Weight Lifting in Women with Breast-Cancer-Related Lymphedema

Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
New England Journal of Medicine (Impact Factor: 55.87). 09/2009; 361(7):664-73. DOI: 10.1056/NEJMoa0810118
Source: PubMed


Weight lifting has generally been proscribed for women with breast-cancer-related lymphedema, preventing them from obtaining the well-established health benefits of weight lifting, including increases in bone density.
We performed a randomized, controlled trial of twice-weekly progressive weight lifting involving 141 breast-cancer survivors with stable lymphedema of the arm. The primary outcome was the change in arm and hand swelling at 1 year, as measured through displaced water volume of the affected and unaffected limbs. Secondary outcomes included the incidence of exacerbations of lymphedema, number and severity of lymphedema symptoms, and muscle strength. Participants were required to wear a well-fitted compression garment while weight lifting.
The proportion of women who had an increase of 5% or more in limb swelling was similar in the weight-lifting group (11%) and the control group (12%) (cumulative incidence ratio, 1.00; 95% confidence interval, 0.88 to 1.13). As compared with the control group, the weight-lifting group had greater improvements in self-reported severity of lymphedema symptoms (P=0.03) and upper- and lower-body strength (P<0.001 for both comparisons) and a lower incidence of lymphedema exacerbations as assessed by a certified lymphedema specialist (14% vs. 29%, P=0.04). There were no serious adverse events related to the intervention.
In breast-cancer survivors with lymphedema, slowly progressive weight lifting had no significant effect on limb swelling and resulted in a decreased incidence of exacerbations of lymphedema, reduced symptoms, and increased strength. ( number, NCT00194363.)

