A Comparison of Yoga and Clinical Pilates Exercise Methods in Women with Breast Cancer-Related Lymphedema: A Randomized Controlled Trial

A Comparison of Yoga and Clinical Pilates Exercise Methods in Women with Breast Cancer-Related Lymphedema: A Randomized Controlled Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Comparison of Yoga and Clinical Pilates Exercise Methods in Women with Breast Cancer-Related Lymphedema: A Randomized Controlled Trial Ferdiye Zabit, Gozde Iyigun, Mehtap Malkoc This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4564431/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: This study conducted a comparison of the benefits of yoga and clinical Pilates exercise methods, both administered with compression stockings, on lymphedema, muscle strength, upper extremity functions, and quality of life in women with BCRL Methods: 28 individuals with breast cancer-related lymphedema were included in the study. The upper extremity lymphedema severity of the individuals was evaluated by circumference and volumeter measurement. Upper extremity muscle strength was measured with an isokinetic dynamometer (HUMAC/NORM Testing & Rehabilitation System, CSMD). The disabilities of the arm, shoulder, and hand (DASH) questionnaire was used to evaluate upper extremity functions, and the Breast Cancer-Specific Quality of Life Questionnaire (QLQ-BR23) was used to evaluate the quality of life. Results: In our study, it was determined that compared to pre-treatment, the severity of lymphedema decreased more in the yoga and clinical Pilates groups than in the control group (P4 = .034). In extremity with lymphedema (EwLE), the clinical Pilates group had the greatest improvement in muscular strength for internal rotation (IR) (P3=.016, P4=.037), while the upper extremity functions were shown to be higher in the yoga and clinical Pilates groups compared to the control group (P3=.008, P4=.004). It was found that the quality of life subscale symptom scores, breast symptom (P3=.006, P4=.028) and arm symptom (P2=.004, P3=.008, P4=.002) scores in the yoga group, and arm symptom (P3=.012, P4=.002) scores in the clinical Pilates group showed a positive increase compared to the control group. Conclusion: Both yoga and clinical Pilates exercises, with the use of compression stockings, have demonstrated favorable results in women with BCRL, showing great potential for treatment. Clinical Pilates exercises have been determined to be useful in several physical aspects, including the reduction of lymphedema, and the improvement of muscle strength and upper extremity functions. On the other hand, the emotional components of quality of life can be effectively improved by yoga exercises. Trial Registration Number: NCT04824807 ,October 29, 2021 Breast cancer-related lymphedema Yoga Clinical Pilates Compression garment Figures Figure 1 Introduction Breast cancer is the most common cancer among women and is the primary cause of their morbidity and mortality [1]. Although the survival rate increases after breast cancer is diagnosed, breast cancer–associated lymphedema, which plays a crucial role in decreasing the quality of life (QoL), is an important public health problem [2]. Common symptoms of lymphedema include edema, pain, heaviness, fullness, tightness, and upper limb dysfunctions. These symptoms can lead to reduced shoulder range of motion and shoulder strength loss, difficulty performing daily activities, impaired social relationships and recreational activities, compromised gross and fine motor skills and occupational performance, and impaired home and personal care functions [3]. A greater prevalence of shoulder dysfunction is observed among breast cancer survivors with lymphedema who exhibit reduced muscle activity in the vicinity of lymph node removal, which hinders the recovery of the lymphatics and adjacent soft tissues [4]. The absence of physical activity, exercise, and everyday activities among individuals with lymphedema may lead to a decline in strength, which in turn can result in dysfunctions of the upper extremities due to muscle atrophy in the affected regions [5]. Breast cancer survivors with lymphedema exhibited reduced muscle strength compared to individuals without lymphedema [6]. Patients with lymphedema commonly avoid engaging in activities that require raising their arms overhead, resulting in the weakening of the muscles responsible for elevating the shoulder [4]. Muscle fatigue may disrupt the normal firing of the surrounding muscle units, resulting in a decline in muscle strength. In addition, because the upper extremity functions used during daily activities are probably affected more frequently by lymphedema and the QoL decreases significantly [7], it is important to evaluate overall muscle strength, upper extremity functions, and QoL, especially in extremity with lymphedema (EwLE). Considering all these factors, effective methods for treating breast cancer–associated lymphedema should be developed. Besides complex decongestive physiotherapy, which includes manual lymphatic drainage, compression, skincare, and exercise and is considered the gold standard in treating lymphedema, group exercises have become increasingly popular in recent years [8]. Group exercises lead to adherence to exercise in breast cancer survivors for reasons including meeting friends, getting out of the house, participating in an enjoyable activity, and contributing to improving both physical and psychosocial health [9]. Previous studies indicated that group exercise was the preferred approach for many individuals undergoing breast cancer treatment [9–11]. Adherence to exercise is essential in reducing and preventing the development of breast cancer–associated lymphedema. However, achieving it remains a challenge for this population [12], highlighting the need for more studies on alternative exercise methods [13]. Pilates exercises, in particular, may serve as a significant exercise approach for early adaptation to daily activities in this population, as they focus on neuromuscle remodeling. Studies have suggested that Pilates exercises are a safe method to reduce symptoms in patients with breast cancer–associated lymphedema. Previous studies have applied these interventions to patients with breast cancer at a frequency of 2–3 sessions per week, lasting 4–8 weeks, and with various intensity levels [11,14]. Yoga exercises are a holistic system of practice aimed at creating balance in the physical, mental, and emotional aspects of self. Physical movements and breathing exercises that align with the principles of lymphatic cleansing can be incorporated as part of a comprehensive approach to reduce the symptoms associated with lymphedema [15]. Studies have also reported that yoga exercises are among the complementary and alternative treatments for breast cancer–associated lymphedema [16,17]. However, no studies comparing the effectiveness of yoga and Pilates exercises in breast cancer–associated lymphedema are lacking. Therefore, this study aimed to compare the effects of yoga and clinical Pilates exercise methods, combined with compression stockings, on lymphedema, upper extremity muscle strength and functions, and QoL in patients with breast cancer–associated lymphedema. Materials and Methods Participants Before commencing the study, ethical approval was obtained from the Eastern Mediterranean University Scientific Research and Publication Ethics Committee in accordance with the Declaration of Helsinki (date: 25.02.2020, decision number: 2020/0103), and the study was registered at ClinicalTrials.gov (identifier: NCT04824807). Patients with breast cancer–associated lymphedema were identified and recruited using patient records and social media. Individuals who agreed to participate in the study were provided with written and verbal information about the purpose of the study, evaluation methods, and exercise training. Written informed consent forms were obtained from all voluntary participants. All participants were assessed in the clinical units of the Eastern Mediterranean University Faculty of Health Sciences Healthy Living Center. The study enrolled 28 patients with breast cancer–associated lymphedema, aged between 30 and 75 years. It included patients with mild-to-moderate lymphedema in the upper extremities, either unilateral or bilateral, following breast cancer treatment, who received any lymphedema treatments at least 6 months prior to the study. However, patients with metastatic breast cancer currently undergoing adjuvant treatment (chemotherapy, radiotherapy, hormone therapy); patients with extremity infections (fungus, rash, high temperature), severe pain in the axillary region (e.g., neuropathy), and heart failure (New York Heart Association (NYHA) Class III-IV); and those who had been following a regular exercise program in the last 6 months were excluded from the study. The CONSORT flow diagram of the study protocol is illustrated in Fig. 1 . Sample size A pilot study involving 15 participants was conducted to assess the difference in volumetric measurement values among the yoga, clinical Pilates, and control groups. The effect size was calculated for repeated-measures analysis of variance, as the study assessed the directional and time-dependent changes in the participants. The effect size obtained from the pilot study was .483, with a significance level of .05, a power of .95, and a correlation of.50 between repeated measures. In the calculation of the total sample size, G*Power 3.1.9.2 was used, resulting in a figure of 21. The sample size for each group was increased by 20% to account for potential participant withdrawals, resulting in a total sample size of 28 across the 3 treatment groups. Study design and randomization A prospective, single-blind, randomized controlled trial was conducted. The participants were assigned to groups using the block randomization method based on age (< 50 years and ≥ 50 years) and lymphedema stage (< 5 years, 5–10 years, and < 10 years) distributions obtained from the pilot study. All participants underwent evaluations pre- and post-treatment. Compression stockings were provided to all participants, and they were instructed to wear them daily for 8 weeks. The clinical Pilates group engaged in clinical Pilates exercises three times each week for eight weeks. The yoga group engaged in yoga sessions three times per week for eight weeks. The third group served as the control group. Compression stockings were purchased and distributed to the participants using the budget provided by the Eastern Mediterranean University Scientific Research Project. BAPC-0D-20-02 Outcome measures The participants’ demographic data, including age (year), height (cm), weight (kg), body mass index (kg/m 2 ), dominant side, age at menarche and menopause, duration of mastectomy, type of mastectomy, side(s) of mastectomy (right unilateral, left unilateral, bilateral), number of lymph nodes removed, type of lymph node dissection (axillary/sentinel), presence of radiotherapy, chemotherapy treatments, duration of lymphedema, stage of lymphedema, and location of lymphedema (proximal/distal), were recorded using a sociodemographic information form. 1. Upper extremity lymphedema measurement 1.1. Circumference measurement The circumference was measured using a tape measure, with anatomical segments (wrist, elbow, axilla) identified. The measurements started from the wrist (specifically, the styloid process of the ulna) and the reference points were marked at 5-cm intervals from the styloid process of the ulna to the olecranon, and from the olecranon to the axilla. The circumference was then measured from these reference points and recorded in centimeters. 1.2. Volumetric measurement The upper extremity volume was measured using the water displacement technique [18]. A cylindrical measuring cup (60 × 16 × 16 cm 3 ) with a soft drainage tube positioned 45 cm above the bottom was filled with water. Participants removed all accessories from their arms. They were then instructed to slowly lower their arms into the volumeter until the top of the volumeter came into contact with their axilla and a bar placed in the web area of their second and third fingers. The volumetric measurements for both arms were recorded in milliliters (ml). 2. Upper extremity muscle strength The upper extremity muscle strength was assessed using an isokinetic dynamometer (HUMAC NORM Testing & Rehabilitation System; CSMi, Stoughton, MA). The isokinetic dynamometer is a widely recognized objective method for measuring muscle strength. The correlation coefficients at 90º shoulder abduction were reported as 0.96 (0.94–0.98) for internal rotation (IR) and 0.94 (0.90–0.96) for external rotation (ER) [19]. The isokinetic strength measurements of shoulder IR (teres major, latissimus dorsi, pectoralis major, and subscapularis) and ER (supraspinatus, infraspinatus, and teres minor) movements were conducted using concentric–concentric contractions for three repetitions at an angular velocity of 180°/s. The measurements were taken with the shoulder in 90° abduction and the elbow in 90° flexion for the extremity to be tested in the supine position. 3. Upper extremity functions The Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) is a standardized survey used to assess impairments, activity limitations, and participation restrictions associated with both leisure and occupation. Apart from the first part, a work module exists comprising four questions aimed at determining the patient’s occupation-associated disability [20]. Among these questions, 21 assess the difficulty level in performing different physical activities due to arm, shoulder, or hand issues, 5 assess symptoms (pain, tingling, stiffness, and weakness), and 4 assess social activity, work, sleep, and self-image. In the DASH, a 5-point Likert-type scale is used, with response options ranging from 1 (no difficulty), 2 (mild difficulty), 3 (moderate difficulty), 4 (severe difficulty), to 5 (unable). A final score between 0 and 100 is obtained for each module, with higher scores indicating a more severe level of disability: 0 (no disability) and 100 (maximum disability) [21]. 4. Quality of life The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-BR23) was used to assess QoL [22]. The EORTC QLQ- BR23 employs a 4-point Likert-type scale consisting of 23 questions. Responses are categorized as follows: 1 (not at all), 2 (a little), 3 (quite a bit), and 4 (very much). The questionnaire comprises a functional scale and a symptom scale. The functional scale assesses body image, sexual functioning, sexual enjoyment, and future perspective, with higher scores indicating better QoL and enhanced functionality. Conversely, the symptom scale evaluates systemic therapy side effects, breast symptoms, arm symptoms, and upset by hair loss, with higher scores indicating poorer QoL and increased symptom severity. Scores are then linearly converted into a 0–100 scale for interpretation [23]. Intervention The participants in the clinical Pilates group attended an educational seminar on clinical Pilates exercises and posture before starting the exercise program. They were instructed on lumbopelvic stability (core stabilization), spine stabilization, and proper posture techniques, which form the foundation of Pilates exercises. Following the seminar, the participants actively participated in clinical Pilates exercises 3 times per week for 8 weeks, for a total of 24 sessions, each lasting 60 minutes. Each session included a 10-minute warm-up, 10-minute cool-down, and 40 minutes of progressive exercises. Participants were instructed to wear compression stockings during exercises and 8 h every day for 8 weeks period of time. The specific clinical Pilates exercise program is provided in Appendix 1. The participants in the yoga group attended a seminar on yoga philosophy, breathing exercises, and relaxation techniques before starting the exercise program. After the seminar, 24 sessions of yoga exercises were performed 3 days a week for 8 weeks, with each session lasting 60 minutes. The session comprised a 10-minute warm-up, 10-minute cool-down, and 40 minutes of progressive exercises. Participants were instructed to wear compression stockings while performing exercises and throughout the day for a period of 8 weeks. The specific yoga exercise program is provided in Appendix 2. A physiotherapist with expertise in two exercise methods designed and implemented the clinical Pilates and yoga exercise protocols tailored to breast cancer–associated lymphedema. The individuals in the control group did not receive any exercise treatment. Instead, they were provided with compression stockings and an educational brochure following the evaluation. The brochure contained information about lymphedema, its types, hygiene practices, and nutritional guidelines to follow. In addition, the brochure outlined treatment protocols and exercises for managing lymphedema. The participants were instructed to read the brochure and wear the compression stockings throughout the day for a period of 8 weeks. Statistical analysis The data obtained in this study were analyzed using the Statistical Package for Social Sciences (SPSS) 26.0 for statistical analysis. Descriptive statistics were employed to analyze the clinical and demographic characteristics. Continuous variables were expressed as mean ± standard deviation ( x̄ ± sd ), whereas categorical variables were presented as frequency ( n ) and percentage (%). Due to the small sample size in each group, the differences between groups pre- and post-treatment were assessed using the Wilcoxon signed-rank test. The chi-square test and Kruskal–Wallis H test were used to determine the changes between groups, and nonparametric Quade analysis of covariance (ANCOVA) was used to evaluate the changes between time and group. The effect sizes were calculated using the Eta-Square ( η 2 ) and the findings were interpreted according to the principles established by Cohen [24]. The interpretation of the effect sizes is as follows: small (η2 = .01), medium (η2 = .06), and large (η2 = .14) effects [25]. A P value < 0.05 indicated a statistically significant difference. Results The sociodemographic and clinical characteristics of the participants are presented in Table 1 . No significant differences in parameters were identified across the three groups when compared to the parameters before treatment. Table 1 General characteristics of the participants Yoga group Clinical Pilates