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
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