Skip to main content

Effects of physical exercise on breast cancer-related secondary lymphedema: a systematic review

Abstract

Purpose

The aim of this systematic review is to assess the effect of different types of exercise on breast cancer-related lymphedema (BCRL) in order to elucidate the role of exercise in this patient group.

Methods

A systematic data search was performed using PubMed (December 2016). The review is focused on the rehabilitative aspect of BCRL and undertaken according to the PRISMA statement with Levels of Evidence (LoE) assessed.

Results

11 randomized controlled trials (9 with LoE 1a and 2 with LoE 1b) that included 458 women with breast cancer in aftercare were included. The different types of exercise consisted of aqua lymph training, swimming, resistance exercise, yoga, aerobic, and gravity-resistive exercise. Four of the studies measured a significant reduction in BCRL status based on arm volume and seven studies reported significant subjective improvements. No study showed adverse effects of exercise on BCRL.

Conclusion

The evidence indicates that exercise can improve subjective and objective parameters in BCRL patients, with dynamic, moderate, and high-frequency exercise appearing to provide the most positive effects.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. 1.

    http://www.wcrf.org/int/cancer-facts-figures/data-specific-cancers/breast-cancer-statistics

  2. 2.

    Coleman MP, Quaresma M, Berrino F, Lutz J, De Angelis R, Capocaccia R, Baili P, Rachet B, Gatta G, Hakulinen T, Micheli A, Sant M, Weir HK, Elwood JM, Tsukuma H, Koifman S, Silva GA, Francisci S, Santaquilani M, Verdecchia A, Storm HH, Young JL (2008) Fast track—articles: cancer survival in five continents: a worldwide population-based study (CONCORD). Lancet Oncol 9:730–756

    Article  PubMed  Google Scholar 

  3. 3.

    Hayes S, Sipio TD, Rye S, Lopez JA, Saunders C et al (2011) Prevalence and prognostic significance of secondary lymphedema following breast cancer. Lymphat Res Biol 9(3):135–141

    Article  PubMed  Google Scholar 

  4. 4.

    Mortimer P (2013) Arm lymphoedema after breast cancer. Lancet Oncol 14:423–442

    Article  Google Scholar 

  5. 5.

    DiSipio T, Rye S, Newman B, Hayes S (2013) Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol 14:500–515

    Article  PubMed  Google Scholar 

  6. 6.

    Hayes SC, Janda M, Cornish B, Battistutta D, Newman B (2008) Lymphedema after breast cancer: incidence, risk factors, and effect on upper body function. J Clin Oncol 26(21):3536–3542

    Article  PubMed  Google Scholar 

  7. 7.

    Armer JM, Stewart BR (2010) Post-breast cancer lymphedema: incidence increases from 12 to 30 to 60 months. Lymphology 43:118–127

    PubMed  PubMed Central  CAS  Google Scholar 

  8. 8.

    Liebl ME, Preiß S, Pögel S et al (2014) Elastic tape as a therapeutic intervention in the maintenance phase of complex decongestive therapy (CDT) in lymphedema. Phys Med Rehabil Kuror 24:34–41

    Article  Google Scholar 

  9. 9.

    Baumann FT, Bloch W, Weissen A et al (2013) Physical activity in breast cancer patients during medical treatment and in the aftercare: a review. Breast Care 8(5):330–334

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Runowicz CD, Leach CR, Henry NL, Henry KS, Mackey HT, Cowens-Alvarado RL, Cannady RS, Pratt-Chapman ML, Edge SB, Jacobs LA, Hurria A, Marks LB, LaMonte SJ, Warner E, Lyman GH, Ganz PA (2016) American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. J Clin Oncol 34(6):611–635

    Article  PubMed  CAS  Google Scholar 

  11. 11.

    Keilani M, Hasenoehrl T, Neubauer M, Crevenna R (2016) Resistance exercise and secondary lymphedema in breast cancer survivors—a systematic review. Support Care Cancer 24(4):1907–1916

    Article  PubMed  CAS  Google Scholar 

  12. 12.

    Nelson NL (2016) Breast cancer-related lymphedema and resistance exercise: a systematic review. J Strength Cond Res 29:2656–2665

    Article  Google Scholar 

  13. 13.

    Paramanandam VS, Roberts D (2014) Weight training is not harmful for women with breast cancer-related lymphoedema: a systematic review. J Physiother 60(3):136–143

    Article  PubMed  Google Scholar 

  14. 14.

