Journal of Cancer Survivorship

, Volume 7, Issue 3, pp 413–424 | Cite as

Is it safe and efficacious for women with lymphedema secondary to breast cancer to lift heavy weights during exercise: a randomised controlled trial

  • Prue CormieEmail author
  • Kate Pumpa
  • Daniel A. Galvão
  • Elizabeth Turner
  • Nigel Spry
  • Christobel Saunders
  • Yvonne Zissiadis
  • Robert U. Newton



Resistance exercise has great potential to aid in the management of breast cancer-related lymphedema (BCRL); however, little is known regarding optimal exercise prescription. The pervasive view is that resistance exercise with heavy loads may be contraindicated, disregarding the dose–response relationship that exists between the load utilised in resistance exercise and the magnitude of structural and functional improvements. No previous research has examined various resistance exercise prescriptions for the management of BCRL. This study compared the effects of high load and low load resistance exercise on the extent of swelling, severity of symptoms, physical function and quality of life in women with BCRL.


Sixty-two women with a clinical diagnosis of BCRL (>5 % inter-limb discrepancy) were randomly assigned to a high-load resistance exercise (n = 22), low-load resistance exercise (n = 21) or usual care (n = 19) group. Participants in the experimental groups completed a 3-month moderate- to high-intensity resistance exercise program in which the load of the exercises was manipulated from 10–6 repetition maximum (75–85 % of one repetition maximum [1RM]) for the high-load group or from 20–15 repetition maximum (55–65 % 1RM) for the low-load group. Outcome measures included the extent of swelling in the affected arm, symptom severity, physical function and quality of life.


There were no differences between groups in the extent of affected arm swelling or severity of symptoms. The change in muscle strength, muscle endurance and quality of life–physical functioning was significantly greater in both high-load and low-load groups compared with the control group (p < 0.040). Change in quality of life–physical function was significantly associated with the change in symptom severity and muscle strength. No lymphedema exacerbations or other adverse events occurred during this trial.


Women with BCRL can safely lift heavy weights during upper body resistance exercise without fear of lymphedema exacerbation or increased symptom severity.

Implications for Cancer Survivors

Women with breast cancer-related lymphedema can be informed that appropriately prescribed and supervised upper body resistance exercise is safe and can aid in the management of lymphedema through improvements in physical function and quality of life.


Resistance exercise Weight-lifting Lymphedema Breast cancer Dose–response relationship 



Prue Cormie is supported by the Cancer Council Western Australia Postdoctoral Research Fellowship. This trial was funded by the Edith Cowan University Early Career Research Scheme and the University of Canberra’s Deputy Vice-Chancellor of Research Fellowship Scheme.

Conflict of interest

The authors declare that they have no conflict of interest.

Disclosure statement

The authors declare that they have no conflict of interest. This research was supported by funding from Edith Cowan University and University of Canberra. Clinical trials registration ACTRN12610000788077.

Supplementary material

11764_2013_284_MOESM1_ESM.doc (218 kb)
ESM 1 (DOC 218 kb)