group Control group χ 2 (p) Dominant extremity, n (%) Right 9 (100.0) 8 (88.9) 9 (90.0) 1.629 (.443) Left 0 (.0) 1 (11.1) 1 (10.0) Side of mastectomy, n (%) Unilateral – right 3 (33.3) 1 (11.1) 3 (30.0) 1.842 (.765) Unilateral – left 5 (55.6) 6 (66.7) 6 (60.0) Bilateral 1 (11.1) 2 (22.2) 1 (10.0) Type of mastectomy, n (%) Total 4 (44.4) 5 (55.6) 6 (60.0) .482 (.786) Partial 5 (55.6) 4 (44.4) 4 (40.0) Time after mastectomy, n (%) 10 years 3 (33.3) 4 (44.4) 6 (60.0) Type of lymph node dissection, n (%) Axillar 5 (55.6) 5 (55.6) 8 (80.0) 1.760 (.415) Sentinel 4 (44.4) 4 (44.4) 2 (20.0) Chemotherapy administration, n (%) Yes 9 (100.0) 7 (77.8) 9 (90.0) 3.032 (.220) No 0 (.0) 2 (22.2) 1 (10.0) Radiotherapy administration, n (%) Yes 8 (88.9) 8 (88.9) 10 (100.0) 1.852 (.396) No 1 (11.1) 1 (11.1) 0 (.0) Time after lymphedema (years) , n (%) 10 years 1 (11.1) 3 (33.3) 4 (40.0) Lymphedema extremity, n (%) Right 4 (44.4) 1 (11.1) 4 (40.0) 3.060 (.217) Left 5 (55.6) 8 (88.9) 6 (60.0) Lymphedema location, n (%) Proximal-distal 5 (55.6) 8 (88.9) 5 (50.0) 3.991 (.136) Distal-proximal 4 (44.4) 1 (11.1) 5 (50.0) H (p) Age (years), x ± sd 57.000 ± 9.474 54.556 ± 11.844 51.500 ± 12.067 1.408 (.495) Height (cm), x ± sd 163.111 ± 6.585 161.667 ± 6.964 160.400 ± 5.739 .468 (.791) Weight (kg), x ± sd 75.000 ± 12.227 78.222 ± 14.481 75.300 ± 16.546 .606 (.735) BMI (kg/m 2 ), x ± sd 28.603 ± 3.275 30.116 ± 3.899 28.964 ± 6.399 .834 (.659) Age of menopause (years), x ± sd 45.444 ± 5.223 45.750 ± 6.409 43.750 ± 3.991 .986 (.611) Age of menarche (years), x ± sd 12.222 ± 1.856 12.222 ± 1.093 12.700 ± 1.767 1.309 (.520) Number of dissected lymph nodes, x ± sd 10.000 ± 6.604 9.143 ± 6.336 12.875 ± 5.842 1.421 (.491) x ± sd: Mean ± standart deviation; n (%): Frequency (percentage); χ 2 : Likelihood Ratio Chi-square; H: Kruskal Wallis H test 1. Findings on Upper Extremity Lymphedema Measurement 1.1. Circumference measurement No significant changes were observed in circumference measurements of EwLE across different groups ( p 1 and p 2 > .05). When assessing time-dependent changes independently within each group, a significant decrease in circumference measurement of EwLE was observed 10 cm above the elbow in the clinical Pilates group post-treatment ( W = − 2.271; p = .023). Significant group × time interactions were observed in the ANCOVA, indicating that edema decreased more in the yoga and clinical Pilates groups in EwLE compared to the control group (10 cm above the elbow) ( F = 3.976; p 4 = .032) and the treatment effect was small ( η 2 = .006). The clinical Pilates group (10 cm above the elbow) exhibited the most significant reduction in edema (3.29%), followed by the yoga (1.75%) and control groups (1.61%). Table 2 Table 2 A comparison of the pre-treatment and post-treatment results of circumference and volumetric measurements for groups Variables Group Pre-treatment Post-treatment Within group Group x Time \(\stackrel{-}{x}\) ± sd H (P 1 ) \(\stackrel{-}{x}\) ± sd H (P 2 ) W (P 3 ) % F (P 4 ) η 2 Wrist (cm) Yoga (n = 9) 19.000 ± 2.345 1.208 (.547) 18.778 ± 1.856 1.851 (.396) -1.000 (.317) 1.17 1.467 (.250) .003 Pilates (n = 9) 19.667 ± 2.646 19.333 ± 2.693 -1.342 (.180) 1.70 Control (n = 10) 20.700 ± 3.653 20.889 ± 3.822 .000 (1.000) 0.91 Wrist ↑5 (cm) Yoga (n = 9) 24.333 ± 3.674 .451 (.798) 23.667 ± 2.958 .212 (.900) -1.857 (.063) 2.74 3.003 (.069) .005 Pilates (n = 9) 25.000 ± 3.640 24.333 ± 3.775 -2.121 ( .034) 2.67 Control (n = 10) 24.300 ± 3.974 24.667 ± 4.770 -1.342 (.180) 1.51 Wrist ↑10 (cm) Yoga (n = 9) 27.333 ± 2.000 .131 (.937) 26.889 ± 2.571 .186 (.911) -1.633 (.102) 1.63 1.384 (.270) .003 Pilates (n = 9) 27.667 ± 2.828 27.333 ± 2.872 -1.342 (.180) 1.21 Control (n = 10) 27.300 ± 4.474 27.111 ± 4.859 -1.000 (.317) 0.69 Elbow (cm) Yoga (n = 9) 28.889 ± 2.522 .469 (.791) 28.222 ± 2.279 .332 (.847) -1.604 (.109) 2.31 .641 (.536) .009 Pilates (n = 9) 29.667 ± 3.937 29.000 ± 3.391 -1.732 (.083) 2.25 Control (n = 10) 28.500 ± 3.866 28.222 ± 4.410 − .816 (.414) 0.98 Elbow ↑5 (cm) Yoga (n = 9) 30.778 ± 1.856 .352 (.839) 30.000 ± 1.803 .493 (.781) -1.841 (.066) 2.53 2.356 (.116) .005 Pilates (n = 9) 32.444 ± 4.876 31.667 ± 4.123 -1.890 (.059) 2.40 Control (n = 10) 31.100 ± 4.383 30.556 ± 4.275 .000 (1.000) 1.75 Elbow ↑10 (cm) Yoga 1 (n = 9) 33.333 ± 3.082 .097 (.953) 32.556 ± 2.920 .022 (.989) -1.890 (.059) 1.75 3.976 (.032) (1–3) (2–3) .006 Pilates 2 (n = 9) 33.778 ± 4.324 32.667 ± 4.301 -2.271 (.023) 3.29 Control 3 (n = 10) 33.200 ± 4.467 32.667 ± 4.301 -1.000 (.317) 1.61 Elbow ↑15 (cm) Yoga (n = 9) 35.000 ± 2.345 .294 (.863) 34.889 ± 2.369 .762 (.683) -1.000 (.317) 0.32 2.343 (.118) .003 Pilates (n = 9) 34.667 ± 4.062 34.222 ± 3.993 -1.633 (.102) 1.28 Control (n = 10) 34.200 ± 4.158 33.889 ± 3.855 -1.000 (.317) 0.91 Axilla (cm) Yoga (n = 9) 39.778 ± 2.333 a 7.837 (.020) 39.778 ± 2.333 b 9.039 (.011) .000 (1.000) 0 .594 (.560) .001 Pilates (n = 9) 39.556 ± 4.304 39.333 ± 4.153 b -1.000 (.317) 0.57 Control (n = 10) 36.100 ± 2.998 b 35.667 ± 2.828 a .000 (1.000) 1.2 Volumetric measurement (ml) Yoga (n = 9) 957.7± 220.044 5.998 (.050) 932.2± 192.014 3.495 (.174) -1.841 (.066) 2.66 2.053 (.150) .003 Pilates (n = 9) 1046.66± 133.417 995.55± 122.077 -2.670 (. 008) 4.89 Control (n = 10) 974.000± 237.543 980.00± 258.602 -1.604 (.109) 0.62 x ± sd: Mean ± standard deviation; Significant p-value ≤ .05; p1 = pre-treatment between-group differences; p2 = post-treatment between-group differences; H: Kruskal-Wallis H test; p3 = within-group differences; W: Wilcoxon Signed-Rank Test; %: percentage change between pre and post-treatment; p 4 : Group*Time change scores; F: Quade Nonparametric ANCOVA test results; η 2 : Partial Eta-Squared for between-group effect sizes; ml: milliliter; cm: centimeter 1.2. Volumetric measurement No significant changes were observed in the volumetric measurement results across the groups ( p 1 and p 2 > .05). However, when analyzing time-dependent changes, a significant decrease in volumetric measurement value of EwLE was noted in the clinical Pilates group post-treatment ( W = − 2.670; p 3 = .008). Nonetheless, ANCOVA revealed no significant Group × Time interactions for volumetric measurements. Table 2 2. Findings on Upper Extremity Muscle Strength The analysis of time-dependent changes revealed that both IR and ER muscle strength increased in EwLE ( W = − 2.414; p 3 = .016 and W = − 2.060) in the clinical Pilates group post-treatment. The ANCOVA test revealed significant Group × Time interactions for the IR muscle strength assessments ( F = 3.977, p 4 = .037). The effect size of this change in the groups was moderate ( η 2 = .023). The percentage change in IR muscle strength was highest in the clinical Pilates group (10.62%), followed by the yoga group (6.36%) and the control group (0.77%). Table 3 3. Findings on Upper Extremity Functions There was no significant difference between the groups in upper extremity functions following treatment ( p 1 and p 2 > .05). Regarding time-dependent changes, both the yoga and clinical Pilates groups showed a decrease in DASH total scores post-treatment ( W = − 2.670; p 3 = .008 in both groups) and DASH percentile scores ( W = − 2.549, p 3 = .011; W = − 2.429, p 3 = .015, respectively). The ANCOVA test showed that there were significant Group × Time interactions, indicating that the overall DASH score was lower in the yoga and clinical Pilates groups compared to the control group ( F = 7.061, p 4 = .004). The effect size of this change was small ( η 2 = .023). The clinical Pilates group experienced the greatest decline in DASH total scores (clinical Pilates: 15.82%, yoga: 14.72%, control: 4.49%). Table 3 Table 3 A comparison of the pre-treatment and post-treatment results of upper extremity isokinetic muscle strength and upper extremity function (DASH) measurements for groups Variables Group Pre-treatment Post-treatment Within group Group x Time \(\stackrel{-}{x}\) ± sd H (P 1 ) \(\stackrel{-}{x}\) ± sd H (P 2 ) W (P 3 ) % F (P 4 ) η 2 LÖE IR- Strength (N·m) Yoga 1 (n = 9) 12.222 ± 2.539 1.279 (.527) 13.000 ± 2.398 3.245 (.197) -1.633 (.102) 6.36 3.977 (.037) (1–3) (1–2) (2–3) .023 Pilates 2 (n = 9) 12.556 ± 2.920 13.889 ± 3.180 -2.414 (. 016) 10.62 Control 3 (n = 4) 10.750 ± 1.500 10.667 ± 1.528 -1.414 (.157) 0.77 LÖOE IR- Strength (N·m) Yoga (n = 9) 13.444 ± 3.283 1.183 (.553) 14.000 ± 2.828 .939 (.625) -1.414 (.157) 4.17 .158 (.855) .014 Pilates (n = 9) 13.750 ± 3.059 14.375 ± 2.722 -1.179 (.238) 4.54 Control (n = 4) 12.000 ± 1.414 12.667 ± 1.155 -1.000 (.317) 5.56 LÖE ER- Strength (N·m) Yoga (n = 9) 10.556 ± 2.920 .656 (.720) 11.000 ± 2.449 .790 (.674) -1.414 (.157) 4.21 .691 (.514) .016 Pilates (n = 9) 11.000 ± 3.240 11.556 ± 3.575 -1.000 (.317) 5.05 Control (n = 4) 10.000 ± 1.633 10.333 ± 1.528 -1.000 (.317) 3.33 LÖOE ER- Strength (N·m) Yoga (n = 9) 11.333 ± 3.354 .078 (.962) 12.000 ± 2.739 .097 (.953) -1.897 (.058) 5.88 2.461 (.115) .004 Pilates (n = 9) 11.750 ± 3.327 12.250 ± 3.240 -2.000 (.046) 4.25 Control (n = 4) 11.750 ± 1.708 12.333 ± 1.528 .000 (1.000) 4.96 DASH -Total score (0-100) Yoga 1 (n = 9) 65.444 ± 19.768 3.057 (.217) 55.778 ± 16.836 .454 (.797) -2.670 (.008) 14.72 7.061 (.004) (1–3) (2–3) .023 Pilates 2 (n = 9) 69.556 ± 12.972 58.556 ± 10.370 -2.670 (.008) 15.82 Control 3 (n = 10) 57.100 ± 17.097 59.667 ± 20.193 -1.625 (.104) 4.49 DASH- Percent value (%) Yoga (n = 9) 24.186 ± 14.041 2.402 (.301) 17.780 ± 12.381 .812 (.666) -2.549 (.011) 26.49 3.086 (.064) .021 Pilates (n = 9) 26.894 ± 8.998 20.839 ± 6.128 -2.429 (.015) 22.52 Control (n = 10) 18.326 ± 12.565 18.867 ± 14.849 -1.625 (.104) 2.95 x ± sd: Mean ± standard deviation; Significant p-value ≤ .05; p1 = pre-treatment between-group differences; p2 = post-treatment between-group differences; H: Kruskal-Wallis H test; p3 = within-group differences; W: Wilcoxon Signed-Rank Test; %: percentage change between pre and post-treatment; p4: Group*Time change scores; F: Quade Nonparametric ANCOVA test results; η2: Partial Eta-Squared for between-group effect sizes; 1 :Yoga, 2 :Clinical Pilates, 3 :Control; N·m: Newton meter 4. QoL scoring A significant difference was observed between the groups in terms of breast symptoms ( H = 10.199; p 2 = .006) and arm symptom scores ( H = 11.002; p 2 = .004) post-treatment, considering both time and groups. The breast symptom scores were lower in the yoga and clinical Pilates groups compared with the control group. The arm symptom scores were significantly lower in the clinical Pilates group compared with the control group. Regarding the evaluation of time-dependent changes, the systemic therapy side effect score ( W = − 2.521; p 3 = .012), breast symptom scores ( W = − 2.201; p 3 = .028), and arm symptom scores ( W = − 2.668; p 3 = .008) decreased in the yoga group, and only arm symptom scores ( W = − 2.521; p 3 = .012) decreased in the clinical Pilates group post-treatment. The ANCOVA test revealed significant Group × Time interactions for the breast symptom scores ( F = 7.889; p 4 = .002) and arm symptom scores ( F = 8.581; p 4 = .002) with the clinical Pilates and yoga groups exhibiting a greater decrease in arm symptom scores compared to the control group. The effect size of this change was large for the arm symptom score ( η 2 = .086) and breast symptom score ( η 2 = .094). The yoga group exhibited the most substantial reduction in arm symptom scores (clinical Pilates: 33.74%, yoga: 43.37%, control: 16.59%) and breast symptom scores (clinical Pilates: 42.20%, yoga: 57.80%, control: 19.53%). Table 4 Table 4 A comparison of the pre-treatment and post-treatment results of quality of life (EORTC QLQ- BR23) measurements for groups Variables Group Pre-treatment Post-treatment Within group Group x Time \(\stackrel{-}{x}\) ± sd H (P 1 ) \(\stackrel{-}{x}\) ± sd H (P 2 ) W (P 3 ) % F (P 4 ) η 2 Body image Yoga (n = 9) 26.07 ± 8.941 4.809 (.090) 26.54± 9.225 3.704 (.157) .000 (1.000) 1.80 .365 (.698) .030 Pilates (n = 9) 30.55 ± 5.893 28.23± 8.275 − .816 (.414) 7.06 Control (n = 10) 43.88 ± 20.361 47.83± 22.726 − .447 (.655) 9 Sexual functioning Yoga (n = 9) 38.26 ± 16.768 .898 (.638) 41.66± 19.542 .688 (.709) .000 (1.000) 8.88 .049 (.952) .049 Pilates (n = 9) 31.47 ± 5.557 35.18± 13.029 -1.000 (.317) 11.79 Control (n = 10) 39.16 ± 14.273 40.73± 14.697 -1.000 (.317) 4.01 Sexual enjoyment Yoga (n = 9) 38.25 ± 17.681 .980 (.613) 33.62± 14.479 2.171 (.338) -1.342 (.180) 12.11 2.922 (.073) .021 Pilates (n = 9) 37.03 ± 11.110 37.03± 11.110 .000 1.000 0 Control (n = 10) 43.32 ± 16.100 40.73± 14.697 .000 (1.000) 5.98 Future perspective Yoga (n = 9) 39.81 ± 15.464 3.248 (.197) 38.88± 16.135 1.833 (.400) − .272 (.785) 2.34 .480 (.625) .038 Pilates (n = 9) 36.40 ± 19.080 40.10± 21.490 -1.000 (.317) 10.16 Control (n = 10) 49.99 ± 17.566 48.14± 17.566 .000 (1.000) 3.07 Systemic therapy side effects Yoga (n = 9) 33.49 ± 13.787 1.195 (.550) 22.19 ± 6.723 3.092 (.213) -2.521 (.012) 33.74 2.329 (.119) .044 Pilates (n = 9) 23.15 ± 11.339 19.31 ± 12.169 − .944 (.345) 16.59 Control (n = 10) 31.39 ± 18.925 34.51 ± 19.059 -1.219 (.223) 9.94 Breast symptoms Yoga 1 (n = 9) 39.29 ± 15.917 1.624 (.444) 22.71 ± 6.964 b 10.199 (.006) -2.201 (.028) 57.80 7.889 (.002) (1–3) (2–3) .094 Pilates 2 (n = 9) 29.03 ± 13.456 20.96 ± 11.031 b -1.826 (.068) 42.20 Control 3 (n = 10) 35.53 ± 18.246 42.47 ± 16.638 a -1.461 (.144) 19.53 Arm symptoms Yoga 1 (n = 9) 43.33 ± 18.820 3.450 (.178) 24.54 ± 10.730 11.002 (. 004) -2.668 (.008) 43.37 8.581 (.002) (1–3) (2–3) .086 Pilates 2 (n = 9) 29.52 ± 9.359 17.36 ± 8.140 b -2.521 (.012) 33.74 Control 3 (n = 10) 40.18 ± 17.322 49.06 ± 21.425 a -1.219 (.223) 16.59 Upset by hair loss Yoga (n = 9) 49.62 ± 19.751 3.608 (.165) 49.58 ± 19.785 3.624 (.163) -1.000 (.317) 9.94 1.316 (.287) .002 Pilates (n = 9) 43.88 ± 22.111 43.33 ± 20.683 -1.000 (.317) 42.20 Control (n = 10) 34.99 ± 12.297 31.47 ± 5.557 .000 (1.000) 27.80 x ± sd: Mean ± standard deviation; Significant p-value ≤ .05; p1 = pre-treatment between-group differences; p2 = post-treatment between-group differences; H: Kruskal-Wallis H test; p3 = within-group differences; W: Wilcoxon Signed-Rank Test; %: percentage change between pre and post-treatment; p4: Group*Time change scores; F: Quade Nonparametric ANCOVA test results; η2: Partial Eta-Squared for between-group effect sizes; 1 :Yoga, 2 :Clinical Pilates, 3 :Control Discussion This study aimed to compare the effects of yoga and clinical Pilates exercise methods, combined with compression stockings, on lymphedema, upper extremity muscle strength and functions, and QoL in patients with breast cancer–associated lymphedema. The results revealed that lymphedema reduction was more pronounced in the yoga and clinical Pilates groups compared with the control group. The participants in the clinical Pilates group exhibited a significant increase in IR muscle strength in EwLE compared with the yoga and control groups. Moreover, the improvements in upper extremity function were more significant in the yoga and clinical Pilates groups compared with the control group. Further, the subscale symptom scores of QoL indicated a positive increase in the breast and arm symptoms in the yoga group, and arm symptoms in the clinical Pilates group, compared with the control group. Pilates exercises are generally considered safe and may contribute to reducing the symptoms of breast cancer–associated lymphedema [26]. Şener et al. reported the effectiveness of clinical Pilates exercises applied with compression stockings in decreasing the severity of lymphedema in various segments, except for the axillary region, compared with that in the control group [14]. Similarly, we observed significant differences in lymphedema severity in the clinical Pilates group at two levels (5 cm above the wrist and 10 cm above the elbow) and in volumetric measurements post-treatment compared with pre-treatment. In addition, in circumference measurements, lymphedema reduction was more pronounced in the clinical Pilates group compared with the control group at one level (10 cm above the elbow). Lymphedema was alleviated the most in the clinical Pilates group in terms of percentage (clinical Pilates: 3.29%, yoga: 1.75%, control: 1.61%). Clinical Pilates exercises may potentially alleviate lymphedema by promoting core stability, a key principle of Pilates. This stability can facilitate lymphatic flow by stimulating the ductus thoracicus and abdominal lymph nodes through the contractions of trunk muscles and the diaphragm. Moreover, Pilates exercises involving extremity movements may further stimulate the lymphatic system through their pumping action. Previous studies showed that Satyananda yoga exercises did not lead to a decrease in lymphedema severity or arm volume. However, they demonstrated a decrease in the amount of fibrous tissue and enhanced skin tissue elasticity compared with the control group. These findings suggested that the long-term use of Satyananda yoga exercises might reduce EwLE volume [15,27]. Fisher et al. reported that hatha yoga exercises, without additional resistance or repeated muscle contractions, improved lymphatic fluid pumping and flow, thereby reducing lymphedema [17]. Similarly, although the present study did not observe a significant reduction in lymphedema severity in any segment with yoga exercises, a significant reduction of 10 cm above the elbow was observed compared with that in the control group. This reduction in lymphedema in the yoga group compared with the control group suggested that hatha yoga might enhance lymphatic flow. This improvement could be attributed to the activation of lymphatic collecting vessels during yoga postures and breathing techniques, along with stimulation of the ductus thoracicus by lymphatic fluid movement, resulting in increased lymphatic flow due to pressure changes. Upper extremity muscle strength is affected more in the EwLE compared with that in the extremity without lymphedema in breast cancer survivors [28,29]. Bertoli et al. found that mat Pilates exercises enhanced shoulder abductor and trunk extensor muscle strength in the upper extremity muscles on both the operated and intact upper extremities [30]. Zengin Alpozgen et al. reported that Pilates exercises played a crucial role in increasing muscle strength in breast cancer survivors than in the home exercise group [31]. The present study found that clinical Pilates was more effective than yoga, and yoga was more effective than the control, in increasing IR muscle strength in the affected extremities. The clinical Pilates group demonstrated the greatest increase in IR