Table 1 BC Rehabilitation program

• Preparation phase

1. If possible, exercise in a quiet room.

2. Do not exercise when you feel dizzy, nauseous, or have lower back pain.

3. If you take blood pressure medication, exercise after 30 minutes.

4. If your shoulder appears morning stiffness more than 30 minutes please perform 5-10 minutes arm stretch training combined with massage before exercise.

• BC Rehabilitation

1. 1–2 days after surgery

a. Please stand relaxed and hold a bouncy ball in the palm of your hand, put your arm in a position with flexed elbows and slightly extended shoulders, then squeeze the ball as hard as possible for 2-3 seconds, then spread and relax fingers.

b. Arms are positioned in the same as above, then rotate the wrist clockwise and anticlockwise.

Frequency: 10 repetitions a set, 2 sets a group, 2 groups daily.

Efficacy: to promote muscle contraction, blood, and lymph flow, and avoid upper limbs swelling

2. 3-7days after surgery.

a. Please stand relaxed, put your arm by your sides, then touch the ipsilateral and contralateral shoulder alternately by your hand of the affected limb.

b. keep the exercise in stage 1.

Frequency: 10 repetitions a set, 2 sets a group, 2 groups daily.

Efficacy: to recover rotation and adduction.

3. 8-14days after surgery.

a. Please stand, put your arm by your sides, raise the arms forward in a range around 120°, perform backward in a range around 60°.

b. Please stand, put your arm in a position with flexed elbows and slightly extended shoulders( neutral ), then perform abduction and adduction of the shoulder(shoulder in adduction).

c. Please stand, put your arm by your sides, then perform abduction and adduction of the shoulder in a range around 120°

d. ** Turn your shoulders forward and backward

e. ** please stand in front of the wall, place your palm of the affected arm on the wall and run up by moving your finger until you feel can’t run up more, maintain for 1mins, then run down.

Frequency:10 repeats a set, 3 sets a group, 2 groups daily.

Efficacy: to promote shoulder flexion, abduction, and adduction.

4. 2-8weeks after surgery

a. Please stand relaxed, put your arms by your sides, then raise your arms forward and backward to an active range of motion as most tolerated

b. Please stand relaxed, place your arms in abduction at shoulder height and flex elbows in 90 degrees( 90° of abducted position), then rotate the forearms up and down.

c. Please stand relaxed, put your arm by your sides, then perform abduction and adduction of the shoulders to an active range of motion as most tolerated

d. Keep the “d and e” in stage 3.

Frequency:10 repeats a set, 3 sets a group, 2 groups daily, 4days per week.

Efficacy: to stretch and release the softness in the anterior chest wall to avoid the chest wall tightness.

•Attention!

1. Please don’t forget the “Preparation phase” before your exercise.

2. It’s better not to arbitrarily change the prearranged sequence of exercise for safety and efficacy.

3. At stages 3 and 4, increase the range of motion as tolerated.

4. A muscular glide in the wrist can be seen when you squeeze the ball.

5. Don't bend the elbow when you perform flexion and abduction of the Shoulder.

6. If the pain after exercise persists, please contact the intervention nurse as soon as possible.