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Background Musculoskeletal shoulder problems are common after breast cancer treatment. There is some evidence to suggest that early postoperative exercise is safe and may improve shoulder function. We describe the development and delivery of a complex intervention for evaluation within a randomised controlled trial (RCT), designed to target prevention of musculoskeletal shoulder problems after breast cancer surgery (The Prevention of Shoulder Problems Trial; PROSPER). Methods A pragmatic, multicentre RCT to compare the clinical and cost-effectiveness of best practice usual care versus a physiotherapy-led exercise and behavioural support intervention in women at high risk of shoulder problems after breast cancer treatment. PROSPER will recruit 350 women from approximately 15 UK centres, with follow-up at 6 and 12 months. The primary outcome is shoulder function at 12 months; secondary outcomes include postoperative pain, health related quality of life, adverse events and healthcare resource use. A multi-phased approach was used to develop the PROSPER intervention which was underpinned by existing evidence and modified for implementation after input from clinical experts and women with breast cancer. The intervention was tested and refined further after qualitative interviews with patients newly diagnosed with breast cancer; a pilot RCT was then conducted at three UK clinical centres. Discussion The PROSPER intervention incorporates three main components: shoulder-specific exercises targeting range of movement and strength; general physical activity; and behavioural strategies to encourage adherence and support exercise behaviour. The final PROSPER intervention is fully manualised with clear, documented pathways for clinical assessment, exercise prescription, use of behavioural strategies, and with guidance for treatment of postoperative complications. This paper adheres to TIDieR and CERT recommendations for the transparent, comprehensive and explicit reporting of complex interventions. Trial registration International Standard Randomised Controlled Trial Number: ISRCTN 35358984 .

Background: Repetitive or sustained elevated shoulder postures have been identified as a significant risk factor for occupationally related shoulder musculoskeletal disorders. Construction workers exposed to routine overhead work have high rates of shoulder pain that frequently progresses to functional loss and disability. Exercise interventions have potential for slowing this progression. Aims: To evaluate a therapeutic exercise programme intended to reduce pain and improve shoulder function. Methods: Construction worker volunteers were screened by history and clinical examination to test for inclusion/exclusion criteria consistent with shoulder pain and impingement syndrome. Sixty seven male symptomatic workers (mean age 49) were randomised into a treatment intervention group (n = 34) and a control group (n = 33); asymptomatic subjects (n = 25) participated as an additional control group. Subjects in the intervention group were instructed in a standardised eight week home exercise programme of five shoulder stretching and strengthening exercises. Subjects in the control groups received no intervention. Subjects returned after 8–12 weeks for follow up testing. Results: The intervention group showed significantly greater improvements in the Shoulder Rating Questionnaire (SRQ) score and shoulder satisfaction score than the control groups. Average post-test SRQ scores for the exercise group remained below levels for asymptomatic workers. Intervention subjects also reported significantly greater reductions in pain and disability than controls. Conclusions: Results suggest a home exercise programme can be effective in reducing symptoms and improving function in construction workers with shoulder pain.

As health awareness increases in modern society, interest in exercise is surging. In particular, as home training has become popular due to the COVID-19 pandemic, and shoulder injuries have become more frequent due to the increase in the aging population in Korea, there is a growing need for a system that can perform accurate exercises at home. We propose a real-time motion classification and feedback system that allows shoulder exercises to be monitored and evaluated at home. We implement a system that classifies shoulder exercise movements using annotated keypoint data (wrist, elbow, and shoulder) obtained through CVAT, and checks exercise accuracy in real time by training yolov5’s object detection model. The system utilizes six machine learning models: Random Forest Classifier, Logistic Regression Classifier, Gradient Boosting Classifier, Histogram-based Gradient Boosting Classifier, SVM Classifier, and Extra Trees Classifier, and utilizes cross-validation and sampling techniques. This enables the identification of critical features that contribute to successful exercise performance. The system also provides real-time feedback to the user to improve their behavior during exercise. This approach demonstrates the applicability of human posture estimation and motion classification in real-world settings and highlights the importance of keypoints in shoulder exercise performance for accurate feedback and instruction.