muscle strength (clinical Pilates: 10.62%, yoga: 6.36%, control: 0.77%). Clinical Pilates exercises (triceps pull and swimming) promoted significant activation of IR muscles compared with yoga exercises. Furthermore, it was noted that the majority of participants exhibited kinesiophobia (fear of movement) leading them to limit their range of shoulder joint motion during exercise in order to prevent injury. The participants reported less fear when engaging in clinical Pilates exercises than with yoga exercises. This could be attributed to the fact that clinical Pilates exercises were similar to those performed by the patients in previous rehabilitation programs. These factors might explain why IR muscle strength improvement was the most pronounced in the clinical Pilates group. Mazor et al. demonstrated that Ashtanga yoga exercises increased shoulder abductor muscle strength in EwLE and increased elbow flexor muscle strength in EwLE and Ew/oLE [32]. Another study found that yoga exercises applied with compression stockings in patients with lymphedema associated with unilateral breast cancer resulted in an increase in only serratus anterior muscle strength in both EwLE and Ew/oLE and no change in other muscle groups [33]. The present study revealed that yoga exercises increased IR muscle strength compared with that in the control group. This outcome could be attributed to the fact that asana postures aimed at stabilizing the scapula/shoulder complex (amsa bandha), which might regulate the scapulohumeral rhythm and increase the strength of internal rotator muscles commonly affected post-surgery. In addition, the isometric contraction induced by asana postures, along with increased resistance with an increase in body weight during pose transitions, likely contributed to increased IR muscle strength through isotonic contractions in the muscles. A previous systematic review and meta-analysis examined the effects of exercise on upper extremity functions in breast cancer–associated lymphedema, revealing significant benefits across various exercise modalities including aerobic, resistance training, yoga, and Pilates [34]. Additionally, clinical Pilates exercises positively influenced the functional status compared with that in the control groups [14]. Fisher et al. stated that hatha yoga exercises did not yield statistically significant effects on upper extremity function, but a decrease in DASH scores was observed post-treatment [17]. In our study, significant improvements in DASH scores were observed in the clinical Pilates and yoga exercises groups compared with the control group. Specifically, the clinical Pilates group demonstrated the most significant reduction in DASH total scores (15.82%), followed by the yoga (14.72%) and control groups (4.49%), compared with the pretreatment scores. The results further indicated that the clinical Pilates group experienced a significant increase in physical parameters (increase in IR muscle strength and decreased proximal edema) compared with the yoga group. In this context, the significant improvement in upper extremity functions in the clinical Pilates group could be attributed to the more pronounced reduction in proximal arm lymphedema and the greater increase in upper extremity muscle strength compared with the yoga group. Lymphedema is a prevalent post-treatment complication negatively affecting QoL in breast cancer survivors [35]. A study investigating QoL in breast cancer survivors with and without lymphedema using the EORTC QLQ-BR23 found that the symptom scores associated with arm and breast issues were higher in patients with lymphedema compared with those without it [36]. Previous studies examining the QoL in patients with breast cancer–associated lymphedema found that Pilates exercises improved QoL [14,37,38]. Similarly, studies on the effects of yoga demonstrated positive increases in QoL and significant decreases in breast and arm symptom scores after yoga exercises [39,40]. In the present study, the symptom scores of QoL decreased in the Pilates group post-treatment compared with the control group, and a decrease in arm and breast symptoms was observed in the yoga group compared with the control group. In addition, the arm symptom scores (yoga: 43.37%, clinical Pilates: 33.74%, control: 16.59%) and breast symptom scores (yoga: 57.80%, clinical Pilates: 42.20%, control: 19.53%) decreased more in the yoga group compared with the clinical Pilates group. Breathing techniques, focusing methods, and meditation practiced during yoga exercises contribute to the clearing of blockages, balancing of the body’s energy channels, and mental healing, thereby reducing symptoms. This explained why yoga exercises resulted in more improvement in symptom subscales compared with clinical Pilates exercises. In the present study, despite differences observed in symptom subscales between the groups, no differences were found in functional subscales such as future perspective and sexual enjoyment. This could be because the questions in these subscales were more emotionally oriented and the patients might have been suffering from breast cancer for many years. Consequently, the aforementioned issues remained unnoticed compared with physical functions. Implications for Practice Considering that patients with breast cancer–associated lymphedema may experience significant challenges in EwLE compared with Ew/oLE, exploring the severity of edema, upper extremity muscle strength, upper extremity functions, and QoL in this population in terms of exercise protocols may offer valuable insights. The research findings indicated that the clinical Pilates group experienced greater improvements in physical parameters, including lymphedema, muscle strength, and upper extremity functions. However, it is worth noting that yoga activities possess the capacity to enhance emotional well-being and overall quality of life. Hence, the findings of this study might be crucial for encouraging the adoption of appropriate exercise methods among patients with breast cancer–associated lymphedema. Strength and Potential Limitations This study investigated the effectiveness of yoga and clinical Pilates exercises in reducing lymphedema severity, improving muscle strength, and enhancing upper extremity functions and QoL. These two exercise methods were not compared in previous studies, making our results promising and potentially pioneering. In this study, all participants were instructed to use compression stockings daily for 8 h. However, the feedback received post-treatment showed that some participants might not have adhered to this recommendation inadequately. Therefore, the lack of a systematic follow-up method to monitor the use of compression stockings, including a daily or weekly usage log, could be considered a significant limitation of the study. Kinesiophobia due to potential injury or pain, was not evaluated in our study. However, individuals avoided certain exercises in the initial weeks due to fear of movement, leading to incomplete performance of exercises within the full range of motion. Therefore, the absence of kinesiophobia assessment was another limitation, highlighting the importance of evaluating this physiological factor in future studies. Conclusions Clinical Pilates exercises demonstrate effectiveness in improving various physical parameters, including reducing lymphedema, increasing muscle strength, and enhancing upper extremity functions. However, yoga exercises contribute to improving emotional aspects such as QoL. Both clinical Pilates and yoga exercises, using compression stockings, may be recommended as alternative treatment approaches for managing lymphedema. This study provided valuable insights in terms of directing patients toward exercise modalities that might sustain motivation in long-term treatment protocols, considering the chronic nature of lymphedema. Declarations Conflict of Interest: The authors declare that there is no conflict of interest. Funding: The research received financial assistance from the Eastern Mediterranean University Scientific Research Project financing program under project number BAPC-OD-20-02. The financial support was used to supply the volumetric measurement equipment and compression stockings. Author Contribution F.Z:writing and performing surgeries, data analysis and performing surgeries, G.I: writing and performing surgeries, review of the article, and intellectual concept of the article, M. 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Galantino M Lou, Desai K, Greene L, Demichele A, Stricker CT, Mao JJ (2012)Impact of yoga on functional outcomes in breast cancer survivors with aromatase inhibitor-associated arthralgias. Integr Cancer Ther 11(4):313–20. Andysz A, Merecz D, Wójcik A, ͆wiątkowska B, Sierocka K, Najder A (2014) Effect of a 10-week yoga programme on the quality of life of women after breast cancer surgery. Prz Menopauzalny 13(3):186–93. Additional Declarations No competing interests reported. Supplementary Files Appendix.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4564431","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":317300444,"identity":"e6cd998b-fbfb-4b76-b6e4-a608e0aae649","order_by":0,"name":"Ferdiye Zabit","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIie3RsarCMBSA4UjgZDniegbRVwgUtKLYV1GETHW900WcMqnP4uRcKMbNuY4iODgJgjiI96YB17ajYP6hp5TzQUIZ8/k+MDFnjEb2RTKe2EHNUoLJmwDkg7AaYY6gdB/KiVges6MeRN324nbJfkNkIt2uCwnugnCsFe/p+qYfG3swVCorIhEpoLFOQZr6JojBEsJOIcH2OSd/KA2eg/hVhRDkJCFL+GmqqxBUPBztJ7KnVYdPV4RQdhcUpnZ4/AyjLk9Pt/g+azVEagqJqwZugPtBULrueronv1bb9vl8vm/rHxCdP9vMRMuZAAAAAElFTkSuQmCC","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Ferdiye","middleName":"","lastName":"Zabit","suffix":""},{"id":317300445,"identity":"00047ec1-efc9-421c-b52a-4b5128fcbdb0","order_by":1,"name":"Gozde Iyigun","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Gozde","middleName":"","lastName":"Iyigun","suffix":""},{"id":317300446,"identity":"2d29129b-3096-4064-ad2d-f98c65f0e909","order_by":2,"name":"Mehtap Malkoc","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Mehtap","middleName":"","lastName":"Malkoc","suffix":""}],"badges":[],"createdAt":"2024-06-11 13:21:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4564431/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4564431/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60614959,"identity":"5bba7c0c-53ff-4828-af61-e3106957460c","added_by":"auto","created_at":"2024-07-18 20:07:23","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":77843,"visible":true,"origin":"","legend":"\u003cp\u003eCONSORT flowchart parcitipation in the study\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4564431/v1/96254e9c1f468bd97c6ce8fc.jpg"},{"id":61186504,"identity":"74b4abbe-ac03-44f5-880e-d83aa6131e7c","added_by":"auto","created_at":"2024-07-26 17:49:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1460438,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4564431/v1/7efdda67-5446-4862-8b22-6764ab265f1d.pdf"},{"id":60615821,"identity":"dafb50cd-f553-48df-ba20-b2a60348cb74","added_by":"auto","created_at":"2024-07-18 20:15:23","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":23102,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-4564431/v1/07048ea7690c5ebebb8eed85.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eA Comparison of Yoga and Clinical Pilates Exercise Methods in Women with Breast Cancer-Related Lymphedema: A Randomized Controlled Trial\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBreast cancer is the most common cancer among women and is the primary cause of their morbidity and mortality [1]. Although the survival rate increases after breast cancer is diagnosed, breast cancer\u0026ndash;associated lymphedema, which plays a crucial role in decreasing the quality of life (QoL), is an important public health problem [2]. Common symptoms of lymphedema include edema, pain, heaviness, fullness, tightness, and upper limb dysfunctions. These symptoms can lead to reduced shoulder range of motion and shoulder strength loss, difficulty performing daily activities, impaired social relationships and recreational activities, compromised gross and fine motor skills and occupational performance, and impaired home and personal care functions [3].\u003c/p\u003e \u003cp\u003eA greater prevalence of shoulder dysfunction is observed among breast cancer survivors with lymphedema who exhibit reduced muscle activity in the vicinity of lymph node removal, which hinders the recovery of the lymphatics and adjacent soft tissues [4]. The absence of physical activity, exercise, and everyday activities among individuals with lymphedema may lead to a decline in strength, which in turn can result in dysfunctions of the upper extremities due to muscle atrophy in the affected regions [5]. Breast cancer survivors with lymphedema exhibited reduced muscle strength compared to individuals without lymphedema [6]. Patients with lymphedema commonly avoid engaging in activities that require raising their arms overhead, resulting in the weakening of the muscles responsible for elevating the shoulder [4]. Muscle fatigue may disrupt the normal firing of the surrounding muscle units, resulting in a decline in muscle strength. In addition, because the upper extremity functions used during daily activities are probably affected more frequently by lymphedema and the QoL decreases significantly [7], it is important to evaluate overall muscle strength, upper extremity functions, and QoL, especially in extremity with lymphedema (EwLE).\u003c/p\u003e \u003cp\u003eConsidering all these factors, effective methods for treating breast cancer\u0026ndash;associated lymphedema should be developed. Besides complex decongestive physiotherapy, which includes manual lymphatic drainage, compression, skincare, and exercise and is considered the gold standard in treating lymphedema, group exercises have become increasingly popular in recent years [8]. Group exercises lead to adherence to exercise in breast cancer survivors for reasons including meeting friends, getting out of the house, participating in an enjoyable activity, and contributing to improving both physical and psychosocial health [9]. Previous studies indicated that group exercise was the preferred approach for many individuals undergoing breast cancer treatment [9\u0026ndash;11]. Adherence to exercise is essential in reducing and preventing the development of breast cancer\u0026ndash;associated lymphedema. However, achieving it remains a challenge for this population [12], highlighting the need for more studies on alternative exercise methods [13].\u003c/p\u003e \u003cp\u003ePilates exercises, in particular, may serve as a significant exercise approach for early adaptation to daily activities in this population, as they focus on neuromuscle remodeling. Studies have suggested that Pilates exercises are a safe method to reduce symptoms in patients with breast cancer\u0026ndash;associated lymphedema. Previous studies have applied these interventions to patients with breast cancer at a frequency of 2\u0026ndash;3 sessions per week, lasting 4\u0026ndash;8 weeks, and with various intensity levels [11,14]. Yoga exercises are a holistic system of practice aimed at creating balance in the physical, mental, and emotional aspects of self. Physical movements and breathing exercises that align with the principles of lymphatic cleansing can be incorporated as part of a comprehensive approach to reduce the symptoms associated with lymphedema [15]. Studies have also reported that yoga exercises are among the complementary and alternative treatments for breast cancer\u0026ndash;associated lymphedema [16,17]. However, no studies comparing the effectiveness of yoga and Pilates exercises in breast cancer\u0026ndash;associated lymphedema are lacking. Therefore, this study aimed to compare the effects of yoga and clinical Pilates exercise methods, combined with compression stockings, on lymphedema, upper extremity muscle strength and functions, and QoL in patients with breast cancer\u0026ndash;associated lymphedema.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003e Before commencing the study, ethical approval was obtained from the Eastern Mediterranean University Scientific Research and Publication Ethics Committee in accordance with the Declaration of Helsinki (date: 25.02.2020, decision number: 2020/0103), and the study was registered at ClinicalTrials.gov (identifier: NCT04824807). Patients with breast cancer\u0026ndash;associated lymphedema were identified and recruited using patient records and social media. Individuals who agreed to participate in the study were provided with written and verbal information about the purpose of the study, evaluation methods, and exercise training. Written informed consent forms were obtained from all voluntary participants. All participants were assessed in the clinical units of the Eastern Mediterranean University Faculty of Health Sciences Healthy Living Center.