Improving lower limb function in patients with major muscular loss or denervation following resection of a sarcoma

[Truncated abstract] Lower limb soft tissue sarcomas are rare malignant tumours that often occupy large portions of muscular tissue, peripheral nerves or bone. Major muscle and peripheral nerve resections are now less likely to result in limb amputation due to the use of neoadjuvant and/or adjuvant therapy, and the ability to obtain a wide surgical margin, allowing limb salvage surgery (LSS) to be the preferred treatment modality. However, LSS may still leave patients with functional disabilities which may cause persistent emotional and social suffering. Numerous randomised studies have investigated the effects of exercise interventions in cancer survivors, revealing aerobic, resistance, and their combination to be safe, feasible and beneficial interventions. Currently, no researchers have investigated the effects of an exercise rehabilitation programme on the restoration of lower limb function following major muscle loss or denervation due to sarcoma resection; and no recommendations have been made for exercising patients with damage to their sciatic or femoral nerve. In this study we evaluated the effects of a 12 week supervised exercise programme on muscle strength, muscle mobility, functional movement, quality of life (QOL) and ability to perform activities of daily living. Nine patients (5 female, 4 male) with damage to their sciatic or femoral nerve, or respective areas of muscle innervation following LSS, participated in the study. Patients attended the clinic three times per week for 12 weeks of supervised exercise rehabilitation which comprised of aerobic, resistance and hydrotherapy training. Patients’ physical and mental status in the form of the Short Form 36 (SF-36), Toronto Extremity Salvage Score (TESS), High Level Mobility Assessment Tool (HiMAT), strength (isokinetic and/or 3RM), joint range of motion (ROM), six minute walk test (6MWT) and timed up and go (TUG) were collected twice at baseline, then at 6 and 12 weeks into the intervention.