Background: Implementation of overhead activity, a key component of many professional sports, requires an effective and balanced activation of the shoulder girdle muscles, particularly during forceful external rotation (ER) motions. Purpose: To identify activation strategies of 16 shoulder girdle muscles/muscle segments during common shoulder ER exercises. Study Design: Descriptive laboratory study. Method: Thirty healthy subjects were included in this study, and 16 shoulder girdle muscles/muscle segments were investigated (surface electrode: anterior, middle, and posterior deltoid; upper, middle, and lower trapezius; serratus anterior; teres major; upper and lower latissimus dorsi; and upper and lower pectoralis major; fine wire electrodes: supraspinatus, infraspinatus, subscapularis, and rhomboid major) using a telemetric electromyography (EMG) system. Five ER exercises (standing ER at 0° and 90° of abduction, with underarm towel roll, prone ER at 90° of abduction, side-lying ER with underarm towel) were studied. Exercise EMG amplitudes were normalized to EMG at maximum ER force in a standard position. Univariate analysis of variance and post hoc analysis applied on EMG activity of each muscle were used to assess the main effect of the exercise condition. Results: Muscular activity differed significantly among the ER exercises (P < .05 to P < .001). The greatest activation for anterior and middle deltoid, supraspinatus, upper trapezius, and serratus anterior occurred during standing ER at 90° of abduction; for posterior deltoid, middle trapezius, and rhomboid during side-lying ER with underarm towel; for lower trapezius, upper and lower latissimus dorsi, subscapularis, and teres major during prone ER at 90° of abduction; and for the clavicular and sternal part of the pectoralis major during standing ER with underarm towel. Conclusion: Key glenohumeral and scapular muscles can be optimally activated during specific ER exercises, particularly in positions that stimulate athletic overhead motions. Clinical Relevance: These results enable sports medicine professionals to target specific muscles during shoulder rehabilitation protocols while minimizing the effect of others, providing a foundation for optimal evidence-based exercise prescription. They also provide information for tailored muscle training and injury prevention in overhead sports.

Electromyography (EMG) biofeedback training affords patients a better sense of the different muscle activation patterns involved in the movement of the shoulder girdle. It is important to address scapular kinematics with labourers who have daily routines involving large amounts of lifting at shoulder level or higher. This population is at a heightened risk of developing subacromial impingement syndrome (SAIS). The purpose of this study was to investigate the acute effects of scapular stabilization exercises with EMG biofeedback training on scapular kinematics. Twenty-three healthy subjects volunteered for the study. Electrodes were placed on the upper and lower trapezius, serratus anterior, and lumbar paraspinals to measure EMG activity. Subjects underwent scapular kinematic testing, which consisted of humeral elevation in the scapular plane, before and after biofeedback training. The latter consisted of 10 repetitions of the I, W, T, and Y scapular stabilization exercises. Subjects were told to actively reduce the muscle activation shown on the screen for the upper trapezius during the exercises. The scapular external rotation had a statistically significant difference at all humeral elevation angles (p<0.004) after biofeedback was administered. After the exercises, the scapula was in a more externally rotated orientation with a mean difference of 6.5°. There were no significant differences found with scapular upward rotation, or posterior tilt at all humeral elevation angles following biofeedback. Scapular kinematics are altered by EMG biofeedback training utilizing scapular stabilization exercises. However, only scapular external rotation was affected by the exercises.

To date, the cortical effect of exercise has not been fully elucidated. Using the functional near infrared spectroscopy, we attempted to compare the cortical effect between shoulder vibration exercise and shoulder simple exercise. Eight healthy subjects were recruited for this study. Two different exercise tasks（shoulder vibration exercise using the flexible pole and shoulder simple exercise） were performed using a block paradigm. We measured the values of oxygenated hemoglobin in the four regions of interest： the primary sensory-motor cortex（SM1 total, arm somatotopy, and leg and trunk somatotopy）, the premotor cortex, the supplementary motor area, and the prefrontal cortex. During shoulder vibration exercise and shoulder simple exercise, cortical activation was observed in SM1（total, arm somatotopy, and leg and trunk somatotopy）, premotor cortex, supplementary motor area, and prefrontal cortex. Higher oxygenated hemoglobin values were also observed in the areas of arm somatotopy of SM1 compared with those of other regions of interest. However, no significant difference in the arm somatotopy of SM1 was observed between the two exercises. By contrast, in the leg and trunk somatotopy of SM1, shoulder vibration exercise led to a significantly higher oxy-hemoglobin value than shoulder simple exercise. These two exercises may result in cortical activation effects for the motor areas relevant to the shoulder exercise, especially in the arm somatotopy of SM1. However, shoulder vibration exercise has an additional cortical activation effect for the leg and trunk somatotopy of SM1.