\u003c/p\u003e \u003cp\u003eThe study enrolled 28 patients with breast cancer\u0026ndash;associated lymphedema, aged between 30 and 75 years. It included patients with mild-to-moderate lymphedema in the upper extremities, either unilateral or bilateral, following breast cancer treatment, who received any lymphedema treatments at least 6 months prior to the study. However, patients with metastatic breast cancer currently undergoing adjuvant treatment (chemotherapy, radiotherapy, hormone therapy); patients with extremity infections (fungus, rash, high temperature), severe pain in the axillary region (e.g., neuropathy), and heart failure (New York Heart Association (NYHA) Class III-IV); and those who had been following a regular exercise program in the last 6 months were excluded from the study. The CONSORT flow diagram of the study protocol is illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSample size\u003c/h2\u003e \u003cp\u003eA pilot study involving 15 participants was conducted to assess the difference in volumetric measurement values among the yoga, clinical Pilates, and control groups. The effect size was calculated for repeated-measures analysis of variance, as the study assessed the directional and time-dependent changes in the participants. The effect size obtained from the pilot study was .483, with a significance level of .05, a power of .95, and a correlation of.50 between repeated measures. In the calculation of the total sample size, G*Power 3.1.9.2 was used, resulting in a figure of 21. The sample size for each group was increased by 20% to account for potential participant withdrawals, resulting in a total sample size of 28 across the 3 treatment groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and randomization\u003c/h2\u003e \u003cp\u003eA prospective, single-blind, randomized controlled trial was conducted. The participants were assigned to groups using the block randomization method based on age (\u0026lt;\u0026thinsp;50 years and \u0026ge;\u0026thinsp;50 years) and lymphedema stage (\u0026lt;\u0026thinsp;5 years, 5\u0026ndash;10 years, and \u0026lt;\u0026thinsp;10 years) distributions obtained from the pilot study. All participants underwent evaluations pre- and post-treatment. Compression stockings were provided to all participants, and they were instructed to wear them daily for 8 weeks. The clinical Pilates group engaged in clinical Pilates exercises three times each week for eight weeks. The yoga group engaged in yoga sessions three times per week for eight weeks. The third group served as the control group. Compression stockings were purchased and distributed to the participants using the budget provided by the Eastern Mediterranean University Scientific Research Project. BAPC-0D-20-02\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eOutcome measures\u003c/h2\u003e \u003cp\u003eThe participants\u0026rsquo; demographic data, including age (year), height (cm), weight (kg), body mass index (kg/m\u003csup\u003e2\u003c/sup\u003e), dominant side, age at menarche and menopause, duration of mastectomy, type of mastectomy, side(s) of mastectomy (right unilateral, left unilateral, bilateral), number of lymph nodes removed, type of lymph node dissection (axillary/sentinel), presence of radiotherapy, chemotherapy treatments, duration of lymphedema, stage of lymphedema, and location of lymphedema (proximal/distal), were recorded using a sociodemographic information form.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e1. Upper extremity lymphedema measurement\u003c/h2\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e1.1. Circumference measurement\u003c/h2\u003e \u003cp\u003eThe circumference was measured using a tape measure, with anatomical segments (wrist, elbow, axilla) identified. The measurements started from the wrist (specifically, the styloid process of the ulna) and the reference points were marked at 5-cm intervals from the styloid process of the ulna to the olecranon, and from the olecranon to the axilla. The circumference was then measured from these reference points and recorded in centimeters.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e1.2. Volumetric measurement\u003c/h2\u003e \u003cp\u003eThe upper extremity volume was measured using the water displacement technique [18]. A cylindrical measuring cup (60 \u0026times; 16 \u0026times; 16 cm\u003csup\u003e3\u003c/sup\u003e) with a soft drainage tube positioned 45 cm above the bottom was filled with water. Participants removed all accessories from their arms. They were then instructed to slowly lower their arms into the volumeter until the top of the volumeter came into contact with their axilla and a bar placed in the web area of their second and third fingers. The volumetric measurements for both arms were recorded in milliliters (ml).\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e2. Upper extremity muscle strength\u003c/h2\u003e \u003cp\u003eThe upper extremity muscle strength was assessed using an isokinetic dynamometer (HUMAC NORM Testing \u0026amp; Rehabilitation System; CSMi, Stoughton, MA). The isokinetic dynamometer is a widely recognized objective method for measuring muscle strength. The correlation coefficients at 90\u0026ordm; shoulder abduction were reported as 0.96 (0.94\u0026ndash;0.98) for internal rotation (IR) and 0.94 (0.90\u0026ndash;0.96) for external rotation (ER) [19]. The isokinetic strength measurements of shoulder IR (teres major, latissimus dorsi, pectoralis major, and subscapularis) and ER (supraspinatus, infraspinatus, and teres minor) movements were conducted using concentric\u0026ndash;concentric contractions for three repetitions at an angular velocity of 180\u0026deg;/s. The measurements were taken with the shoulder in 90\u0026deg; abduction and the elbow in 90\u0026deg; flexion for the extremity to be tested in the supine position.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3. Upper extremity functions\u003c/h2\u003e \u003cp\u003eThe Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) is a standardized survey used to assess impairments, activity limitations, and participation restrictions associated with both leisure and occupation. Apart from the first part, a work module exists comprising four questions aimed at determining the patient\u0026rsquo;s occupation-associated disability [20]. Among these questions, 21 assess the difficulty level in performing different physical activities due to arm, shoulder, or hand issues, 5 assess symptoms (pain, tingling, stiffness, and weakness), and 4 assess social activity, work, sleep, and self-image. In the DASH, a 5-point Likert-type scale is used, with response options ranging from 1 (no difficulty), 2 (mild difficulty), 3 (moderate difficulty), 4 (severe difficulty), to 5 (unable). A final score between 0 and 100 is obtained for each module, with higher scores indicating a more severe level of disability: 0 (no disability) and 100 (maximum disability) [21].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e4. Quality of life\u003c/h2\u003e \u003cp\u003eThe European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-BR23) was used to assess QoL [22]. The EORTC QLQ- BR23 employs a 4-point Likert-type scale consisting of 23 questions. Responses are categorized as follows: 1 (not at all), 2 (a little), 3 (quite a bit), and 4 (very much). The questionnaire comprises a functional scale and a symptom scale. The functional scale assesses body image, sexual functioning, sexual enjoyment, and future perspective, with higher scores indicating better QoL and enhanced functionality. Conversely, the symptom scale evaluates systemic therapy side effects, breast symptoms, arm symptoms, and upset by hair loss, with higher scores indicating poorer QoL and increased symptom severity. Scores are then linearly converted into a 0\u0026ndash;100 scale for interpretation [23].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eIntervention\u003c/h2\u003e \u003cp\u003e The participants in the clinical Pilates group attended an educational seminar on clinical Pilates exercises and posture before starting the exercise program. They were instructed on lumbopelvic stability (core stabilization), spine stabilization, and proper posture techniques, which form the foundation of Pilates exercises. Following the seminar, the participants actively participated in clinical Pilates exercises 3 times per week for 8 weeks, for a total of 24 sessions, each lasting 60 minutes. Each session included a 10-minute warm-up, 10-minute cool-down, and 40 minutes of progressive exercises. Participants were instructed to wear compression stockings during exercises and 8 h every day for 8 weeks period of time. The specific clinical Pilates exercise program is provided in Appendix 1.\u003c/p\u003e \u003cp\u003e The participants in the yoga group attended a seminar on yoga philosophy, breathing exercises, and relaxation techniques before starting the exercise program. After the seminar, 24 sessions of yoga exercises were performed 3 days a week for 8 weeks, with each session lasting 60 minutes. The session comprised a 10-minute warm-up, 10-minute cool-down, and 40 minutes of progressive exercises. Participants were instructed to wear compression stockings while performing exercises and throughout the day for a period of 8 weeks. The specific yoga exercise program is provided in Appendix 2. A physiotherapist with expertise in two exercise methods designed and implemented the clinical Pilates and yoga exercise protocols tailored to breast cancer\u0026ndash;associated lymphedema.\u003c/p\u003e \u003cp\u003eThe individuals in the control group did not receive any exercise treatment. Instead, they were provided with compression stockings and an educational brochure following the evaluation. The brochure contained information about lymphedema, its types, hygiene practices, and nutritional guidelines to follow. In addition, the brochure outlined treatment protocols and exercises for managing lymphedema. The participants were instructed to read the brochure and wear the compression stockings throughout the day for a period of 8 weeks.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe data obtained in this study were analyzed using the Statistical Package for Social Sciences (SPSS) 26.0 for statistical analysis. Descriptive statistics were employed to analyze the clinical and demographic characteristics. Continuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (\u003cem\u003ex̄\u003c/em\u003e \u0026plusmn; \u003cem\u003esd\u003c/em\u003e), whereas categorical variables were presented as frequency (\u003cem\u003en\u003c/em\u003e) and percentage (%). Due to the small sample size in each group, the differences between groups pre- and post-treatment were assessed using the Wilcoxon signed-rank test. The chi-square test and Kruskal\u0026ndash;Wallis \u003cem\u003eH\u003c/em\u003e test were used to determine the changes between groups, and nonparametric Quade analysis of covariance (ANCOVA) was used to evaluate the changes between time and group. The effect sizes were calculated using the Eta-Square (\u003cem\u003eη\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e) and the findings were interpreted according to the principles established by Cohen [24]. The interpretation of the effect sizes is as follows: small (η2\u0026thinsp;=\u0026thinsp;.01), medium (η2\u0026thinsp;=\u0026thinsp;.06), and large (η2\u0026thinsp;=\u0026thinsp;.14) effects [25]. A \u003cem\u003eP\u003c/em\u003e value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicated a statistically significant difference.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe sociodemographic and clinical characteristics of the participants are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. No significant differences in parameters were identified across the three groups when compared to the parameters before treatment.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral characteristics of the participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYoga\u003c/p\u003e \u003cp\u003egroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eClinical Pilates\u003c/p\u003e \u003cp\u003egroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003cp\u003egroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(p)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDominant extremity, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRight\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (88.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (90.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.629\u003c/p\u003e \u003cp\u003e(.443)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLeft\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (10.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eSide of mastectomy, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eUnilateral \u0026ndash; right\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1.842\u003c/p\u003e \u003cp\u003e(.765)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eUnilateral \u0026ndash; left\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (60.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eBilateral\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (10.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eType of mastectomy, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (60.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.482\u003c/p\u003e \u003cp\u003e(.786)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePartial\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (40.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eTime after mastectomy, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;5 years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3.251\u003c/p\u003e \u003cp\u003e(.517)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e5\u0026ndash;10 years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (30.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026gt;\u0026thinsp;10 years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (60.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eType of lymph node dissection, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAxillar\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.760\u003c/p\u003e \u003cp\u003e(.415)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSentinel\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (20.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eChemotherapy administration, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (77.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (90.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3.032\u003c/p\u003e \u003cp\u003e(.220)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (10.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eRadiotherapy administration, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (88.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (88.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.852\u003c/p\u003e \u003cp\u003e(.396)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eTime after lymphedema (years)\u003c/b\u003e,\u003c/p\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;5 years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3.971\u003c/p\u003e \u003cp\u003e(.410)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e5\u0026ndash;10 years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (40.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026gt;\u0026thinsp;10 years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (40.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eLymphedema extremity, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRight\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3.060\u003c/p\u003e \u003cp\u003e(.217)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLeft\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (88.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (60.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eLymphedema location, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eProximal-distal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (88.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3.991\u003c/p\u003e \u003cp\u003e(.136)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDistal-proximal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eH (p)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years), x\u0026thinsp;\u0026plusmn;\u0026thinsp;sd\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.000\u0026thinsp;\u0026plusmn;\u0026thinsp;9.474\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.556\u0026thinsp;\u0026plusmn;\u0026thinsp;11.844\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e51.500\u0026thinsp;\u0026plusmn;\u0026thinsp;12.067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.408 (.495)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHeight (cm), x\u0026thinsp;\u0026plusmn;\u0026thinsp;sd\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e163.111\u0026thinsp;\u0026plusmn;\u0026thinsp;6.585\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e161.667\u0026thinsp;\u0026plusmn;\u0026thinsp;6.964\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e160.400\u0026thinsp;\u0026plusmn;\u0026thinsp;5.739\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.468 (.791)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWeight (kg), x\u0026thinsp;\u0026plusmn;\u0026thinsp;sd\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.000\u0026thinsp;\u0026plusmn;\u0026thinsp;12.227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78.222\u0026thinsp;\u0026plusmn;\u0026thinsp;14.481\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e75.300\u0026thinsp;\u0026plusmn;\u0026thinsp;16.546\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.606 (.735)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI (kg/m\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e), x\u0026thinsp;\u0026plusmn;\u0026thinsp;sd\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.603\u0026thinsp;\u0026plusmn;\u0026thinsp;3.275\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.116\u0026thinsp;\u0026plusmn;\u0026thinsp;3.899\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28.964\u0026thinsp;\u0026plusmn;\u0026thinsp;6.399\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.834 (.659)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge of menopause (years), x\u0026thinsp;\u0026plusmn;\u0026thinsp;sd\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.444\u0026thinsp;\u0026plusmn;\u0026thinsp;5.223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.750\u0026thinsp;\u0026plusmn;\u0026thinsp;6.409\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43.750\u0026thinsp;\u0026plusmn;\u0026thinsp;3.991\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.986 (.611)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge of menarche (years), x\u0026thinsp;\u0026plusmn;\u0026thinsp;sd\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.222\u0026thinsp;\u0026plusmn;\u0026thinsp;1.856\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.222\u0026thinsp;\u0026plusmn;\u0026thinsp;1.093\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.700\u0026thinsp;\u0026plusmn;\u0026thinsp;1.767\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.309 (.520)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of dissected lymph nodes, x\u0026thinsp;\u0026plusmn;\u0026thinsp;sd\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.000\u0026thinsp;\u0026plusmn;\u0026thinsp;6.604\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.143\u0026thinsp;\u0026plusmn;\u0026thinsp;6.336\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.875\u0026thinsp;\u0026plusmn;\u0026thinsp;5.842\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.421 (.491)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003ex\u0026thinsp;\u0026plusmn;\u0026thinsp;sd: Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standart deviation; n (%): Frequency (percentage); \u003cb\u003eχ\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e: Likelihood Ratio Chi-square; H: Kruskal Wallis H test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e1. Findings on Upper Extremity Lymphedema Measurement\u003c/h2\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003e1.1. Circumference measurement\u003c/h2\u003e \u003cp\u003eNo significant changes were observed in circumference measurements of EwLE across different groups (\u003cem\u003ep\u003c/em\u003e\u003csub\u003e1\u003c/sub\u003e and \u003cem\u003ep\u003c/em\u003e\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;\u0026gt;\u0026thinsp;.05). When assessing time-dependent changes independently within each group, a significant decrease in circumference measurement of EwLE was observed 10 cm above the elbow in the clinical Pilates group post-treatment (\u003cem\u003eW\u003c/em\u003e = \u0026minus;\u0026thinsp;2.271; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.023). Significant group \u0026times; time interactions were observed in the ANCOVA, indicating that edema decreased more in the yoga and clinical Pilates groups in EwLE compared to the control group (10 cm above the elbow) (\u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.976; \u003cem\u003ep\u003c/em\u003e\u003csub\u003e4\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.032) and the treatment effect was small (\u003cem\u003eη\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.006). The clinical Pilates group (10 cm above the elbow) exhibited the most significant reduction in edema (3.29%), followed by the yoga (1.75%) and control groups (1.61%). Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eA comparison of the pre-treatment and post-treatment results of circumference and volumetric measurements for groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c3\" namest=\"c2\" rowspan=\"2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003ePre-treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003ePost-treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003eWithin group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003eGroup x Time\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u0026plusmn; sd\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eH\u003c/p\u003e \u003cp\u003e(P\u003csub\u003e1\u003c/sub\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u0026plusmn; sd\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eH\u003c/p\u003e \u003cp\u003e(P\u003csub\u003e2\u003c/sub\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eW\u003c/p\u003e \u003cp\u003e(P\u003csub\u003e3\u003c/sub\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eF\u003c/p\u003e \u003cp\u003e(P\u003csub\u003e4\u003c/sub\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eη\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eWrist (cm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eYoga (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.000\u0026thinsp;\u0026plusmn;\u0026thinsp;2.345\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1.208\u003c/p\u003e \u003cp\u003e(.547)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e18.778\u0026thinsp;\u0026plusmn;\u0026thinsp;1.856\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1.851\u003c/p\u003e \u003cp\u003e(.396)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-1.000\u003c/p\u003e \u003cp\u003e(.317)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1.467\u003c/p\u003e \u003cp\u003e(.250)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePilates (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.667\u0026thinsp;\u0026plusmn;\u0026thinsp;2.646\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e19.333\u0026thinsp;\u0026plusmn;\u0026thinsp;2.693\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-1.342\u003c/p\u003e \u003cp\u003e(.180)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.700\u0026thinsp;\u0026plusmn;\u0026thinsp;3.653\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e20.889\u0026thinsp;\u0026plusmn;\u0026thinsp;3.822\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eWrist \u0026uarr;5 (cm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eYoga (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.333\u0026thinsp;\u0026plusmn;\u0026thinsp;3.674\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.451\u003c/p\u003e \u003cp\u003e(.798)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e23.667\u0026thinsp;\u0026plusmn;\u0026thinsp;2.958\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.212\u003c/p\u003e \u003cp\u003e(.900)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-1.857\u003c/p\u003e \u003cp\u003e(.063)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3.003\u003c/p\u003e \u003cp\u003e(.069)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePilates (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.000\u0026thinsp;\u0026plusmn;\u0026thinsp;3.640\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e24.333\u0026thinsp;\u0026plusmn;\u0026thinsp;3.775\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-2.121\u003c/p\u003e \u003cp\u003e(\u003cb\u003e.034)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.300\u0026thinsp;\u0026plusmn;\u0026thinsp;3.974\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e24.667\u0026thinsp;\u0026plusmn;\u0026thinsp;4.770\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-1.342\u003c/p\u003e \u003cp\u003e(.180)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eWrist \u0026uarr;10 (cm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eYoga (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.333\u0026thinsp;\u0026plusmn;\u0026thinsp;2.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.131\u003c/p\u003e \u003cp\u003e(.937)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e26.889\u0026thinsp;\u0026plusmn;\u0026thinsp;2.571\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.186\u003c/p\u003e \u003cp\u003e(.911)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-1.633\u003c/p\u003e \u003cp\u003e(.102)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1.384\u003c/p\u003e \u003cp\u003e(.270)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePilates (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.667\u0026thinsp;\u0026plusmn;\u0026thinsp;2.828\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e27.333\u0026thinsp;\u0026plusmn;\u0026thinsp;2.872\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-1.342\u003c/p\u003e \u003cp\u003e(.180)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.300\u0026thinsp;\u0026plusmn;\u0026thinsp;4.474\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e27.111\u0026thinsp;\u0026plusmn;\u0026thinsp;4.859\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-1.000\u003c/p\u003e \u003cp\u003e(.317)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eElbow (cm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eYoga (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.889\u0026thinsp;\u0026plusmn;\u0026thinsp;2.522\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.469\u003c/p\u003e \u003cp\u003e(.791)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e28.222\u0026thinsp;\u0026plusmn;\u0026thinsp;2.279\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.332\u003c/p\u003e \u003cp\u003e(.847)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-1.604\u003c/p\u003e \u003cp\u003e(.109)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.641\u003c/p\u003e \u003cp\u003e(.536)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePilates (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.667\u0026thinsp;\u0026plusmn;\u0026thinsp;3.937\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e29.000\u0026thinsp;\u0026plusmn;\u0026thinsp;3.391\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-1.732\u003c/p\u003e \u003cp\u003e(.083)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.500\u0026thinsp;\u0026plusmn;\u0026thinsp;3.866\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e28.222\u0026thinsp;\u0026plusmn;\u0026thinsp;4.410\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.816\u003c/p\u003e \u003cp\u003e(.414)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eElbow \u0026uarr;5 (cm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYoga (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e30.778\u0026thinsp;\u0026plusmn;\u0026thinsp;1.856\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c6\" namest=\"c5\" rowspan=\"3\"\u003e \u003cp\u003e.352\u003c/p\u003e \u003cp\u003e(.839)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e30.000\u0026thinsp;\u0026plusmn;\u0026thinsp;1.803\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.493\u003c/p\u003e \u003cp\u003e(.781)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-1.841\u003c/p\u003e \u003cp\u003e(.066)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2.356\u003c/p\u003e \u003cp\u003e(.116)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePilates (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e32.444\u0026thinsp;\u0026plusmn;\u0026thinsp;4.876\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e31.667\u0026thinsp;\u0026plusmn;\u0026thinsp;4.123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-1.890\u003c/p\u003e \u003cp\u003e(.059)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e31.100\u0026thinsp;\u0026plusmn;\u0026thinsp;4.383\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e30.556\u0026thinsp;\u0026plusmn;\u0026thinsp;4.275\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eElbow \u0026uarr;10 (cm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYoga\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e33.333\u0026thinsp;\u0026plusmn;\u0026thinsp;3.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c6\" namest=\"c5\" rowspan=\"3\"\u003e \u003cp\u003e.097\u003c/p\u003e \u003cp\u003e(.953)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e32.556\u0026thinsp;\u0026plusmn;\u0026thinsp;2.920\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.022\u003c/p\u003e \u003cp\u003e(.989)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-1.890\u003c/p\u003e \u003cp\u003e(.059)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3.976\u003c/p\u003e \u003cp\u003e\u003cb\u003e(.032)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(1\u0026ndash;3) (2\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePilates\u003csup\u003e2\u003c/sup\u003e (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e33.778\u0026thinsp;\u0026plusmn;\u0026thinsp;4.324\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e32.667\u0026thinsp;\u0026plusmn;\u0026thinsp;4.301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-2.271\u003c/p\u003e \u003cp\u003e\u003cb\u003e(.023)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e3.29\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003csup\u003e3\u003c/sup\u003e (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e33.200\u0026thinsp;\u0026plusmn;\u0026thinsp;4.467\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e32.667\u0026thinsp;\u0026plusmn;\u0026thinsp;4.301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-1.000\u003c/p\u003e \u003cp\u003e(.317)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eElbow \u0026uarr;15 (cm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYoga (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e35.000\u0026thinsp;\u0026plusmn;\u0026thinsp;2.345\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c6\" namest=\"c5\" rowspan=\"3\"\u003e \u003cp\u003e.294\u003c/p\u003e \u003cp\u003e(.863)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e34.889\u0026thinsp;\u0026plusmn;\u0026thinsp;2.369\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.762\u003c/p\u003e \u003cp\u003e(.683)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-1.000\u003c/p\u003e \u003cp\u003e(.317)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2.343\u003c/p\u003e \u003cp\u003e(.118)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePilates (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e34.667\u0026thinsp;\u0026plusmn;\u0026thinsp;4.062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e34.222\u0026thinsp;\u0026plusmn;\u0026thinsp;3.993\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-1.633\u003c/p\u003e \u003cp\u003e(.102)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e34.200\u0026thinsp;\u0026plusmn;\u0026thinsp;4.158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e33.889\u0026thinsp;\u0026plusmn;\u0026thinsp;3.855\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-1.000\u003c/p\u003e \u003cp\u003e(.317)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eAxilla (cm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYoga (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e39.778\u0026thinsp;\u0026plusmn;\u0026thinsp;2.333\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c6\" namest=\"c5\" rowspan=\"3\"\u003e \u003cp\u003e7.837\u003c/p\u003e \u003cp\u003e\u003cb\u003e(.020)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e39.778\u0026thinsp;\u0026plusmn;\u0026thinsp;2.333\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e9.039\u003c/p\u003e \u003cp\u003e\u003cb\u003e(.011)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.594\u003c/p\u003e \u003cp\u003e(.560)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePilates (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e39.556\u0026thinsp;\u0026plusmn;\u0026thinsp;4.304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e39.333\u0026thinsp;\u0026plusmn;\u0026thinsp;4.153\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-1.000\u003c/p\u003e \u003cp\u003e(.317)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e36.100\u0026thinsp;\u0026plusmn;\u0026thinsp;2.998\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e35.667\u0026thinsp;\u0026plusmn;\u0026thinsp;2.828\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eVolumetric measurement (ml)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYoga (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e957.7\u0026plusmn;\u003c/p\u003e \u003cp\u003e220.044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c6\" namest=\"c5\" rowspan=\"3\"\u003e \u003cp\u003e5.998\u003c/p\u003e \u003cp\u003e(.050)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e932.2\u0026plusmn;\u003c/p\u003e \u003cp\u003e192.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3.495\u003c/p\u003e \u003cp\u003e(.174)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-1.841\u003c/p\u003e \u003cp\u003e(.066)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.053\u003c/p\u003e \u003cp\u003e(.150)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePilates (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1046.66\u0026plusmn;\u003c/p\u003e \u003cp\u003e133.417\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e995.55\u0026plusmn;\u003c/p\u003e \u003cp\u003e122.077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-2.670\u003c/p\u003e \u003cp\u003e(.\u003cb\u003e008)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e974.000\u0026plusmn;\u003c/p\u003e \u003cp\u003e237.543\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e980.00\u0026plusmn;\u003c/p\u003e \u003cp\u003e258.602\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-1.604\u003c/p\u003e \u003cp\u003e(.109)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"12\"\u003ex\u0026thinsp;\u0026plusmn;\u0026thinsp;sd: Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation; Significant p-value\u0026thinsp;\u0026le;\u0026thinsp;.05; p1\u0026thinsp;=\u0026thinsp;pre-treatment between-group differences; p2\u0026thinsp;=\u0026thinsp;post-treatment between-group differences; H: Kruskal-Wallis H test; p3\u0026thinsp;=\u0026thinsp;within-group differences; W: Wilcoxon Signed-Rank Test; %: percentage change between pre and post-treatment; p\u003csub\u003e4\u003c/sub\u003e: Group*Time change scores; F: Quade Nonparametric ANCOVA test results; η\u003csup\u003e2\u003c/sup\u003e: Partial Eta-Squared for between-group effect sizes; ml: milliliter; cm: centimeter\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e1.2. Volumetric measurement\u003c/h2\u003e \u003cp\u003eNo significant changes were observed in the volumetric measurement results across the groups (\u003cem\u003ep\u003c/em\u003e\u003csub\u003e1\u003c/sub\u003e and \u003cem\u003ep\u003c/em\u003e\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;\u0026gt;\u0026thinsp;.05). However, when analyzing time-dependent changes, a significant decrease in volumetric measurement value of EwLE was noted in the clinical Pilates group post-treatment (\u003cem\u003eW\u003c/em\u003e = \u0026minus;\u0026thinsp;2.670; \u003cem\u003ep\u003c/em\u003e\u003csub\u003e3\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.008). Nonetheless, ANCOVA revealed no significant Group \u0026times; Time interactions for volumetric measurements. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e2. Findings on Upper Extremity Muscle Strength\u003c/h2\u003e \u003cp\u003eThe analysis of time-dependent changes revealed that both IR and ER muscle strength increased in EwLE (\u003cem\u003eW\u003c/em\u003e = \u0026minus;\u0026thinsp;2.414; \u003cem\u003ep\u003c/em\u003e\u003csub\u003e3\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.016 and \u003cem\u003eW\u003c/em\u003e = \u0026minus;\u0026thinsp;2.060) in the clinical Pilates group post-treatment. The ANCOVA test revealed significant Group \u0026times; Time interactions for the IR muscle strength assessments (\u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.977, \u003cem\u003ep\u003c/em\u003e\u003csub\u003e4\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.037). The effect size of this change in the groups was moderate (\u003cem\u003eη\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.023). The percentage change in IR muscle strength was highest in the clinical Pilates group (10.62%), followed by the yoga group (6.36%) and the control group (0.77%). Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e3. Findings on Upper Extremity Functions\u003c/h2\u003e \u003cp\u003eThere was no significant difference between the groups in upper extremity functions following treatment (\u003cem\u003ep\u003c/em\u003e\u003csub\u003e1\u003c/sub\u003e and \u003cem\u003ep\u003c/em\u003e\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;\u0026gt;\u0026thinsp;.05). Regarding time-dependent changes, both the yoga and clinical Pilates groups showed a decrease in DASH total scores post-treatment (\u003cem\u003eW\u003c/em\u003e = \u0026minus;\u0026thinsp;2.670; \u003cem\u003ep\u003c/em\u003e\u003csub\u003e3\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.008 in both groups) and DASH percentile scores (\u003cem\u003eW\u003c/em\u003e = \u0026minus;\u0026thinsp;2.549, \u003cem\u003ep\u003c/em\u003e\u003csub\u003e3\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.011; \u003cem\u003eW\u003c/em\u003e = \u0026minus;\u0026thinsp;2.429, \u003cem\u003ep\u003c/em\u003e\u003csub\u003e3\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.015, respectively). The ANCOVA test showed that there were significant Group \u0026times; Time interactions, indicating that the overall DASH score was lower in the yoga and clinical Pilates groups compared to the control group (\u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7.061, \u003cem\u003ep\u003c/em\u003e\u003csub\u003e4\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.004). The effect size of this change was small (\u003cem\u003eη\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.023). The clinical Pilates group experienced the greatest decline in DASH total scores (clinical Pilates: 15.82%, yoga: 14.72%, control: 4.49%). Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eA comparison of the pre-treatment and post-treatment results of upper extremity isokinetic muscle strength and upper extremity function (DASH) measurements for groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003ePre-treatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003ePost-treatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eWithin group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003eGroup x Time\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u0026plusmn; sd\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eH\u003c/p\u003e \u003cp\u003e(P\u003csub\u003e1\u003c/sub\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u0026plusmn; sd\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eH\u003c/p\u003e \u003cp\u003e(P\u003csub\u003e2\u003c/sub\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eW\u003c/p\u003e \u003cp\u003e(P\u003csub\u003e3\u003c/sub\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eF\u003c/p\u003e \u003cp\u003e(P\u003csub\u003e4\u003c/sub\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eη\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eL\u0026Ouml;E\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eIR- Strength\u003c/b\u003e (N\u0026middot;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYoga\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.222\u0026thinsp;\u0026plusmn;\u0026thinsp;2.539\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1.279\u003c/p\u003e \u003cp\u003e(.527)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.000\u0026thinsp;\u0026plusmn;\u0026thinsp;2.398\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3.245\u003c/p\u003e \u003cp\u003e(.197)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.633\u003c/p\u003e \u003cp\u003e(.102)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3.977\u003c/p\u003e \u003cp\u003e\u003cb\u003e(.037)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(1\u0026ndash;3)\u003c/p\u003e \u003cp\u003e(1\u0026ndash;2)\u003c/p\u003e \u003cp\u003e(2\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePilates\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.556\u0026thinsp;\u0026plusmn;\u0026thinsp;2.920\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.889\u0026thinsp;\u0026plusmn;\u0026thinsp;3.180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.414\u003c/p\u003e \u003cp\u003e(.\u003cb\u003e016)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.750\u0026thinsp;\u0026plusmn;\u0026thinsp;1.500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.667\u0026thinsp;\u0026plusmn;\u0026thinsp;1.528\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.414\u003c/p\u003e \u003cp\u003e(.157)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eL\u0026Ouml;OE\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eIR- Strength\u003c/b\u003e (N\u0026middot;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYoga (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.444\u0026thinsp;\u0026plusmn;\u0026thinsp;3.283\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1.183\u003c/p\u003e \u003cp\u003e(.553)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.000\u0026thinsp;\u0026plusmn;\u0026thinsp;2.828\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.939\u003c/p\u003e \u003cp\u003e(.625)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.414\u003c/p\u003e \u003cp\u003e(.157)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.158\u003c/p\u003e \u003cp\u003e(.855)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePilates (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.750\u0026thinsp;\u0026plusmn;\u0026thinsp;3.059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.375\u0026thinsp;\u0026plusmn;\u0026thinsp;2.722\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.179\u003c/p\u003e \u003cp\u003e(.238)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.000\u0026thinsp;\u0026plusmn;\u0026thinsp;1.414\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.667\u0026thinsp;\u0026plusmn;\u0026thinsp;1.155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.000\u003c/p\u003e \u003cp\u003e(.317)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eL\u0026Ouml;E\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eER- Strength\u003c/b\u003e (N\u0026middot;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYoga (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.556\u0026thinsp;\u0026plusmn;\u0026thinsp;2.920\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.656\u003c/p\u003e \u003cp\u003e(.720)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.000\u0026thinsp;\u0026plusmn;\u0026thinsp;2.449\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.790\u003c/p\u003e \u003cp\u003e(.674)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.414\u003c/p\u003e \u003cp\u003e(.157)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.691\u003c/p\u003e \u003cp\u003e(.514)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePilates (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.000\u0026thinsp;\u0026plusmn;\u0026thinsp;3.240\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.556\u0026thinsp;\u0026plusmn;\u0026thinsp;3.575\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.000\u003c/p\u003e \u003cp\u003e(.317)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.000\u0026thinsp;\u0026plusmn;\u0026thinsp;1.633\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.333\u0026thinsp;\u0026plusmn;\u0026thinsp;1.528\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.000\u003c/p\u003e \u003cp\u003e(.317)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eL\u0026Ouml;OE\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eER- Strength\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(N\u0026middot;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYoga (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.333\u0026thinsp;\u0026plusmn;\u0026thinsp;3.354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.078\u003c/p\u003e \u003cp\u003e(.962)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.000\u0026thinsp;\u0026plusmn;\u0026thinsp;2.739\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.097\u003c/p\u003e \u003cp\u003e(.953)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.897\u003c/p\u003e \u003cp\u003e(.058)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2.461\u003c/p\u003e \u003cp\u003e(.115)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePilates (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.750\u0026thinsp;\u0026plusmn;\u0026thinsp;3.327\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.250\u0026thinsp;\u0026plusmn;\u0026thinsp;3.240\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.000\u003c/p\u003e \u003cp\u003e\u003cb\u003e(.046)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.750\u0026thinsp;\u0026plusmn;\u0026thinsp;1.708\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.333\u0026thinsp;\u0026plusmn;\u0026thinsp;1.528\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eDASH -Total score (0-100)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYoga\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.444\u0026thinsp;\u0026plusmn;\u0026thinsp;19.768\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3.057\u003c/p\u003e \u003cp\u003e(.217)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55.778\u0026thinsp;\u0026plusmn;\u0026thinsp;16.836\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.454\u003c/p\u003e \u003cp\u003e(.797)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.670\u003c/p\u003e \u003cp\u003e\u003cb\u003e(.008)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e14.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e7.061\u003c/p\u003e \u003cp\u003e\u003cb\u003e(.004)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(1\u0026ndash;3)\u003c/p\u003e \u003cp\u003e(2\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePilates\u003csup\u003e2\u003c/sup\u003e (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69.556\u0026thinsp;\u0026plusmn;\u0026thinsp;12.972\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e58.556\u0026thinsp;\u0026plusmn;\u0026thinsp;10.370\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.670\u003c/p\u003e \u003cp\u003e\u003cb\u003e(.008)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e15.82\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003csup\u003e3\u003c/sup\u003e (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.100\u0026thinsp;\u0026plusmn;\u0026thinsp;17.097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e59.667\u0026thinsp;\u0026plusmn;\u0026thinsp;20.193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.625\u003c/p\u003e \u003cp\u003e(.104)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eDASH- Percent value (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYoga (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.186\u0026thinsp;\u0026plusmn;\u0026thinsp;14.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2.402\u003c/p\u003e \u003cp\u003e(.301)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.780\u0026thinsp;\u0026plusmn;\u0026thinsp;12.381\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.812\u003c/p\u003e \u003cp\u003e(.666)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.549\u003c/p\u003e \u003cp\u003e\u003cb\u003e(.011)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e26.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3.086\u003c/p\u003e \u003cp\u003e(.064)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePilates (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.894\u0026thinsp;\u0026plusmn;\u0026thinsp;8.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20.839\u0026thinsp;\u0026plusmn;\u0026thinsp;6.128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.429\u003c/p\u003e \u003cp\u003e\u003cb\u003e(.015)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e22.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.326\u0026thinsp;\u0026plusmn;\u0026thinsp;12.565\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.867\u0026thinsp;\u0026plusmn;\u0026thinsp;14.849\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.625\u003c/p\u003e \u003cp\u003e(.104)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003ex\u0026thinsp;\u0026plusmn;\u0026thinsp;sd: Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation; Significant p-value\u0026thinsp;\u0026le;\u0026thinsp;.05; p1\u0026thinsp;=\u0026thinsp;pre-treatment between-group differences; p2\u0026thinsp;=\u0026thinsp;post-treatment between-group differences; H: Kruskal-Wallis H test; p3\u0026thinsp;=\u0026thinsp;within-group differences; W: Wilcoxon Signed-Rank Test; %: percentage change between pre and post-treatment; p4: Group*Time change scores; F: Quade Nonparametric ANCOVA test results; η2: Partial Eta-Squared for between-group effect sizes; \u003csup\u003e1\u003c/sup\u003e:Yoga, \u003csup\u003e2\u003c/sup\u003e:Clinical Pilates, \u003csup\u003e3\u003c/sup\u003e:Control; N\u0026middot;m: Newton meter\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e4. QoL scoring\u003c/h2\u003e \u003cp\u003eA significant difference was observed between the groups in terms of breast symptoms (\u003cem\u003eH\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10.199; \u003cem\u003ep\u003c/em\u003e\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.006) and arm symptom scores (\u003cem\u003eH\u003c/em\u003e\u0026thinsp;=\u0026thinsp;11.002; \u003cem\u003ep\u003c/em\u003e\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.004) post-treatment, considering both time and groups. The breast symptom scores were lower in the yoga and clinical Pilates groups compared with the control group. The arm symptom scores were significantly lower in the clinical Pilates group compared with the control group. Regarding the evaluation of time-dependent changes, the systemic therapy side effect score (\u003cem\u003eW\u003c/em\u003e = \u0026minus;\u0026thinsp;2.521; \u003cem\u003ep\u003c/em\u003e\u003csub\u003e3\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.012), breast symptom scores (\u003cem\u003eW\u003c/em\u003e = \u0026minus;\u0026thinsp;2.201; \u003cem\u003ep\u003c/em\u003e\u003csub\u003e3\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.028), and arm symptom scores (\u003cem\u003eW\u003c/em\u003e = \u0026minus;\u0026thinsp;2.668; \u003cem\u003ep\u003c/em\u003e\u003csub\u003e3\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.008) decreased in the yoga group, and only arm symptom scores (\u003cem\u003eW\u003c/em\u003e = \u0026minus;\u0026thinsp;2.521; \u003cem\u003ep\u003c/em\u003e\u003csub\u003e3\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.012) decreased in the clinical Pilates group post-treatment. The ANCOVA test revealed significant Group \u0026times; Time interactions for the breast symptom scores (\u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7.889; \u003cem\u003ep\u003c/em\u003e\u003csub\u003e4\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.002) and arm symptom scores (\u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8.581; \u003cem\u003ep\u003c/em\u003e\u003csub\u003e4\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.002) with the clinical Pilates and yoga groups exhibiting a greater decrease in arm symptom scores compared to the control group. The effect size of this change was large for the arm symptom score (\u003cem\u003eη\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.086) and breast symptom score (\u003cem\u003eη\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.094). The yoga group exhibited the most substantial reduction in arm symptom scores (clinical Pilates: 33.74%, yoga: 43.37%, control: 16.59%) and breast symptom scores (clinical Pilates: 42.20%, yoga: 57.80%, control: 19.53%). Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eA comparison of the pre-treatment and post-treatment results of quality of life (EORTC QLQ- BR23) measurements for groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003ePre-treatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003ePost-treatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eWithin group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003eGroup x Time\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u0026plusmn; sd\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eH\u003c/p\u003e \u003cp\u003e(P\u003csub\u003e1\u003c/sub\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u0026plusmn; sd\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eH\u003c/p\u003e \u003cp\u003e(P\u003csub\u003e2\u003c/sub\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eW\u003c/p\u003e \u003cp\u003e(P\u003csub\u003e3\u003c/sub\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eF\u003c/p\u003e \u003cp\u003e(P\u003csub\u003e4\u003c/sub\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eη\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eBody image\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYoga\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.07\u0026thinsp;\u0026plusmn;\u0026thinsp;8.941\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e4.809\u003c/p\u003e \u003cp\u003e(.090)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26.54\u0026plusmn;\u003c/p\u003e \u003cp\u003e9.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3.704\u003c/p\u003e \u003cp\u003e(.157)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.365\u003c/p\u003e \u003cp\u003e(.698)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.030\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePilates (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.55\u0026thinsp;\u0026plusmn;\u0026thinsp;5.893\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28.23\u0026plusmn;\u003c/p\u003e \u003cp\u003e8.275\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.816\u003c/p\u003e \u003cp\u003e(.414)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.88\u0026thinsp;\u0026plusmn;\u0026thinsp;20.361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47.83\u0026plusmn;\u003c/p\u003e \u003cp\u003e22.726\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.447\u003c/p\u003e \u003cp\u003e(.655)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eSexual functioning\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYoga (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.26\u0026thinsp;\u0026plusmn;\u0026thinsp;16.768\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.898\u003c/p\u003e \u003cp\u003e(.638)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41.66\u0026plusmn;\u003c/p\u003e \u003cp\u003e19.542\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.688\u003c/p\u003e \u003cp\u003e(.709)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.049\u003c/p\u003e \u003cp\u003e(.952)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.049\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePilates (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.47\u0026thinsp;\u0026plusmn;\u0026thinsp;5.557\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.18\u0026plusmn;\u003c/p\u003e \u003cp\u003e13.