January 4, 2010 by Gail Pekelis, MA, PT, CLT and Jodi Winicour, PT, CMT, CLT-LANA
Review of current research supporting exercise for
Women with or at risk for breast-cancer-related lymphedema
For decades, many doctors have warned that lifting weights or heavy groceries may cause the onset of arm swelling in women at risk for lymphedema, such as those recovering from breast cancer surgeries including lymph node removal. Common medical advice has included avoiding the use of the "at risk" arm to lift toddlers, garden, lift weights or scrub floors. Thousands of women have been afraid to get back to their usual activities following these surgeries because of this type of advice that lacks medical evidence. Individualized exercise programs have been an integral part of therapeutic rehabilitation for breast-cancer treatment recovery and lymphedema for years, but support of this clinical knowledge in the literature has been difficult to find. We are pleased to report on 2 recent studies that help to support the participation of supervised gradually progressive exercise programs.
In March 2009, a widely read medical journal, The New England Journal of Medicine, published the results of a high
quality study examining weight lifting for women with breast-cancer related lymphedema. In this study, 141 breast cancer survivors with stable arm lymphedema performed twice weekly supervised progressive weight lifting at YMCAs. The primary outcome measured was the change in arm and hand swelling at one year. Secondary outcomes included the incidence of exacerbations of lymphedema, number and severity of lymphedema symptoms and muscle strength. All participants were re
quired to wear a custom fitted compression garment while weight lifting.
The results of this study showed:
1.The weight lifting group had a reduced number and severity of arm and hand symptoms as compared to the group that did not participate in the exercise group.
2.The weight lifting group had a lower number of lymphedema exacerbations as assessed by a certified lymphedema specialist, and required significantly LESS treatments to address the worsened lymphedema than the control group who did not exercise.
3.The proportion of women who had an increase in 5% or more in arm swelling was similar in both the control and weight lifting group.
The conclusions of this controlled study show that weight lifting exercises had no significant effect on the limb swelling and had a positive result in decreasing the incidence of lymphedema exacerbations, reduced subjective symptoms and increased strength.
A second article recently published in March of 2009 in Medicine & Science in Sports and Exercise, examined several of the same parameters surrounding exercise and secondary lymphedema.
This small study examined a mixed-type exercise program on the lymphedema status among women either with breast-cancer related lymphedema or at risk for lymphedema. The mixed type exercise included both aerobic and resistance exercises on land and with an a
quatic exercise program. A gradual increase of the duration of each session, how many sessions per week were completed, repetitions of each exercise and amount of resistance were carried out throughout the study. Wearing a garment was left up to the participants. The duration of the study was 24 weeks. The results of this study showed no significant changes in volume between the control and the exercise group and no exacerbation of any lymphedema that was present at the beginning of the study. Interestingly, when the participants reported a "change" in how their involved arm felt during the course of the study, it was largely due to an objective improvement in the swelling and not to a worsening.
Although this new information is exciting and informative, our trained lymphedema therapists recommend that you receive individualized care when it comes to beginning an exercise program after breast cancer surgery. Kathryn Schmitz, an exercise scientist at the
Pennsylvania who directed the study published in The New England Journal of Medicine suggests that women with breast cancer related lymphedema should not rush into weight training after reading the results of the study. Suddenly changing your activity level may overwhelm your lymphatic system. She realizes that further studies are needed and that individualized care is best. She suggests:
1. Have a certified professional teach you how and when to perform the exercises
2. Progress slowly and gradually with the exercises.
3. Wear a well-fitting compression garment during the exercise work-out.
Exercise and Secondary Lymphedema: Safety, Potential Benefits, and Research issues, Hayes, Sandi C.; Reul-Hirche, Hildegard; Turner, Jane,Medicine & Science in Sports & Exercise:
March 2009, Volume 41 PP 483-489
2 Weight Lifing in Women with Breast-Canacer-Related Lymphedema, Kathryn H. Schmize,Ph.d, MP>H, rehana L Ahmed, M.D, Ph.D.The New England Journal of Medicine, volume 361:664-73, August 13, 2009
3.Weight lifting may help breast cancer survivors, MSNBC.COM
August 12, 2009.
4.Exercise in the Management of Breast Cancer-Related Lymphedema,
Linda T. Miller, BA,BS,PT, Innovations in Breast Cancer Care,