Among breast cancer survivors with stable lymphedema, a program of twice-weekly, slowly progressive weight lifting increased strength and reduced lymphedema symptoms without affecting arm and hand swelling. These results were published in the New England Journal of Medicine.
Lymphedema refers to swelling of the arm due to an accumulation of lymph fluid. It commonly affects women who have had axillary (underarm) lymph nodes removed for the staging of early breast cancer. The extensive removal of lymph nodes (known as axillary lymph node dissection) is more apt to cause lymphedema than the removal of only a small number of nodes (known as a sentinel lymph node biopsy), but lymphedema can occur following either procedure.
Because of concern that upper-body exercise may increase the risk of developing lymphedema or worsen existing lymphedema, breast cancer survivors are sometimes advised to avoid heavy lifting and other upper-body exercises. These recommendations, however, are based on little evidence.
Determining whether weight lifting is safe for breast cancer survivors is important because this type of exercise can provide important benefits, including an increase in bone density.
To explore the effects of weight training among breast cancer survivors with lymphedema, researchers conducted a study among 141 women with stable lymphedema of the arm. Half the study participants were assigned to a weight lifting program, and the other half served as the comparison group.
The weight lifting group received a one-year membership at a community fitness center. For 13 weeks women met in small groups with a fitness instructor for two 90-minute workouts per week. The exercise sessions included stretching, a cardiovascular warm-up, abdominal and back exercises, and weight lifting. Weight lifting included both upper-body and lower-body exercises. Weight was gradually increased over a period of several weeks so long as no changes in symptoms occurred. After the first 13 weeks, study participants were asked to continue exercising on their own twice a week. Women wore a compression garment while weight lifting.
Women in the comparison group were asked not to change their activity levels during the study. These women were offered a one-year fitness center membership and 13 weeks of instruction after the study ended.
- An increase in limb swelling of 5% or more occurred with similar frequency in the two study groups (11% of women in the weight lifting group experienced an increase in swelling compared with 12% of women in the comparison group).
- Women in the weight lifting group had greater improvement in self-reported lymphedema symptoms than women in the comparison group. Women in the weight lifting group also had greater improvements in upper- and lower-body strength and fewer lymphedema exacerbations.
These results suggest that a slowly progressive weight lifting program does not increase limb swelling among breast cancer survivors with arm lymphedema, and provides benefits such as increased strength and reduced symptoms.
Breast cancer survivors with arm lymphedema may wish to talk with their doctor about what upper-body exercises are safe and beneficial and how to go about starting an exercise program.
Reference: Schmitz KH, Agmed RL, Troxel A et al. Weight lifting in women with breast-cancer-related lymphedema. New England Journal of Medicine [early online publication]. August 13, 2009.
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