Journal of Cancer Survivorship

, Volume 5, Issue 4, pp 320–336 | Cite as

Exercise in patients with lymphedema: a systematic review of the contemporary literature

  • Marilyn L. Kwan
  • Joy C. Cohn
  • Jane M. Armer
  • Bob R. Stewart
  • Janice N. Cormier



Controversy exists regarding the role of exercise in cancer patients with or at risk for lymphedema, particularly breast. We conducted a systematic review of the contemporary literature to distill the weight of the evidence and provide recommendations for exercise and lymphedema care in breast cancer survivors.


Publications were retrieved from 11 major medical indices for articles published from 2004 to 2010 using search terms for exercise and lymphedema; 1,303 potential articles were selected, of which 659 articles were reviewed by clinical lymphedema experts for inclusion, yielding 35 articles. After applying exclusion criteria, 19 articles were selected for final review. Information on study design/objectives, participants, outcomes, intervention, results, and study strengths and weaknesses was extracted. Study evidence was also rated according to the Oncology Nursing Society Putting Evidence Into Practice® Weight-of-Evidence Classification.


Seven studies were identified addressing resistance exercise, seven studies on aerobic and resistance exercise, and five studies on other exercise modalities. Studies concluded that slowly progressive exercise of varying modalities is not associated with the development or exacerbation of breast cancer-related lymphedema and can be safely pursued with proper supervision. Combined aerobic and resistance exercise appear safe, but confirmation requires larger and more rigorous studies.


Strong evidence is now available on the safety of resistance exercise without an increase in risk of lymphedema for breast cancer patients. Comparable studies are needed for other cancer patients at risk for lymphedema.

Implications for cancer survivors

With reasonable precautions, it is safe for breast cancer survivors to exercise throughout the trajectory of their cancer experience, including during treatment.


Lymphedema Breast cancer Exercise Physical activity Systematic review Literature review 



This systematic review of contemporary peer-reviewed exercise and lymphedema literature was jointly commissioned by the ALFP and the International Lymphoedema Framework to evaluate the level of evidence in support of exercise in the management of lymphedema. A summary of these findings will be used to support the revisions of the second edition of the Best Practices document [35]. The objectives of the ALFP are to provide evidence of the best practice of lymphedema care, to assist in establishing guidelines for the management of lymphedema, and to increase awareness of this condition in the USA and worldwide. We acknowledge the reference librarian at the University of Missouri and the staff of the ALFP for their contribution to this systematic review.

Source of support

ALFP staff and reference librarian time were supported by industry donations to the ALFP. All authors donated their time in preparation of this manuscript.


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Marilyn L. Kwan
    • 1
  • Joy C. Cohn
    • 2
  • Jane M. Armer
    • 3
  • Bob R. Stewart
    • 4
  • Janice N. Cormier
    • 5
  1. 1.Division of ResearchKaiser PermanenteOaklandUSA
  2. 2.Penn Therapy and Fitness, Good Shepherd Penn PartnersPhiladelphiaUSA
  3. 3.Sinclair School of NursingUniversity of MissouriColumbiaUSA
  4. 4.College of Education, Sinclair School of NursingUniversity of MissouriColumbiaUSA
  5. 5.Department of Surgical OncologyUT MD Anderson Cancer CenterHoustonUSA

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