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Lymphland International Lymphedema Online
| Weight Lifting Improves Symptoms of Breast Cancer Related Arm Lymphedema According to the American Cancer Society, approximately 184,000 women in the United States are diagnosed with breast cancer each year. Early detection and treatment of breast cancer have led to improvement in survival with 90% of women living at least 5 years after diagnosis. Among the most serious concerns for survivors of breast cancer surgery is the development of lymphedema, a chronic, progressive swelling of subcutaneous tissue caused by obstruction of the lymphatic vessels. Lymphedema results in the accumulation of large amounts of fluid (lymph) in the affected region leading to massive swelling of the limb, discomfort, and impairment of arm function. Breast cancer survivors with arm lymphedema have, in general, been discouraged from lifting heavy objects or performing weight lifting exercises, out of fear that these activities may worsen the symptoms of lymphedema. Adherence to these guidelines, however, may limit physical recovery following breast cancer surgery and may also adversely affect employment. A program of controlled exercise through weight lifting, on the other hand, offers numerous benefits including increasing the work capacity of the affected arm, control of body fat, improved functional capacity, and increased bone density. The issue of whether weight lifting should be discouraged or recommended for breast cancer survivors with arm lymphedema currently remains controversial. Clearly, additional research to better establish the risks and benefits of weight lifting for women with breast cancer related arm lymphedema is needed. In an article published in the August 13, 2009 issue of the New England Journal of Medicine, researchers reported the outcome of a randomized, controlled trial of twice-weekly progressive weight lifting in 141 breast cancer survivors with stable lymphedema of the arm. Seventy one (71) subjects were randomly assigned to the weight lifting group while 70 subjects were assigned to the control group (no weight lifting). Participants in the weight lifting group received a 12-month membership at a fitness center near their home. For the first 13-weeks of the study, weight lifting and other exercises (stretching; abdominal; back excercises) were performed under the supervision of a certified fitness professional and were conducted in 90-minute sessions twice each week. For the weight lifting exercises, the resistance and number of repetitions was gradually increased over time. After the first 13-weeks, the participants continued twice- weekly exercises by themselves without supervision for an additional 39-weeks. Prior to entry into the study, subjects in both the weight lifting and control groups were given a custom-fitted compression garment. Participants in the weight lifting group were required to wear their compression garments during weight lifting exercises. Subjects in both groups were also required to attend a 1-hour seminar that reviewed the National Lymphedema Network guidelines for risk reduction, treatment, and exercise. The major outcomes of the study can be summarized as follows: •Weight lifting did not adversely affect the severity of breast cancer related arm lymphedema. The proportion of women who had an increase of 5% or more in arm swelling was similar in the weight lifting group (11%) and the control group (12%). •Compared to the control group, women assigned to the weight lifting group also demonstrated: •greater improvements in the severity of lymphedema symptoms such as swelling, leathery skin texture, pain, and pitting of the skin; •greater improvements in upper and lower body strenght; •a lower incidence of lymphedema exacerbations such as an increase in the volume of the affected arm of 5% or greater and by indication of tissue changes (i.e., skin fibrosis) In summary, this randomized, controlled trial suggests that, contrary to current guidelines that recommend avoidance of weight lifting, this activity did not significantly increase the severity of arm swelling in women with breast cancer related lymphedema. Moreover, weight lifting appeared to provide significant benefits including reducing the severity of arm lymphedema symptoms, increased muscle strength, and a lower incidence of lymphedema exacerbations. Women with breast cancer related lymphedema of the arm, should talk to their doctor about the risks and benefits of starting a progressive weight lifting program |