Optimizing Pulmonary Health and Quality of Life in Breast Cancer Survivors: A Randomized Controlled Trial Combining Incentive Spirometry and Aerobic Exercise

Inclusion Criteria:

* age between 30 and 59 years;
* diagnosis of histological breast cancer (AJCC Stage I to III) and completion of RT for \> 3 months;
* hemoglobin level \> 10 mg/dL;
* ability to comprehend verbal and written instructions;
* cooperative participants, willingness to participate in the study, and ability to engage in exercises by signing an informed consent form; and
* Nonreactive COVID-19 antigen swab test results.

Exclusion Criteria:

* cancer metastasis to the bone, lungs, or surrounding organs;
* aerobic exercise and incentive spirometry breathing exercises within the last six months;
* uncontrolled hypertension (blood pressure \>140/90 mmHg on antihypertensive treatment);
* unstable cardiovascular diseases (including unstable angina, acute myocardial infarction, arrhythmias, severe valvular heart disease, severe arteriovenous stenosis, and decompensated congestive heart failure) determined from medical records, history, physical examination, and electrocardiograms;
* uncontrolled blood sugar level (random blood sugar \>200 mg/dL or fasting blood sugar \>126 mg/dL);
* acute or chronic respiratory diseases (asthma, chronic obstructive pulmonary disease, and pulmonary tuberculosis);
* neuromuscular dysfunction (spinal muscular atrophy, Guillain-Barré syndrome, and multiple sclerosis);
* degenerative arthritis;
* physical limitations affecting stationary cycling; and
* musculoskeletal disorders.