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.000\u003c/p\u003e \u003cp\u003e(.317)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.16\u0026thinsp;\u0026plusmn;\u0026thinsp;14.273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40.73\u0026plusmn;\u003c/p\u003e \u003cp\u003e14.697\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.000\u003c/p\u003e \u003cp\u003e(.317)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eSexual enjoyment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYoga (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.25\u0026thinsp;\u0026plusmn;\u0026thinsp;17.681\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.980\u003c/p\u003e \u003cp\u003e(.613)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.62\u0026plusmn;\u003c/p\u003e \u003cp\u003e14.479\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2.171\u003c/p\u003e \u003cp\u003e(.338)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.342\u003c/p\u003e \u003cp\u003e(.180)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e12.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2.922\u003c/p\u003e \u003cp\u003e(.073)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePilates (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.03\u0026thinsp;\u0026plusmn;\u0026thinsp;11.110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37.03\u0026plusmn;\u003c/p\u003e \u003cp\u003e11.110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.32\u0026thinsp;\u0026plusmn;\u0026thinsp;16.100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40.73\u0026plusmn;\u003c/p\u003e \u003cp\u003e14.697\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eFuture perspective\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYoga (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.81\u0026thinsp;\u0026plusmn;\u0026thinsp;15.464\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3.248\u003c/p\u003e \u003cp\u003e(.197)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38.88\u0026plusmn;\u003c/p\u003e \u003cp\u003e16.135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1.833\u003c/p\u003e \u003cp\u003e(.400)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.272\u003c/p\u003e \u003cp\u003e(.785)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.480\u003c/p\u003e \u003cp\u003e(.625)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.038\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePilates (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.40\u0026thinsp;\u0026plusmn;\u0026thinsp;19.080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40.10\u0026plusmn;\u003c/p\u003e \u003cp\u003e21.490\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.000\u003c/p\u003e \u003cp\u003e(.317)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.99\u0026thinsp;\u0026plusmn;\u0026thinsp;17.566\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e48.14\u0026plusmn;\u003c/p\u003e \u003cp\u003e17.566\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eSystemic therapy side effects\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYoga (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.49\u0026thinsp;\u0026plusmn;\u0026thinsp;13.787\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1.195\u003c/p\u003e \u003cp\u003e(.550)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.19\u0026thinsp;\u0026plusmn;\u0026thinsp;6.723\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3.092\u003c/p\u003e \u003cp\u003e(.213)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.521\u003c/p\u003e \u003cp\u003e\u003cb\u003e(.012)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e33.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2.329\u003c/p\u003e \u003cp\u003e(.119)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.044\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePilates (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.15\u0026thinsp;\u0026plusmn;\u0026thinsp;11.339\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19.31\u0026thinsp;\u0026plusmn;\u0026thinsp;12.169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.944\u003c/p\u003e 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colname=\"c8\"\u003e \u003cp\u003e57.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e7.889\u003c/p\u003e \u003cp\u003e\u003cb\u003e(.002)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(1\u0026ndash;3)\u003c/p\u003e \u003cp\u003e(2\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.094\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePilates\u003csup\u003e2\u003c/sup\u003e (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.03\u0026thinsp;\u0026plusmn;\u0026thinsp;13.456\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20.96\u0026thinsp;\u0026plusmn;\u0026thinsp;11.031\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.826\u003c/p\u003e \u003cp\u003e(.068)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e42.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003csup\u003e3\u003c/sup\u003e (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.53\u0026thinsp;\u0026plusmn;\u0026thinsp;18.246\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42.47\u0026thinsp;\u0026plusmn;\u0026thinsp;16.638\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.461\u003c/p\u003e \u003cp\u003e(.144)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e19.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eArm symptoms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYoga\u003csup\u003e1\u003c/sup\u003e (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.33\u0026thinsp;\u0026plusmn;\u0026thinsp;18.820\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3.450\u003c/p\u003e \u003cp\u003e(.178)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24.54\u0026thinsp;\u0026plusmn;\u0026thinsp;10.730\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e11.002\u003c/p\u003e \u003cp\u003e(.\u003cb\u003e004)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.668\u003c/p\u003e \u003cp\u003e\u003cb\u003e(.008)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e43.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e8.581\u003c/p\u003e \u003cp\u003e\u003cb\u003e(.002)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(1\u0026ndash;3)\u003c/p\u003e \u003cp\u003e(2\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.086\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePilates\u003csup\u003e2\u003c/sup\u003e (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.52\u0026thinsp;\u0026plusmn;\u0026thinsp;9.359\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.36\u0026thinsp;\u0026plusmn;\u0026thinsp;8.140\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.521\u003c/p\u003e \u003cp\u003e\u003cb\u003e(.012)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e33.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003csup\u003e3\u003c/sup\u003e (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.18\u0026thinsp;\u0026plusmn;\u0026thinsp;17.322\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49.06\u0026thinsp;\u0026plusmn;\u0026thinsp;21.425\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.219\u003c/p\u003e \u003cp\u003e(.223)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e16.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eUpset by hair loss\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYoga (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.62\u0026thinsp;\u0026plusmn;\u0026thinsp;19.751\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3.608\u003c/p\u003e \u003cp\u003e(.165)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49.58\u0026thinsp;\u0026plusmn;\u0026thinsp;19.785\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3.624\u003c/p\u003e \u003cp\u003e(.163)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.000\u003c/p\u003e \u003cp\u003e(.317)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1.316\u003c/p\u003e \u003cp\u003e(.287)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePilates (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.88\u0026thinsp;\u0026plusmn;\u0026thinsp;22.111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43.33\u0026thinsp;\u0026plusmn;\u0026thinsp;20.683\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.000\u003c/p\u003e \u003cp\u003e(.317)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e42.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.99\u0026thinsp;\u0026plusmn;\u0026thinsp;12.297\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31.47\u0026thinsp;\u0026plusmn;\u0026thinsp;5.557\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003cp\u003e(1.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e27.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003ex\u0026thinsp;\u0026plusmn;\u0026thinsp;sd: Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation; Significant p-value\u0026thinsp;\u0026le;\u0026thinsp;.05; p1\u0026thinsp;=\u0026thinsp;pre-treatment between-group differences; p2\u0026thinsp;=\u0026thinsp;post-treatment between-group differences; H: Kruskal-Wallis H test; p3\u0026thinsp;=\u0026thinsp;within-group differences; W: Wilcoxon Signed-Rank Test; %: percentage change between pre and post-treatment; p4: Group*Time change scores; F: Quade Nonparametric ANCOVA test results; η2: Partial Eta-Squared for between-group effect sizes; \u003csup\u003e1\u003c/sup\u003e:Yoga, \u003csup\u003e2\u003c/sup\u003e:Clinical Pilates, \u003csup\u003e3\u003c/sup\u003e:Control\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to compare the effects of yoga and clinical Pilates exercise methods, combined with compression stockings, on lymphedema, upper extremity muscle strength and functions, and QoL in patients with breast cancer\u0026ndash;associated lymphedema. The results revealed that lymphedema reduction was more pronounced in the yoga and clinical Pilates groups compared with the control group. The participants in the clinical Pilates group exhibited a significant increase in IR muscle strength in EwLE compared with the yoga and control groups. Moreover, the improvements in upper extremity function were more significant in the yoga and clinical Pilates groups compared with the control group. Further, the subscale symptom scores of QoL indicated a positive increase in the breast and arm symptoms in the yoga group, and arm symptoms in the clinical Pilates group, compared with the control group.\u003c/p\u003e \u003cp\u003ePilates exercises are generally considered safe and may contribute to reducing the symptoms of breast cancer\u0026ndash;associated lymphedema [26]. Şener et al. reported the effectiveness of clinical Pilates exercises applied with compression stockings in decreasing the severity of lymphedema in various segments, except for the axillary region, compared with that in the control group [14]. Similarly, we observed significant differences in lymphedema severity in the clinical Pilates group at two levels (5 cm above the wrist and 10 cm above the elbow) and in volumetric measurements post-treatment compared with pre-treatment. In addition, in circumference measurements, lymphedema reduction was more pronounced in the clinical Pilates group compared with the control group at one level (10 cm above the elbow). Lymphedema was alleviated the most in the clinical Pilates group in terms of percentage (clinical Pilates: 3.29%, yoga: 1.75%, control: 1.61%). Clinical Pilates exercises may potentially alleviate lymphedema by promoting core stability, a key principle of Pilates. This stability can facilitate lymphatic flow by stimulating the ductus thoracicus and abdominal lymph nodes through the contractions of trunk muscles and the diaphragm. Moreover, Pilates exercises involving extremity movements may further stimulate the lymphatic system through their pumping action.\u003c/p\u003e \u003cp\u003ePrevious studies showed that Satyananda yoga exercises did not lead to a decrease in lymphedema severity or arm volume. However, they demonstrated a decrease in the amount of fibrous tissue and enhanced skin tissue elasticity compared with the control group. These findings suggested that the long-term use of Satyananda yoga exercises might reduce EwLE volume [15,27]. Fisher et al. reported that hatha yoga exercises, without additional resistance or repeated muscle contractions, improved lymphatic fluid pumping and flow, thereby reducing lymphedema [17]. Similarly, although the present study did not observe a significant reduction in lymphedema severity in any segment with yoga exercises, a significant reduction of 10 cm above the elbow was observed compared with that in the control group. This reduction in lymphedema in the yoga group compared with the control group suggested that hatha yoga might enhance lymphatic flow. This improvement could be attributed to the activation of lymphatic collecting vessels during yoga postures and breathing techniques, along with stimulation of the ductus thoracicus by lymphatic fluid movement, resulting in increased lymphatic flow due to pressure changes.\u003c/p\u003e \u003cp\u003eUpper extremity muscle strength is affected more in the EwLE compared with that in the extremity without lymphedema in breast cancer survivors [28,29]. Bertoli et al. found that mat Pilates exercises enhanced shoulder abductor and trunk extensor muscle strength in the upper extremity muscles on both the operated and intact upper extremities [30]. Zengin Alpozgen et al. reported that Pilates exercises played a crucial role in increasing muscle strength in breast cancer survivors than in the home exercise group [31]. The present study found that clinical Pilates was more effective than yoga, and yoga was more effective than the control, in increasing IR muscle strength in the affected extremities. The clinical Pilates group demonstrated the greatest increase in IR muscle strength (clinical Pilates: 10.62%, yoga: 6.36%, control: 0.77%). Clinical Pilates exercises (triceps pull and swimming) promoted significant activation of IR muscles compared with yoga exercises. Furthermore, it was noted that the majority of participants exhibited kinesiophobia (fear of movement) leading them to limit their range of shoulder joint motion during exercise in order to prevent injury. The participants reported less fear when engaging in clinical Pilates exercises than with yoga exercises. This could be attributed to the fact that clinical Pilates exercises were similar to those performed by the patients in previous rehabilitation programs. These factors might explain why IR muscle strength improvement was the most pronounced in the clinical Pilates group.\u003c/p\u003e \u003cp\u003eMazor et al. demonstrated that Ashtanga yoga exercises increased shoulder abductor muscle strength in EwLE and increased elbow flexor muscle strength in EwLE and Ew/oLE [32]. Another study found that yoga exercises applied with compression stockings in patients with lymphedema associated with unilateral breast cancer resulted in an increase in only serratus anterior muscle strength in both EwLE and Ew/oLE and no change in other muscle groups [33]. The present study revealed that yoga exercises increased IR muscle strength compared with that in the control group. This outcome could be attributed to the fact that asana postures aimed at stabilizing the scapula/shoulder complex (amsa bandha), which might regulate the scapulohumeral rhythm and increase the strength of internal rotator muscles commonly affected post-surgery. In addition, the isometric contraction induced by asana postures, along with increased resistance with an increase in body weight during pose transitions, likely contributed to increased IR muscle strength through isotonic contractions in the muscles.\u003c/p\u003e \u003cp\u003eA previous systematic review and meta-analysis examined the effects of exercise on upper extremity functions in breast cancer\u0026ndash;associated lymphedema, revealing significant benefits across various exercise modalities including aerobic, resistance training, yoga, and Pilates [34]. Additionally, clinical Pilates exercises positively influenced the functional status compared with that in the control groups [14]. Fisher et al. stated that hatha yoga exercises did not yield statistically significant effects on upper extremity function, but a decrease in DASH scores was observed post-treatment [17]. In our study, significant improvements in DASH scores were observed in the clinical Pilates and yoga exercises groups compared with the control group. Specifically, the clinical Pilates group demonstrated the most significant reduction in DASH total scores (15.82%), followed by the yoga (14.72%) and control groups (4.49%), compared with the pretreatment scores. The results further indicated that the clinical Pilates group experienced a significant increase in physical parameters (increase in IR muscle strength and decreased proximal edema) compared with the yoga group. In this context, the significant improvement in upper extremity functions in the clinical Pilates group could be attributed to the more pronounced reduction in proximal arm lymphedema and the greater increase in upper extremity muscle strength compared with the yoga group.\u003c/p\u003e \u003cp\u003eLymphedema is a prevalent post-treatment complication negatively affecting QoL in breast cancer survivors [35]. A study investigating QoL in breast cancer survivors with and without lymphedema using the EORTC QLQ-BR23 found that the symptom scores associated with arm and breast issues were higher in patients with lymphedema compared with those without it [36]. Previous studies examining the QoL in patients with breast cancer\u0026ndash;associated lymphedema found that Pilates exercises improved QoL [14,37,38]. Similarly, studies on the effects of yoga demonstrated positive increases in QoL and significant decreases in breast and arm symptom scores after yoga exercises [39,40]. In the present study, the symptom scores of QoL decreased in the Pilates group post-treatment compared with the control group, and a decrease in arm and breast symptoms was observed in the yoga group compared with the control group. In addition, the arm symptom scores (yoga: 43.37%, clinical Pilates: 33.74%, control: 16.59%) and breast symptom scores (yoga: 57.80%, clinical Pilates: 42.20%, control: 19.53%) decreased more in the yoga group compared with the clinical Pilates group. Breathing techniques, focusing methods, and meditation practiced during yoga exercises contribute to the clearing of blockages, balancing of the body\u0026rsquo;s energy channels, and mental healing, thereby reducing symptoms. This explained why yoga exercises resulted in more improvement in symptom subscales compared with clinical Pilates exercises. In the present study, despite differences observed in symptom subscales between the groups, no differences were found in functional subscales such as future perspective and sexual enjoyment. This could be because the questions in these subscales were more emotionally oriented and the patients might have been suffering from breast cancer for many years. Consequently, the aforementioned issues remained unnoticed compared with physical functions.