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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. ================================================ Lymphedema and Weight Lifting Misconceptions by Karen Berry, Lymphland Member. Weight Training Prevents Lymphedema WRONG! There is no evidence that weight lifting prevents lymphedema women with lymphedema should not be told that they could have prevented their condition by weight-lifting. If weight lifting is safe and all those years we told women not to weight-lift, then all those other cautions like avoiding blood pressure or blood draws on the affected side must be wrong too! WRONG! When lymph nodes are removed, the part of the body that was served by those lymph nodes Is forever altered with regard to responding to infection, inflammation, injury and trauma. The study results mean that all women with lymphedema can buy weights or a gym Membership and do what they want without fear of their lymphedema getting worse. WRONG! Lymphedema should be stable prior to starting weight-lifting – no cellulitic infections that required antibiotics over the past three months and no “flare-ups” also in the past three months. If I do weight-lifting, I will never have another exacerbation. WRONG! Most of the women who experiences exacerbations did not follow the safety guidelines. If it is safe for me to do weight-lifting, then it is okay for me to lift heavy things at work. WRONG! If a woman starts weight-lifting at 1 to 3 lbs., increases gradually overtime, and experiences no negative effects from weight-lifting, her ability to safely lift heavy things at work and at home will gradually increase. ------------------------ Weight Lifting and Lymphedema: Clearing up Misconceptions Written by Kathryn Schmitz, PhD, MPH, Associate Professor University of Pennsylvania The purpose of this article is to clarify what the PAL trial results do and do not mean and to clarify how women with lymphedema should interpret the results for their own situation. In August 2009, results of a large randomized controlled trial called the Physical Activity and Lymphedema or ‘PAL’ trial were published in the New England Journal of Medicine. The results indicated that slowly progressive weight training with no upper limit on the amount of weight lifted did not worsen swelling for women with breast cancer related lymphedema. Further, women in the weight-lifting group had half as many ‘flare-ups’ of their lymphedema that required therapist delivered intensive complete decongestive therapy, and that the number and severity of lymphedema symptoms were reduced by weight lifting. This is exciting news! There was a large amount of media attention to the results, given that they run counter to what women had been told for decades, including prior versions of exercise guidelines from the National Lymphedema Network (NLN). Most women are told not to lift anything heavier than 5-15 pounds ever again with their affected limb to avoid worsening of lymphedema once they are diagnosed. The results of the PAL trial indicated that the guidance may not be accurate. However, not all of the media accounts of the PAL trial results were complete and, as a result, it has come to the attention of the leaders in the field of lymphedema clinical care that there are some misconceptions that require clarification. Though this article is written by the principal investigator of the PAL trial, it has been vetted and approved by the NLN Medical Advisory Committee as well. Overall, the Medical Advisory Committee agrees that exercise is important and can be accomplished safely. However, lymphedema patients should not be cavalier about progressive weight-lifting. Patients should be mindful of the proper guidelines and should avoid rushing into weight-lifting without following some key safety guidelines (see below). Slow and steady is the way to go. It is important for patients to know their own body and how it responds; not to ignore signs of a possible exacerbation of swelling; to know what to do if there are signs of swelling or increased swelling, and to seek care from a certified lymphedema therapist when/if those signs occur. Below we clarify some of the misconceptions that seem to have arisen based on media attention to the PAL trial results. Misconception #1: Weight Training Prevents Lymphedema WRONG! The PAL trial paper published in August 2009 did not address prevention of lymphedema. There is no evidence that weight training prevents lymphedema. Women with lymphedema should not be told that they could have prevented their condition by weight-lifting. That is a boldly inaccurate statement, not supported by the results of the PAL trial. There is a second paper that will be published from the PAL trial about the results in the 154 women in the study who did NOT have lymphedema. This separate paper will comment on prevention. Stay tuned. |