  1. 1.
    Morgan PA, Franks PJ, Moffatt CJ. Health-related quality of life with lymphoedema: a review of the literature. Int Wound J. 2005;2(1):47–62.PubMedCrossRefGoogle Scholar
  2. 2.
    Ahmed RL, Prizment A, Lazovich D, Schmitz KH, Folsom AR. Lymphedema and quality of life in breast cancer survivors: the Iowa women's health study. J Clin Oncol. 2008;26(35):5689–96.PubMedCrossRefGoogle Scholar
  3. 3.
    Rymal C. Lymphedema management in patients with lymphoma. Nurs Clin North Am. 2001;36(4):709–34.PubMedGoogle Scholar
  4. 4.
    Hayes S, Battistutta D, Newman B. Objective and subjective upper body function six months following diagnosis of breast cancer. Breast Cancer Res Treat. 2005;94(1):1–10.PubMedCrossRefGoogle Scholar
  5. 5.
    Hayes S, Rye S, Battistutta D, Newman B. Prevalence of upper-body symptoms following breast cancer and its relationship with upper-body function and lymphoedema. Lymphology. 2010;43(4):178–87.PubMedGoogle Scholar
  6. 6.
    Moffatt CJ, Franks PJ, Doherty DC, Williams AF, Badger C, Jeffs E, et al. Lymphoedema: an underestimated health problem. QJM. 2003;96(10):731–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Tobin MB, Lacey HJ, Meyer L, Mortimer PS. The psychological morbidity of breast cancer-related arm swelling. Psychological morbidity of lymphoedema. Cancer. 1993;72(11):3248–52.PubMedCrossRefGoogle Scholar
  8. 8.
    Velanovich V, Szymanski W. Quality of life of breast cancer patients with lymphedema. Am J Surg. 1999;177(3):184–7. discussion 8.PubMedCrossRefGoogle Scholar
  9. 9.
    Passik SD, McDonald MV. Psychosocial aspects of upper extremity lymphedema in women treated for breast carcinoma. Cancer. 1998;83(12 Suppl American):2817–20.PubMedCrossRefGoogle Scholar
  10. 10.
    Courneya KS, Friedenreich CM, editors. Physical activity and cancer. Recent results in cancer research. London: Springer; 2011.Google Scholar
  11. 11.
    Galvao DA, Newton RU. Review of exercise intervention studies in cancer patients. J Clin Oncol. 2005;23(4):899–909.PubMedCrossRefGoogle Scholar
  12. 12.
    Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvao DA, Pinto BM, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010;42(7):1409–26.PubMedCrossRefGoogle Scholar
  13. 13.
    Courneya KS, Segal RJ, Mackey JR, Gelmon K, Reid RD, Friedenreich CM, et al. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. J Clin Oncol. 2007;25(28):4396–404.PubMedCrossRefGoogle Scholar
  14. 14.
    McKenzie DC, Kalda AL. Effect of upper extremity exercise on secondary lymphedema in breast cancer patients: a pilot study. J Clin Oncol. 2003;21(3):463–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Harris SR, Niesen-Vertommen SL. Challenging the myth of exercise-induced lymphedema following breast cancer: a series of case reports. J Surg Oncol. 2000;74(2):95–8. discussion 8–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Schmitz KH, Ahmed RL, Troxel AB, Cheville A, Lewis-Grant L, Smith R, et al. Weight lifting for women at risk for breast cancer-related lymphedema: a randomized trial. JAMA. 2010;304(24):2699–705.PubMedCrossRefGoogle Scholar
  17. 17.
    Schmitz KH, Ahmed RL, Troxel A, Cheville A, Smith R, Lewis-Grant L, et al. Weight lifting in women with breast-cancer-related lymphedema. N Engl J Med. 2009;361(7):664–73.PubMedCrossRefGoogle Scholar
  18. 18.
    Hayes SC, Reul-Hirche H, Turner J. Exercise and secondary lymphedema: safety, potential benefits, and research issues. Med Sci Sports Exerc. 2009;41(3):483–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Hayes SC, Janda M, Cornish B, Battistutta D, Newman B. Lymphedema after breast cancer: incidence, risk factors, and effect on upper body function. J Clin Oncol. 2008;26(21):3536–42.PubMedCrossRefGoogle Scholar
  20. 20.
    Ahmed RL. Randomized controlled trial of weight training and lymphedema in breast cancer survivors. J Clin Oncol. 2006;24(18):2765–72.PubMedCrossRefGoogle Scholar
  21. 21.
    McNeely ML, Campbell K, Ospina M, Rowe BH, Dabbs K, Klassen TP, et al. Exercise interventions for upper-limb dysfunction due to breast cancer treatment. Cochrane Database Syst Rev. 2010;6:76.Google Scholar
  22. 22.
    Kwan ML, Cohn JC, Armer JM, Stewart BR, Cormier JN. Exercise in patients with lymphedema: a systematic review of the contemporary literature. J Cancer Surviv. 2011;5(4):320–36. doi: 10.1007/s11764-011-0203-9.PubMedCrossRefGoogle Scholar
  23. 23.
    Liu CJ, Latham NK. Progressive resistance strength training for improving physical function in older adults. Cochrane Database Syst Rev. 2009;3:267.Google Scholar
  24. 24.
    Lieber RL. Skeletal muscle structure, function and plasticity: the physiological basis of rehabilitation. 3rd ed. Philadelphia: Lippincott Williams & Williams; 2010.Google Scholar
  25. 25.
    Gashev AA. Physiologic aspects of lymphatic contractile function: current perspectives. Ann N Y Acad Sci. 2002;979:178–87. discussion 88–96.PubMedCrossRefGoogle Scholar
  26. 26.
    Goddard AA, Pierce CS, McLeod KJ. Reversal of lower limb edema by calf muscle pump stimulation. J Cardiopulm Rehabil Prev. 2008;28(3):174–9.PubMedGoogle Scholar
  27. 27.
    Olszewski WL, Engeset A. Intrinsic contractility of prenodal lymph vessels and lymph flow in human leg. Am J Physiol. 1980;239(6):H775–83.PubMedGoogle Scholar