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Available from: Andrea B Troxel, Jan 01, 2014
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    • "Previously, exercise participation was discouraged due to concerns that exercise may exacerbate the condition; however, there is growing evidence to support the use of progressive and supervised exercise for women with BCRL with adequate warm-up, cool-down, appropriate rests [9] and suitable training of staff [10]. This evidence comes from studies covering a range of exercise modalities, which have reported no increase in severity [11,12] and fewer exacerbations of lymphoedema [13], increased strength [13], reductions in symptoms [13,14], and improvements in QOL [15,16]. In light of this, research into other holistic interventions, including yoga, for women with BCRL has been recommended [6,9,14]. "
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    ABSTRACT: Background Secondary arm lymphoedema continues to affect at least 20% of women after treatment for breast cancer requiring lifelong professional treatment and self-management. The holistic practice of yoga may offer benefits as an adjunct self-management option. The aim of this small pilot trial was to gain preliminary data to determine the effect of yoga on women with stage one breast cancer-related lymphoedema (BCRL). This paper reports the results for the primary and secondary outcomes. Methods Participants were randomised, after baseline testing, to receive either an 8-week yoga intervention (n = 15), consisting of a weekly 90-minute teacher-led class and a 40-minute daily session delivered by DVD, or to a usual care wait-listed control group (n = 13). Primary outcome measures were: arm volume of lymphoedema measured by circumference and extra-cellular fluid measured by bioimpedance spectroscopy. Secondary outcome measures were: tissue induration measured by tonometry; levels of sensations, pain, fatigue, and their limiting effects all measured by a visual analogue scale (VAS) and quality of life based on the Lymphoedema Quality of Life Tool (LYMQOL). Measurements were conducted at baseline, week 8 (post-intervention) and week 12 (four weeks after cessation of the intervention). Results At week 8, the intervention group had a greater decrease in tissue induration of the affected upper arm compared to the control group (p = 0.050), as well as a greater reduction in the symptom sub-scale for QOL (p = 0.038). There was no difference in arm volume of lymphoedema or extra-cellular fluid between groups at week 8; however, at week 12, arm volume increased more for the intervention group than the control group (p = 0.032). Conclusions An 8-week yoga intervention reduced tissue induration of the affected upper arm and decreased the QOL sub-scale of symptoms. Arm volume of lymphoedema and extra-cellular fluid did not increase. These benefits did not last on cessation of the intervention when arm volume of lymphoedema increased. Further research trials with a longer duration, higher levels of lymphoedema and larger numbers are warranted before definitive conclusions can be made.
    BMC Complementary and Alternative Medicine 07/2014; 14(1):214. DOI:10.1186/1472-6882-14-214 · 2.02 Impact Factor
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    • "The primary outcome measure is change in lean body mass (LBM) at 12 weeks. Exercise interventions In breast cancer populations have shown LBM increases of 0.7 kg to 1 kg [21-23,27], however other exercise intervention studies have reported attenuation of LBM loss rather than increase [60-62]. Assuming that the minimum difference in LBM across the comparison groups is a mean of 2%, 38 participants per group will be required to detect this difference with 90% power and type 1 error of 5% or less (two-tailed) A total of 114 participants are therefore required. "
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    ABSTRACT: Loss of lean body mass (LBM) is a common occurrence after treatment for breast cancer and is related to deleterious metabolic health outcomes [Clin Oncol, 22(4):281-288, 2010; Appl Physiol Nutr Metab, 34(5):950-956, 2009]. The aim of this research is to determine the effectiveness of long chain omega-3 fatty acids (LCn-3s) and exercise training alone, or in combination, in addressing LBM loss in breast cancer survivors.Methods/design: A total of 153 women who have completed treatment for breast cancer in the last 12 months, with a Body Mass Index (BMI) of 20 to 35kg/m2, will be randomly assigned to one of 3 groups: 3g/d LCn-3s (LC), a 12-week nutrition and exercise education program plus olive oil (P-LC) or the education program plus LCn-3s (E-LC). Participants randomised to the education groups will be blinded to treatment, and will receive either olive oil placebo (P) or LCn-3 provision, while the LC group will be open label. The education program includes nine 60-75min sessions over 12 weeks that will involve breast cancer specific healthy eating advice, plus a supervised exercise session run as a resistance exercise circuit. They will also be advised to conduct the resistance training and aerobic training 5 to 7 days per week collectively. Outcome measures will be taken at baseline, 12-weeks and 24-weeks. The primary outcome is % change in LBM as measured by the air displacement plethysmograhy. Secondary outcomes include quality of life (FACT-B + 4) and inflammation (C-Reactive protein: CRP). Additional measures taken will be erythrocyte fatty acid analysis, fatigue, physical activity, menopausal symptoms, dietary intake, joint pain and function indices. This research will provide the first insight into the efficacy of LCn-3s alone or in combination with exercise in breast cancer survivors with regards to LBM and quality of life. In addition, this study is designed to improve evidence-based dietetic practice, and how specific dietary prescription may link with appropriate exercise interventions.Trials registration: ACTRN12610001005044; and World Health Organisation Universal trial number: U1111-1116-8520.
    BMC Cancer 04/2014; 14(1):264. DOI:10.1186/1471-2407-14-264 · 3.36 Impact Factor
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    • "These effects of decreased physical activity appear to have more profound effects on cardiovascular and psychosocial health in those undergoing radiation and some forms of chemotherapy [3,11]. While the effects between decreased physical activity and factors of overall well-being has been established in moderate and long-term survivors [12-15], less information is available with regards to ‘early’ (0–6 months post-treatment) survivors. "
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    ABSTRACT: Metabolic syndrome (MetS) is increasingly present in breast cancer survivors, possibly worsened by cancer-related treatments, such as chemotherapy. MetS greatly increases risk of cardiovascular disease and diabetes, co-morbidities that could impair the survivorship experience, and possibly lead to cancer recurrence. Exercise has been shown to positively influence quality of life (QOL), physical function, muscular strength and endurance, reduce fatigue, and improve emotional well-being; however, the impact on MetS components (visceral adiposity, hyperglycemia, low serum high-density lipoprotein cholesterol, hypertriglyceridemia, and hypertension) remains largely unknown. In this trial, we aim to assess the effects of combined (aerobic and resistance) exercise on components of MetS, as well as on physical fitness and QOL, in breast cancer survivors soon after completing cancer-related treatments.Methods/design: This study is a prospective randomized controlled trial (RCT) investigating the effects of a 16-week supervised progressive aerobic and resistance exercise training intervention on MetS in 100 breast cancer survivors. Main inclusion criteria are histologically-confirmed breast cancer stage I-III, completion of chemotherapy and/or radiation within 6 months prior to initiation of the study, sedentary, and free from musculoskeletal disorders. The primary endpoint is MetS; secondary endpoints include: muscle strength, shoulder function, cardiorespiratory fitness, body composition, bone mineral density, and QOL. Participants randomized to the Exercise group participate in 3 supervised weekly exercise sessions for 16 weeks. Participants randomized to the Control group are offered the same intervention after the 16-week period of observation. This is the one of few RCTs examining the effects of exercise on MetS in breast cancer survivors. Results will contribute a better understanding of metabolic disease-related effects of resistance and aerobic exercise training and inform intervention programs that will optimally improve physiological and psychosocial health during cancer survivorship, and that are ultimately aimed at improving prognosis.Trial registration: NCT01140282; Registration: June 10, 2010.
    BMC Cancer 04/2014; 14(1):238. DOI:10.1186/1471-2407-14-238 · 3.36 Impact Factor
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