S.Y. Evidence of Rotator Cuff Disease after Breast Cancer Treatment: Scapular Kinematics of Post-Mastectomy and Post-Reconstruction Breast Cancer Survivors. Ann. Med. 2022, 54, 1058–1066. [Google Scholar] [CrossRef]
  40. Prieto-Gómez, V.; Navarro-Brazález, B.; Sánchez-Méndez, Ó.; De-La-Villa, P.; Sánchez-Sánchez, B.; Torres-Lacomba, M. Electromyographic Analysis of Shoulder Neuromuscular Activity in Women Following Breast Cancer Treatment: A Cross-Sectional Descriptive Study. J. Clin. Med. 2020, 9, 1804. [Google Scholar] [CrossRef] [PubMed]
  41. Brookham, R.L.; Cudlip, A.C.; Dickerson, C.R. Examining upper limb kinematics and dysfunction of breast cancer survivors in functional dynamic tasks. Clin. Biomech. 2018, 55, 86–93. [Google Scholar] [CrossRef] [PubMed]
  42. O’Donoghue, P. Research Methods for Sports Performance Analysis; Routledge: London, UK, 2010. [Google Scholar]
  43. Campbell, S.; Greenwood, M.; Prior, S.; Shearer, T.; Walkem, K.; Young, S.; Bywaters, D.; Walker, K. Purposive sampling: Complex or simple? Research case examples. J. Res. Nurs. 2020, 25, 652–661. [Google Scholar] [CrossRef]
  44. Campbell, K.L.; Winters-Stone, K.M.; Wiskemann, A.; May, A.M.; Schwartz, A.L.; Schmitz, K.H.; Courneya, K.S. Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Med. Sci. Sports Exerc. 2019, 51, 2375–2390. [Google Scholar] [CrossRef]
  45. World Medical Association. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Participants. JAMA 2025, 333, 71–74. [Google Scholar] [CrossRef] [PubMed]
  46. Delavier, F.; Gundill, M. The Strength Training Anatomy Workout; Hum. Kinet.: Champaign, IL, USA, 2011. [Google Scholar]
  47. Clemente, F.M.; Akyildiz, Z.; Pino-Ortega, J.; Rico-González, M. Validity and Reliability of the Inertial Measurement Unit for Barbell Velocity Assessments: A Systematic Review. Sensors 2021, 21, 2511. [Google Scholar] [CrossRef] [PubMed]
  48. Molina-Carmona, I.; Gómez-Carmona, C.; Bastida-Castillo, A.; Pino-Ortega, J. Validez del Dispositivo Inercial WIMU PRO para el Registro de la Frecuencia Cardíaca en un Test de Campo. SPORT TK-Rev. Euroam. Cienc. Deporte 2018, 7, 81–86. [Google Scholar] [CrossRef] [PubMed]
  49. Pérez-Castilla, A.; Comfort, P.; McMahon, J.J.; Pestaña-Melero, F.L.; García-Ramos, A. Comparison of the Force-, Velocity-, and Power-Time Curves between the Concentric-Only and Eccentric-Concentric Bench Press Exercises. J. Strength Cond. Res. 2020, 34, 1618–1624. [Google Scholar] [CrossRef]
  50. López-Vivancos, A.; González-Gálvez, N.; Orquín-Castrillón, F.J.; Vale, R.G.d.S.; Marcos-Pardo, P.J. Electromyographic Activity of the Pectoralis Major Muscle during Traditional Bench Press and Other Variants of Pectoral Exercises: A Systematic Review and Meta-Analysis. Appl. Sci. 2023, 13, 5203. [Google Scholar] [CrossRef]
  51. Díez-Fernández, D.M.; Esteban-Simón, A.; Baena-Raya, A.; Rodríguez-Rosell, D.; Conceição, F.; Rodríguez-Pérez, M.A.; Soriano-Maldonado, A. Optimizing Exercise Prescription during Breast Cancer Rehabilitation in Women: Analysis of the Load-Velocity Relationship in the Box Squat Exercise. Eur. J. Sport Sci. 2024, 24, 1021–1031. [Google Scholar] [CrossRef]
Women 05 00041 g001