Neck pain is a burden to employers and employees amenable to improvement with neck/shoulder strengthening exercises. However, the benefits of such interventions on office workers’ work ability remains unknown. This study evaluated the effects of a 12-week combined ergonomics and neck/shoulder strengthening exercise intervention (EET, n = 177, mean age 41.7 years, 26% female), versus a 12-week combined ergonomics and health promotion intervention (EHP, n = 173, mean age 43 years, 29% female) on work ability among office workers. Work ability was measured by a single question. Differences in the work ability score were analyzed using the intention-to-treat (ITT) and per-protocol (i.e., adherence ≥70%) analyses for between- and within-group differences at baseline, 12 weeks, and 12 months. A sub-group analysis was performed for neck cases, defined as reporting neck pain as ≥3 (out of 10). No significant between-group differences for work ability were observed in the general population, and subgroup of neck cases. A significant group-by-time interaction effect at 12 weeks and the trend for significance at 12 months favored the EET group in the per-protocol analysis of the neck cases. EET was effective in increasing work ability post-intervention and potentially, in the long-term, in symptomatic participants with ≥70% adherence to the intervention. However, EET was not superior to EHP.

Background/Objectives: Shoulder injuries are common in overhead sports like tennis due to repetitive unilateral movements that can lead to muscle imbalances. This study aimed to compare muscle recruitment and asymmetry during bilateral shoulder injury prevention exercises (performed with both arms simultaneously) in tennis players versus non-tennis athletes. Methods: Thirty-nine athletes (sixteen tennis players, twenty-three non-tennis athletes) performed two bilateral scapular retraction exercises at 45° and 90° shoulder abduction. Surface electromyography (sEMG) recorded the activation of the middle and lower trapezius. Root Mean Square (RMS), peak RMS and muscle symmetry indices were analyzed. Results: Tennis players showed significantly lower trapezius activation, especially during prone retraction at 90°. Muscle symmetry was slightly higher in tennis players at 90°, but asymmetry increased at 45°, suggesting angle-specific adaptations. Conclusions: Repetitive asymmetric loading in tennis may reduce the activation of scapular stabilizers and contribute to muscular imbalances. Including targeted bilateral exercises in training may help improve scapular muscle function and reduce injury risk in overhead athletes.

Background The postoperative severity of symptoms among women with breast cancer affects their quality of life (QoL). Although it is recommended that performing shoulder-arm exercise 30 min/day can alleviate symptoms and improve the QoL, there is little research on the mediating effects of performing shoulder-arm exercise 30 min/day on the postoperative severity of symptoms and QoL among patients with breast cancer. Methods A cross-sectional study was conducted 2 ~ 4 months after surgery on women diagnosed with breast cancer but with no distant metastasis and who had undergone breast cancer surgery for the first time. A structured questionnaire was employed which included a severity of symptoms scale, performing shoulder-arm exercise for 30 min/day, a QoL scale, demographic characteristics, and medical status. Results In total, 117 women with breast cancer completed the survey. The severity of symptoms and performing shoulder-arm exercise 30 min/day separately affected the QoL (B = -0.447, standard error (SE) = 0.050, p  < 0.001; B = 15.666, SE = 4.542, p  = 0.001, respectively). In model 3, performing shoulder-arm exercise for 30 min/day played a partial mediating role in the relationship of the severity of symptoms and QoL ( R 2  = 0.51, F  = 5.41, p  < 0.001). Conclusions During 2 ~ 4 months after surgery, regular shoulder-arm exercise for 30 min/day could decrease the effect of the severity of symptoms on the QoL among women with breast cancer. Clinical healthcare providers may inform and educate patients as to the benefits of regular shoulder-arm exercise for 30 min/day.