    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JPA et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):1000100

    Article  Google Scholar 

  15. 15.

    Bok SK, Jeon Y, Hwang PS (2016) Ultrasonographic evaluation of the effects of progressive resistive exercise in breast cancer-related lymphedema. Lymphat Res Biol 14(1):18–24

    Article  PubMed  Google Scholar 

  16. 16.

    Letellier ME, Towers A, Shimony A, Tidhar D (2014) Breast cancer-related lymphedema: a randomized controlled pilot and feasibility study. Am J Phys Med Rehabil 93(9):751–759

    Article  PubMed  Google Scholar 

  17. 17.

    Cormie P, Pumpa K, Galvao DA, Turner E, Spry N, Saunders C, Zissiadis Y, Newton RU (2013) Is it safe and efficacious for women with lymphedema secondary to breast cancer to lift wights during exercise: a randomized controlled trial. J Cancer Surviv 7(3):413–424

    Article  PubMed  Google Scholar 

  18. 18.

    Johansson K, Hayes S, Speck RM, Schmitz KH (2013) Water-based exercise for patients with chronic arm lymphedema: a randomized controlled pilot trial. Am J Phys Med Rehabil 92(4):312–319

    Article  PubMed  Google Scholar 

  19. 19.

    Jeffs E, Wiseman T (2013) Randomised controlled trial to determine the benefit of daily home-based exercise in addition to self-care in the management of breast cancer-related lymphoedema: a feasibility study. Support Care Cancer 21(4):1013–1023

    Article  PubMed  Google Scholar 

  20. 20.

    Loudon A, Barnett T, Piller N, Immink MA, Williams AD (2014) Yoga management of breast cancer-related lymphoedema: a randomised controlled pilot-trial. BMC Complement Altern Med 14:214

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Sim YJ, Jeong HJ, Kim GC (2010) Effect of active resistive exercise on breast cancer-related lymphedema: a randomized controlled trial. Arch Phys Med Rehabil 91(12):1844–1848

    Article  PubMed  Google Scholar 

  22. 22.

    McClure MK, McClure RJ, Day R, Brufsky AM (2010) Randomized controlled trial of the breast cancer recovery program for women with breast cancer-related lymphedema. Am J Occup Ther 64(1):59–72

    Article  PubMed  Google Scholar 

  23. 23.

    Hayes SC, Reul-Hirche H, Turner J (2009) Exercise and secondary lymphedema: safety, potential benefits, and research issues. Med Sci Sports Exerc 41(3):483–489

    Article  PubMed  Google Scholar 

  24. 24.

    McKenzie DC, Kalda AL (2003) Effect of upper extremity exercise on secondary lymphedema in breast cancer patients: a pilot study. J Clin Oncol 21(3):463–466

    Article  PubMed  Google Scholar 

  25. 25.

    Schmitz KH, Ahmed RL, Troxel A, Cheville A, Smith R, Lewis-Grant L, Bryan CJ, Williams-Smith CT, Greene QP (2009) Weight lifting in women with breast-cancer-related lymphedema. N Engl J Med 361:664–673

    Article  PubMed  CAS  Google Scholar 

  26. 26.

    Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvão DA, Pinto BM, Irwin ML, Wolin KY, Segal RJ, Lucia A, Schneider CM, von Gruenigen VE, Schwartz AL (2010) American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 42(7):1409–1426

    Article  PubMed  Google Scholar 

  27. 27.

    Harris SR, Niesen-Vertommen SL (2000) Challenging the myth of exercise-induced lymphedema following breast cancer: a series of case reports. J Surg Oncol 74:95–99

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors Freerk T. Baumann, Alexandra Reike, Vanessa Reimer, Moritz Schumann, Michael Hallek, Dennis R. Taaffe, Robert U. Newton, and Daniel A. Galvao certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Funding

No sources of funding were used to assist in the preparation of this manuscript.

Author information

Affiliations

Authors

Corresponding author

Correspondence to F. T. Baumann.

Ethics declarations

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical approval

The authors declare that the publication has been prepared in accordance with ethical standards.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Baumann, F.T., Reike, A., Reimer, V. et al. Effects of physical exercise on breast cancer-related secondary lymphedema: a systematic review. Breast Cancer Res Treat 170, 1–13 (2018). https://doi.org/10.1007/s10549-018-4725-y

Download citation

Keywords

  • Breast cancer
  • Oncology
  • Exercise
  • Physical activity
  • Lymphedema