Figure 1. Interaction between the evaluated limb and side of breast cancer surgery on the mean angular velocity. * Statistically significant interaction (p < 0.05).
Figure 1. Interaction between the evaluated limb and side of breast cancer surgery on the mean angular velocity. * Statistically significant interaction (p < 0.05).
Women 05 00041 g001
Women 05 00041 g002
Figure 2. Phases of the lateral fly test on an inclined bench: (a) initial position; (b) final position.
Figure 2. Phases of the lateral fly test on an inclined bench: (a) initial position; (b) final position.
Women 05 00041 g002
Table 1. Description of the Clinical Status of the Sample.
Table 1. Description of the Clinical Status of the Sample.
VariableCategoryn (%)/Mean ± SD
Operated SideRight14 (64%)
Left8 (36%)
Disease StatusDisease-Free10 (45%)
Adjuvant TreatmentYes8 (35%)
LymphedemaWithout20 (91%)
With2 (9%)
Strength Training ExperienceMonths29.35 ± 30.58
Time Since Treatment<6 months9
6–12 months7
12–32 months1
>32 months1
Musculoskeletal InjuriesWithout15 (68%)
With7 (32%)
SD: standard deviation; n: sample.
Table 2. Mean Angular Velocity (°/s) According to Arm Assessed and Side of Surgery.
Table 2. Mean Angular Velocity (°/s) According to Arm Assessed and Side of Surgery.
Surgery SideRight Arm (°/s)Left Arm (°/s)nHedges’ g [95% CI]
Right100.37 ± 31.07111.74 ± 32.03140.35 [−0.18, 0.85]
Left100.16 ± 20.1992.09 ± 22.3380.36 [−0.27, 0.94]
° = degress; s = seconds.
Table 3. Results of the Two-Way ANOVA (Measurements × Surgery) on Mean Angular Velocity (°/s).
Table 3. Results of the Two-Way ANOVA (Measurements × Surgery) on Mean Angular Velocity (°/s).
FactorSourceSum of SquaresdfMean SquareFp
AMeasurements27.621127.6210.8450.369
BSurgery510.9601510.9600.3050.587
A × BMeasurements × Surgery962.0351992.03529.4370.001 *
Error (Measurements)31,587.168201579.358
* p < 0.05 indicates a statistically significant interaction between the evaluated limb and surgery side.
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Navarro-Martínez, C.; Villarejo-García, D.H.; Carvajal-Espinosa, R.; Cánovas-Ambit, G.; Becerra-Patiño, B.A.; Pino-Ortega, J. IMU-Based Assessment of Arm Movement in Breast Cancer Survivors: An Exploratory Study. Women 2025, 5, 41. https://doi.org/10.3390/women5040041

AMA Style

Navarro-Martínez C, Villarejo-García DH, Carvajal-Espinosa R, Cánovas-Ambit G, Becerra-Patiño BA, Pino-Ortega J. IMU-Based Assessment of Arm Movement in Breast Cancer Survivors: An Exploratory Study. Women. 2025; 5(4):41. https://doi.org/10.3390/women5040041

Chicago/Turabian Style

Navarro-Martínez, Carlos, Diego Hernán Villarejo-García, Rafael Carvajal-Espinosa, Germán Cánovas-Ambit, Boryi A. Becerra-Patiño, and José Pino-Ortega. 2025. "IMU-Based Assessment of Arm Movement in Breast Cancer Survivors: An Exploratory Study" Women 5, no. 4: 41. https://doi.org/10.3390/women5040041

APA Style

Navarro-Martínez, C., Villarejo-García, D. H., Carvajal-Espinosa, R., Cánovas-Ambit, G., Becerra-Patiño, B. A., & Pino-Ortega, J. (2025). IMU-Based Assessment of Arm Movement in Breast Cancer Survivors: An Exploratory Study. Women, 5(4), 41. https://doi.org/10.3390/women5040041

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