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003eImplications for Practice\u003c/h2\u003e \u003cp\u003eConsidering that patients with breast cancer\u0026ndash;associated lymphedema may experience significant challenges in EwLE compared with Ew/oLE, exploring the severity of edema, upper extremity muscle strength, upper extremity functions, and QoL in this population in terms of exercise protocols may offer valuable insights. The research findings indicated that the clinical Pilates group experienced greater improvements in physical parameters, including lymphedema, muscle strength, and upper extremity functions. However, it is worth noting that yoga activities possess the capacity to enhance emotional well-being and overall quality of life. Hence, the findings of this study might be crucial for encouraging the adoption of appropriate exercise methods among patients with breast cancer\u0026ndash;associated lymphedema.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eStrength and Potential Limitations\u003c/h2\u003e \u003cp\u003eThis study investigated the effectiveness of yoga and clinical Pilates exercises in reducing lymphedema severity, improving muscle strength, and enhancing upper extremity functions and QoL. These two exercise methods were not compared in previous studies, making our results promising and potentially pioneering.\u003c/p\u003e \u003cp\u003eIn this study, all participants were instructed to use compression stockings daily for 8 h. However, the feedback received post-treatment showed that some participants might not have adhered to this recommendation inadequately. Therefore, the lack of a systematic follow-up method to monitor the use of compression stockings, including a daily or weekly usage log, could be considered a significant limitation of the study.\u003c/p\u003e \u003cp\u003eKinesiophobia due to potential injury or pain, was not evaluated in our study. However, individuals avoided certain exercises in the initial weeks due to fear of movement, leading to incomplete performance of exercises within the full range of motion. Therefore, the absence of kinesiophobia assessment was another limitation, highlighting the importance of evaluating this physiological factor in future studies.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eClinical Pilates exercises demonstrate effectiveness in improving various physical parameters, including reducing lymphedema, increasing muscle strength, and enhancing upper extremity functions. However, yoga exercises contribute to improving emotional aspects such as QoL. Both clinical Pilates and yoga exercises, using compression stockings, may be recommended as alternative treatment approaches for managing lymphedema. This study provided valuable insights in terms of directing patients toward exercise modalities that might sustain motivation in long-term treatment protocols, considering the chronic nature of lymphedema.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eConflict of Interest:\u003c/h2\u003e \u003cp\u003eThe authors declare that there is no conflict of interest.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThe research received financial assistance from the Eastern Mediterranean University Scientific Research Project financing program under project number BAPC-OD-20-02. The financial support was used to supply the volumetric measurement equipment and compression stockings.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eF.Z:writing and performing surgeries, data analysis and performing surgeries, G.I: writing and performing surgeries, review of the article, and intellectual concept of the article, M. M: writing and performing surgeries, review of the article, and intellectual concept of the article.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe express our sincere appreciation to all the patients who contributed to the carrying out of this research. The authors express their gratitude to the staff of Eastern Mediterranean University's Health Sciences Faculty Physiotherapy and Rehabilitation Department and Healthy Living Center for their valuable assistance in conducting this research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTorgbenu E, Luckett T, Buhagiar MA, Chang S, Phillips JL (2020) Prevalence and incidence of cancer related lymphedema in low and middle-income countries: A systematic review and meta-analysis. BMC Cancer 20(1).\u003c/li\u003e\n\u003cli\u003eJain MS, Danoff JV, Paul SM (2010) Correlation between bioelectrical spectroscopy and perometry in assessment of upper extremity swelling. Lymphology 43(2):85\u0026ndash;94. \u003c/li\u003e\n\u003cli\u003eHayes SC, Johansson K, Stout NL, Prosnitz R, Armer JM, Gabram S, et al (2012) Upper-body morbidity after breast cancer: Incidence and evidence for evaluation, prevention, and management within a prospective surveillance model of care. Cancer 118(SUPPL.8):2237\u0026ndash;49. \u003c/li\u003e\n\u003cli\u003eBrennan MJ (1992) Lymphedema following the surgical treatment of breast cancer: A review of pathophysiology and treatment. J Pain Symptom Manage 7(2):110\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eKilbreath SL, Refshauge KM, Beith JM, Ward LC, Lee M, Simpson JM, et al (2012) Upper limb progressive resistance training and stretching exercises following surgery for early breast cancer: A randomized controlled trial. Breast Cancer Res Treat 133(2):667\u0026ndash;76. \u003c/li\u003e\n\u003cli\u003eChachaj A, Małyszczak K, Pyszel K, Lukas J, Tarkowski R, Pudełko M, et al (2010) Physical and psychological impairments of women with upper limb lymphedema following breast cancer treatment. Psychooncology 19(3):299\u0026ndash;305. \u003c/li\u003e\n\u003cli\u003eDe Brucker B, Zeltzer A, Seidenstuecker K, Hendrickx B, Adriaenssens N, Hamdi M (2016) Breast Cancer-Related Lymphedema: Quality of Life after Lymph Node Transfer. Plast Reconstr Surg 137(6):1673\u0026ndash;80. \u003c/li\u003e\n\u003cli\u003eBuchan J, Janda M, Box R, Schmitz K, Hayes S (2016) A Randomized Trial on the Effect of Exercise Mode on Breast Cancer-Related Lymphedema Medicine and Science in Sports and Exercise Vol. 48,1866\u0026ndash;1874. \u003c/li\u003e\n\u003cli\u003eBernardo LM, Abt KL, Ren D, Bender C (2010) Self-reported exercise during breast cancer treatment: Results of a national survey. Cancer Nurs 33(4):304\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eEmslie C, Whyte F, Campbell A, Mutrie N, Lee L, Ritchie D, et al (2007) \u0026ldquo;I wouldn\u0026rsquo;t have been interested in just sitting round a table talking about cancer\u0026rdquo;; exploring the experiences of women with breast cancer in a group exercise trial. Health Educ Res 22(6):827\u0026ndash;38. \u003c/li\u003e\n\u003cli\u003ePinto-carral A, Molina AJ, Pedro \u0026Aacute; De, Ay\u0026aacute;n C (2018) Complementary Therapies in Medicine Pilates for women with breast cancer : A systematic review and meta-analysis. Complement Ther Med 41(August):130\u0026ndash;40. Available from: https://doi.org/10.1016/j.ctim.2018.09.011\u003c/li\u003e\n\u003cli\u003eDieli-Conwright CM, Orozco BZ (2015) Exercise after breast cancer treatment: Current perspectives. Breast Cancer Targets Ther 7:353\u0026ndash;62. \u003c/li\u003e\n\u003cli\u003eLipsett A, Barrett S, Haruna F, Mustian K, O\u0026rsquo;Donovan A (2017) The impact of exercise during adjuvant radiotherapy for breast cancer on fatigue and quality of life: A systematic review and meta-analysis. Breast 32:144\u0026ndash;55. Available from: http://dx.doi.org/10.1016/j.breast.2017.02.002\u003c/li\u003e\n\u003cli\u003eSener HO, Malkoc M, Ergin G, Karadibak D, Yavuzsen T (2017) Effects of Clinical Pilates Exercises on Patients Developing Lymphedema after Breast Cancer Treatment: A Randomized Clinical Trial. J Breast Heal 13(1):16\u0026ndash;22. \u003c/li\u003e\n\u003cli\u003eLoudon A, Barnett T, Piller N, Immink MA, Williams AD (2014) Yoga management of breast cancer-related lymphoedema: A randomised controlled pilot-trial. BMC Complement Altern Med 2014;14(1):1\u0026ndash;13. \u003c/li\u003e\n\u003cli\u003eFinnane A, Liu Y, Battistutta D, Janda M, Hayes SC (2011) Lymphedema after breast or gynecological cancer: Use and effectiveness of mainstream and complementary therapies. J Altern Complement Med 17(9):867\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eFisher MI, Donahoe-Fillmore B, Leach L, O\u0026rsquo;Malley C, Paeplow C, Prescott T, et al (2014) Effects of yoga on arm volume among women with breast cancer related lymphedema: A pilot study. J Bodyw Mov Ther 18(4):559\u0026ndash;65. Available from: http://dx.doi.org/10.1016/j.jbmt.2014.02.006\u003c/li\u003e\n\u003cli\u003eSander AP, Hajer NM, Hemenway K, Miller AC (2002) Upper-extremity volume measurements in women with lymphedema: A comparison of measurements obtained via water displacement with geometrically determined volume. Phys Ther 82(12):1201\u0026ndash;12. \u003c/li\u003e\n\u003cli\u003eAger AL, Roy JS, Roos M, Belley AF, Cools A, H\u0026eacute;bert LJ (2017) Shoulder proprioception: How is it measured and is it reliable? A systematic review. J Hand Ther 30(2):221\u0026ndash;31. Available from: http://dx.doi.org/10.1016/j.jht.2017.05.003\u003c/li\u003e\n\u003cli\u003eAtroshi I, Gummesson C, Andersson B, Dahlgren E, Johansson A (2000) The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: reliability and validity of the Swedish version evaluated in 176 patients. Acta Orthop Scand 71(6):613\u0026ndash;8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11145390\u003c/li\u003e\n\u003cli\u003eGummesson C, Atroshi I, Ekdahl C (2003)The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: Longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord 4:1\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eDemirci, S., Eser, E., Ozsaran, Z., Tankisi, D., Aras, A. B., et al (2011) Validation of the Turkish Versions of EORTC QLQ-C30 and BR23 Modules in Breast Cancer Patients. Asian Pacific J Cancer Prev 12, 1283-1287\u003c/li\u003e\n\u003cli\u003eNguyen J, Popovic M, Chow E, Cella D, Beaumont JL, Chu D, et al (2015) EORTC QLQ-BR23 and FACT-B for the assessment of quality of life in patients with breast cancer: A literature review. J Comp Eff Res 4(2):157\u0026ndash;66. \u003c/li\u003e\n\u003cli\u003eCohen, Cohen J (1988) Statistical Power Analysis for the Behavioral Sciences Second Edition 579 p. \u003c/li\u003e\n\u003cli\u003eCohen J. Statistical Power Analysis (1992) Curr Dir Psychol Sci 1(3):98\u0026ndash;101. \u003c/li\u003e\n\u003cli\u003eMokhtari Hesari R, Poozesh Jadidi R, Shaikhi Mobarakeh Z, Azali Alamdari K (2021) The effect of exercise and complete decongestive therapy on edema volume and shoulder range of motion in patients with breast cancer related lymphedema: A randomized clinical trial. Heal Monit J Iran Inst Heal Sci Res 20(1):59\u0026ndash;69. \u003c/li\u003e\n\u003cli\u003eDouglass, J., Immink, M. A., Piller, N., Ullah, S., \u0026amp; Health, S. A. (2012) Yoga for women with breast cancer-related lymphoedema: a preliminary 6-month study. Journal of Lymphoedema, Vol 7, No 2 \u003c/li\u003e\n\u003cli\u003eG\u0026uuml;rlek, F.K (2023) \u003cem\u003e\u0026Uuml;st Ekstremite Kas G\u0026uuml;c\u0026uuml; Lenf\u0026ouml;demden Etkilenir Mi? Omuz, Dirsek Ve El Bileği Fleks\u0026ouml;r Ve Ekstans\u0026ouml;r Kas Gruplarının Değerlendirilmesi. \u003c/em\u003eY\u0026uuml;ksek Lisans Tezi, T.\u0026Uuml;. \u003c/li\u003e\n\u003cli\u003eZabit F, Iyigun G, Malkoc M (2023) Assessment of proprioception, muscle strength and endurance during dynamic isokinetic test in patients with breast cancer-related lymphedema. Clin Biomech 110(September):106100. Available from: https://doi.org/10.1016/j.clinbiomech.2023.106100\u003c/li\u003e\n\u003cli\u003eBertoli J, Bezerra E de S, Winters-Stone KM, Alberto Gobbo L, Freitas IF (2023) Mat Pilates improves lower and upper body strength and flexibility in breast cancer survivors undergoing hormone therapy: a randomized controlled trial (HAPiMat study). Disabil Rehabil 45(3):494\u0026ndash;503. Available from: https://doi.org/10.1080/09638288.2022.2032410\u003c/li\u003e\n\u003cli\u003eZengin Alpozgen A, Razak Ozdincler A, Karanlik H, Yaman Agaoglu F, Narin AN (2017) Effectiveness of Pilates-based exercises on upper extremity disorders related with breast cancer treatment. Eur J Cancer Care 26(6):1\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eMazor M, Lee JQ, Peled A, Zerzan S, Irwin C, Chesney MA, et al (2018) The effect of yoga on arm volume, strength, and range of motion in women at risk for breast cancer-related lymphedema. J Altern Complement Med 24(2):154\u0026ndash;60. \u003c/li\u003e\n\u003cli\u003eLoudon A, Barnett T, Piller N, Immink MA, Visentin D, Williams AD (2016) The effects of yoga on shoulder and spinal actions for women with breast cancer-related lymphoedema of the arm: A randomised controlled pilot study. BMC Complement Altern Med 16(1). Available from: http://dx.doi.org/10.1186/s12906-016-1330-7\u003c/li\u003e\n\u003cli\u003eErickson VS, Pearson ML, Ganz P a, Adams J, Kahn KL (2001) Arm Edema in Breast Cancer Patients. JNCI J Natl Cancer Inst 93(2):96\u0026ndash;111. Available from: http://jnci.oxfordjournals.org/cgi/doi/10.1093/jnci/93.2.96\u003c/li\u003e\n\u003cli\u003eLai YT, Hsieh CC, Huang LS, Liu WS, Lin SH, Wang LL, et al (2017)The effects of upper limb exercise through yoga on limb swelling in Chinese breast cancer survivors - A pilot study. Rehabil Nurs 42(1):46\u0026ndash;54. \u003c/li\u003e\n\u003cli\u003eKorucu, T.C (2020) Meme Kanseri Cerrahisi Sonrası Lenf\u0026ouml;demi Olan ve Olmayan Kadınlarda Skapula Ve \u0026Uuml;st Ekstremite Fonksiyonları Ve Yaşam Kalitesinin Karşılaştırılması. Y\u0026uuml;ksek Lisans Tezi, İ.K.\u0026Ccedil;.\u0026Uuml;.\u003c/li\u003e\n\u003cli\u003eStan DL, Rausch SM, Sundt K, Cheville AL, Youdas JW, Krause DA, et al (2012) Pilates for breast cancer survivors. Clin J Oncol Nurs 16(2):131\u0026ndash;41. \u003c/li\u003e\n\u003cli\u003eEyigor S, Karapolat H, Yesil H, Uslu R, Durmaz B (2010) Effects of pilates exercises on functional capacity, flexibility, fatigue, depression and quality of life in female breast cancer patients: A randomized controlled study. Eur J Phys Rehabil Med 46(4):481\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eGalantino M Lou, Desai K, Greene L, Demichele A, Stricker CT, Mao JJ (2012)Impact of yoga on functional outcomes in breast cancer survivors with aromatase inhibitor-associated arthralgias. Integr Cancer Ther 11(4):313\u0026ndash;20. \u003c/li\u003e\n\u003cli\u003eAndysz A, Merecz D, W\u0026oacute;jcik A, ͆wiątkowska B, Sierocka K, Najder A (2014) Effect of a 10-week yoga programme on the quality of life of women after breast cancer surgery. Prz Menopauzalny 13(3):186\u0026ndash;93. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Breast cancer-related lymphedema, Yoga, Clinical Pilates, Compression garment","lastPublishedDoi":"10.21203/rs.3.rs-4564431/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4564431/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003e\u003c/em\u003eThis study conducted a comparison of the benefits of yoga and clinical Pilates exercise methods, both administered with compression stockings, on lymphedema, muscle strength, upper extremity functions, and quality of life in women with BCRL\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e \u003c/strong\u003e28 individuals with breast cancer-related lymphedema were included in the study. The upper extremity lymphedema severity of the individuals was evaluated by circumference and volumeter measurement. Upper extremity muscle strength was measured with an isokinetic dynamometer (HUMAC/NORM Testing \u0026amp; Rehabilitation System, CSMD). The disabilities of the arm, shoulder, and hand (DASH) questionnaire was used to evaluate upper extremity functions, and the Breast Cancer-Specific Quality of Life Questionnaire (QLQ-BR23) was used to evaluate the quality of life.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eResults: \u003c/strong\u003e\u003c/em\u003eIn our study, it was determined that compared to pre-treatment, the severity of lymphedema decreased more in the yoga and clinical Pilates groups than in the control group (P4 = .034). In extremity with lymphedema (EwLE), the clinical Pilates group had the greatest improvement in muscular strength for internal rotation (IR) (P3=.016, P4=.037), while the upper extremity functions were shown to be higher in the yoga and clinical Pilates groups compared to the control group (P3=.008, P4=.004). It was found that the quality of life subscale symptom scores, breast symptom (P3=.006, P4=.028) and arm symptom (P2=.004, P3=.008, P4=.002) scores in the yoga group, and arm symptom (P3=.012, P4=.002) scores in the clinical Pilates group showed a positive increase compared to the control group.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/em\u003e Both yoga and clinical Pilates exercises, with the use of compression stockings, have demonstrated favorable results in women with BCRL, showing great potential for treatment. Clinical Pilates exercises have been determined to be useful in several physical aspects, including the reduction of lymphedema, and the improvement of muscle strength and upper extremity functions. On the other hand, the emotional components of quality of life can be effectively improved by yoga exercises.\u003c/p\u003e\n\u003cp\u003eTrial Registration Number: NCT04824807 ,October 29, 2021\u003c/p\u003e","manuscriptTitle":"A Comparison of Yoga and Clinical Pilates Exercise Methods in Women with Breast Cancer-Related Lymphedema: A Randomized Controlled Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-18 20:07:18","doi":"10.21203/rs.3.rs-4564431/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9191fd23-bb72-4f45-b472-eaf869e7e2bd","owner":[],"postedDate":"July 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-26T17:41:44+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-18 20:07:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4564431","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4564431","identity":"rs-4564431","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}