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Do Women with Breast Cancer–related Lymphoedema Need to Wear Compression While Exercising?: Results from a Systematic Review and Meta-analysis

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Purpose of Review To undertake a systematic review and meta-analysis to evaluate the effects of wearing compression versus no compression during a single bout of exercise, and during an exercise intervention, for those with breast cancer-related lymphoedema (BCRL). A multiple database search was undertaken to identify eligible randomised controlled trials (RCTs) and non-RCTs involving those with BCRL. The primary outcome variable was lymphoedema and pooled statistics were calculated using standardised mean differences (SMDs) within or between compression and no compression groups. Recent Findings Six eligible studies were identified and rated as either moderate (n = 5) or strong (n = 1) quality. No within-group change in lymphoedema was observed after a single bout of exercise or after an exercise intervention period with compression (SMD = − 0.08 [95% CI = − 0.36, 0.21]; and SMD = − 0.20 [95% CI = − 0.63, 0.22], respectively) or without compression (SMD = 0.05 [95% CI = − 0.23, 0.34]; and, SMD = − 0.17 [95% CI = − 0.56, 0.22], respectively). There was also no between-group difference found post-exercise (single bout or intervention period) between those exercising with and without compression (SMD = − 0.08 [95% CI = − 0.28, 0.12]). Summary There appears to be no consistent benefit or adverse effect of wearing compression for BCRL during a single exercise bout or an exercise intervention period.
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LYMPHEDEMA INCIDENCE, PREVENTION AND TREATMENT (J ARMER, SECTION EDITOR)
Do Women with Breast Cancerrelated Lymphoedema Need to Wear
Compression While Exercising?: Results from a Systematic Review
and Meta-analysis
Sandi Hayes
1
&Ben Singh
2
&Kira Bloomquist
3
&Karin Johansson
4
#Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract
Purpose of Review To undertake a systematic review and meta-analysis to evaluate the effects of wearing compression versus no
compression during a single bout of exercise, and during an exercise intervention, for those with breast cancer-related
lymphoedema (BCRL). A multiple database search was undertaken to identify eligible randomised controlled trials (RCTs)
and non-RCTs involving those with BCRL. The primary outcome variable was lymphoedema and pooled statistics were
calculated using standardised mean differences (SMDs) within or between compression and no compression groups.
Recent Findings Six eligible studies were identified and rated as either moderate (n=5)orstrong(n=1)quality. No within-
group change in lymphoedema was observed after a single bout of exercise or after an exercise intervention period with
compression (SMD = 0.08 [95% CI = 0.36, 0.21]; and SMD = 0.20 [95% CI = 0.63, 0.22], respectively) or without
compression (SMD = 0.05 [95% CI = 0.23, 0.34]; and, SMD = 0.17 [95% CI = 0.56, 0.22], respectively). There was also
no between-group difference found post-exercise (single bout or intervention period) between those exercising with and without
compression (SMD = 0.08 [95% CI = 0.28, 0.12]).
Summary There appears to be no consistent benefit or adverse effect of wearing compression for BCRL during a single exercise
bout or an exercise intervention period.
Keywords Lymphoedema .Exercise .Compression .Breast cancer
Introduction
Exercise is considered an important and effective means of
reducing morbidity and improving quality of life for those
with cancer, with much of the evidence in support of exercise
drawn from studies involving women with breast cancer [1,
2]. Specifically, consistent evidence from clinical trials shows
that mixed-mode exercise (i.e. aerobic and resistance exercise)
for women with breast cancer is safe, feasible, and effective at
improving fitness, strength, psychosocial well-being (includ-
ing anxiety and depression), and treatment-related side effects
(such as fatigue) during and following breast cancer treatment
[2]. Further, strong observational evidence links exercise post-
breast cancer with reduced risk of chronic disease (such as
cardiovascular disease and type II diabetes), breast cancer re-
currence, cancer-related mortality, and all-cause mortality
[3]. Despite widespread endorsement of participation in reg-
ular physical activity by cancer organisations worldwide, the
majority of women experience declines in physical activity
post-breast cancer or fail to meet recommended physical
This article is part of the Topical Collection on Lymphedema incidence,
prevention and treatment
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s12609-020-00373-0) contains supplementary
material, which is available to authorized users.
*Sandi Hayes
sandi.hayes@griffith.edu.au
1
Menzies Health Institute Queensland, Griffith University,
Brisbane, Queensland, Australia
2
Inter-University Laboratory of Human Movement Biology,
University of Lyon, UJM-Saint-Etienne, A 7424,
F-42023 Saint-Etienne, France
3
University Hospitals Centre for Health Research (UCSF),
Rigshospitalet, Copenhagen, Denmark
4
Department of Health Sciences, Lund University, Lund, Sweden
https://doi.org/10.1007/s12609-020-00373-0
Published online: 20 July 2020
Current Breast Cancer Reports (2020) 12:193–201
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... The standard conservative treatment is Complete Decongestive Therapy (CDT) or Combined Physical Therapy (CPT), which consists of a combination of techniques that includes skin care, manual lymphatic drainage, joint mobility exercises, compression garments and multilayer bandages; however, there are no solid data to recommend its universal use due to the characteristics of the treatment itself [9][10][11]. The prescription of compression garments for lymphedema is very varied due to the lack of evidence to support the treatment [12], whose use neither provides benefit nor is contraindicated during the practice of physical activity [13], and it can cause irritation, skin discomfort and pain, and even soft tissue and nerve injuries [14,15]. In addition, there is no optimal level of adherence to its use as it causes patients discomfort and negative emotions related to their visibility and interference with function and social situations [16]. ...
... Not using compression garments with the experimental treatment proposed in this study could be one of the justifications that support the results obtained, with a better participation of patients in the social dimension. A lack of consistent benefit or occurrence of any adverse effect of wearing a compression garment in performing physical activity is also the conclusion of the systematic review conducted by Hayes et al. [14]. ...
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... The positive results from the implementation of physical exercise programs before even the surgery and postoperatively, have been seen in other studies [41]. Despite the fact that progressive regular exercise seems to be safe without worsening the lymphedema, no significant improvement is confirmed even if compression therapy is combined [42,43]. ...
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Aim: This study assessed the association between compression use and changes in lymphedema observed in women with breast cancer-related lymphedema who completed a 12-week exercise intervention. Methods: This work uses data collected from a 12 week exercise trial, whereby women were randomly allocated into either aerobic-based only (n = 21) or resistance-based only (n = 20) exercise. Compression use during the trial was at the participants discretion. Differences in lymphedema (measured by lymphedema index [L-Dex] score and interlimb circumference difference [%]) and associated symptoms between those who wore, and did not wear compression during the 12-week intervention were assessed. We also explored participants' reasons surrounding compression during exercise. Results: No significant interaction effect between time and compression use for lymphedema was observed. There was no difference between groups over time in the number or severity of lymphedema symptoms. Irrespective of compression use, there were trends for reductions in the proportion of women reporting severe symptoms, but lymphedema status did not change. Individual reasons for the use of compression, or lack thereof, varied markedly. Conclusion: Our findings demonstrated an absence of a positive or negative effect from compression use during exercise on lymphedema. Current and previous findings suggest the clinical recommendation that garments must be worn during exercise is questionable, and its application requires an individualized approach.