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Does the effect of weight lifting on lymphedema following breast cancer differ by diagnostic method: results from a randomized controlled trial

  • Sandra C. Hayes
  • Rebecca M. Speck
  • Elizabeth Reimet
  • Azadeh Stark
  • Kathryn H. SchmitzEmail author
Epidemiology

Abstract

The lymphedema diagnostic method used in descriptive or intervention studies may influence results found. The purposes of this work were to compare baseline lymphedema prevalence in the physical activity and lymphedema (PAL) trial cohort and to subsequently compare the effect of the weight-lifting intervention on lymphedema, according to four standard diagnostic methods. The PAL trial was a randomized controlled intervention study, involving 295 women who had previously been treated for breast cancer, and evaluated the effect of 12 months of weight lifting on lymphedema status. Four diagnostic methods were used to evaluate lymphedema outcomes: (i) interlimb volume difference through water displacement, (ii) interlimb size difference through sum of arm circumferences, (iii) interlimb impedance ratio using bioimpedance spectroscopy, and (iv) a validated self-report survey. Of the 295 women who participated in the PAL trial, between 22 and 52% were considered to have lymphedema at baseline according to the four diagnostic criteria used. No between-group differences were noted in the proportion of women who had a change in interlimb volume, interlimb size, interlimb ratio, or survey score of ≥5, ≥5, ≥10%, and 1 unit, respectively (cumulative incidence ratio at study end for each measure ranged between 0.6 and 0.8, with confidence intervals spanning 1.0). The variation in proportions of women within the PAL trial considered to have lymphoedema at baseline highlights the potential impact of the diagnostic criteria on population surveillance regarding prevalence of this common morbidity of treatment. Importantly though, progressive weight lifting was shown to be safe for women following breast cancer, even for those at risk or with lymphedema, irrespective of the diagnostic criteria used.

Keywords

Lymphedema Breast cancer Strength training Diagnostic methods Randomized controlled trial 

Notes

Acknowledgments

This work was supported by grants from the National Cancer Institute (R01-CA106851, to Dr. Schmitz), the Geisinger Research Fund (ACR 500, to Azadeh Stark), and the National Center for Research Resources (UL1RR024134, to the University of Pennsylvania). BSN Medical provided custom-fitted compression garments to participants in the study, and the fitness centers where the weight-lifting sessions took place (YMCA of Philadelphia and Vicinity, Sisters in Shape, and the Family YMCA of Burlington County, NJ) provided discounted membership fees for study participants. We are greatly indebted to all the wonderful women who participated in this work.

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Copyright information

© Springer Science+Business Media, LLC. 2011

Authors and Affiliations

  • Sandra C. Hayes
    • 1
  • Rebecca M. Speck
    • 2
    • 3
  • Elizabeth Reimet
    • 4
  • Azadeh Stark
    • 2
    • 5
    • 6
  • Kathryn H. Schmitz
    • 2
    • 7
    Email author
  1. 1.Queensland University of TechnologySchool of Public Health, Institute of Biomedical InnovationBrisbaneAustralia
  2. 2.Department of Biostatistics and EpidemiologyUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Department of Anesthesiology and Critical CareUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.Department of Physical Medicine and Rehabilitation, School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  5. 5.Center for Health ResearchGeisinger Health SystemDanvilleUSA
  6. 6.Department of PathologyHenry Ford Health SystemDetroitUSA
  7. 7.Department of Family Medicine and Community HealthUniversity of PennsylvaniaPhiladelphiaUSA

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