  28. 28.
    Seynnes O, Fiatarone Singh MA, Hue O, Pras P, Legros P, Bernard PL. Physiological and functional responses to low-moderate versus high-intensity progressive resistance training in frail elders. J Gerontol A Biol Sci Med Sci. 2004;59(5):503–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Rhea MR, Alvar BA, Burkett LN, Ball SD. A meta-analysis to determine the dose response for strength development. Med Sci Sports Exerc. 2003;35(3):456–64.PubMedCrossRefGoogle Scholar
  30. 30.
    Kraemer WJ, Adams K, Cafarelli E, Dudley GA, Dooly C, Feigenbaum MS, et al. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2002;34(2):364–80.PubMedCrossRefGoogle Scholar
  31. 31.
    Fry AC. The role of resistance exercise intensity on muscle fibre adaptations. Sports Med. 2004;34(10):663–79.PubMedCrossRefGoogle Scholar
  32. 32.
    Singh NA, Stavrinos TM, Scarbek Y, Galambos G, Liber C, Fiatarone Singh MA. A randomized controlled trial of high versus low intensity weight training versus general practitioner care for clinical depression in older adults. J Gerontol A Biol Sci Med Sci. 2005;60(6):768–76.PubMedCrossRefGoogle Scholar
  33. 33.
    Johansson K, Tibe K, Weibull A, Newton RU. Low intensity resistance exercise for breast cancer patients with arm lymphedema with or without compression sleeve. Lymphology. 2005;38(4):167–80.PubMedGoogle Scholar
  34. 34.
    Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012;62(4):242–74.CrossRefGoogle Scholar
  35. 35.
    Cheville AL, McGarvey CL, Petrek JA, Russo SA, Thiadens SR, Taylor ME. The grading of lymphedema in oncology clinical trials. Semin Radiat Oncol. 2003;13(3):214–25.PubMedCrossRefGoogle Scholar
  36. 36.
    Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–59.PubMedCrossRefGoogle Scholar
  37. 37.
    Borg G. Borg's perceived exertion and pain scales. Champaign, IL: Human Kinetics; 1998.Google Scholar
  38. 38.
    Ward LC, Bunce IH, Cornish BH, Mirolo BR, Thomas BJ, Jones LC. Multi-frequency bioelectrical impedance augments the diagnosis and management of lymphoedema in post-mastectomy patients. Eur J Clin Invest. 1992;22(11):751–4.PubMedCrossRefGoogle Scholar
  39. 39.
    Horber FF, Thomi F, Casez JP, Fonteille J, Jaeger P. Impact of hydration status on body composition as measured by dual energy X-ray absorptiometry in normal volunteers and patients on haemodialysis. Br J Radiol. 1992;65(778):895–900.PubMedCrossRefGoogle Scholar
  40. 40.
    Gjorup C, Zerahn B, Hendel HW. Assessment of volume measurement of breast cancer-related lymphedema by three methods: circumference measurement, water displacement, and dual energy X-ray absorptiometry. Lymphat Res Biol. 2010;8(2):111–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Brorson H, Ohlin K, Olsson G, Karlsson MK. Breast cancer-related chronic arm lymphedema is associated with excess adipose and muscle tissue. Lymphat Res Biol. 2009;7(1):3–10.PubMedCrossRefGoogle Scholar
  42. 42.
    Schmitz KH, Troxel AB, Cheville A, Grant LL, Bryan CJ, Gross CR, et al. Physical activity and lymphedema (the PAL trial): assessing the safety of progressive strength training in breast cancer survivors. Contemp Clin Trials. 2009;30(3):233–45.PubMedCrossRefGoogle Scholar
  43. 43.
    Hayes SC, Speck RM, Reimet E, Stark A, Schmitz KH. Does the effect of weight lifting on lymphedema following breast cancer differ by diagnostic method: results from a randomized controlled trial. Breast Cancer Res Treat. 2011;130(1):227–34.PubMedCrossRefGoogle Scholar
  44. 44.
    Gummesson C, Atroshi I, Ekdahl C. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord. 2003;4:11. doi: 10.1186/1471-2474-4-11.PubMedCrossRefGoogle Scholar
  45. 45.
    Tan G, Jensen MP, Thornby JI, Shanti BF. Validation of the Brief Pain Inventory for chronic nonmalignant pain. J Pain. 2004;5(2):133–7.PubMedCrossRefGoogle Scholar
  46. 46.
    Brady MJ, Cella DF, Mo F, Bonomi AE, Tulsky DS, Lloyd SR, et al. Reliability and validity of the functional assessment of cancer therapy-breast quality-of-life instrument. J Clin Oncol. 1997;15(3):974–86.PubMedGoogle Scholar
  47. 47.
    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85(5):365–76.PubMedCrossRefGoogle Scholar
  48. 48.
    Clark BC, Manini TM. Functional consequences of sarcopenia and dynapenia in the elderly. Curr Opin Clin Nutr Metab Care. 2010;13(3):271–6.PubMedCrossRefGoogle Scholar
  49. 49.
    Cantarero-Villanueva I, Fernandez-Lao C, Diaz-Rodriguez L, Fernandez-de-Las-Penas C, Ruiz JR, Arroyo-Morales M. The handgrip strength test as a measure of function in breast cancer survivors: relationship to cancer-related symptoms and physical and physiologic parameters. Am J Phys Med Rehabil. 2012;91(9):774–82. doi: 10.1097/PHM.0b013e31825f1538.PubMedCrossRefGoogle Scholar
  50. 50.
    Galvao DA, Taaffe DR, Spry N, Joseph D, Newton RU. Combined resistance and aerobic exercise program reverses muscle loss in men undergoing androgen suppression therapy for prostate cancer without bone metastases: a randomized controlled trial. J Clin Oncol. 2010;28(2):340–7.PubMedCrossRefGoogle Scholar
  51. 51.
    Smoot B, Wong J, Cooper B, Wanek L, Topp K, Byl N, et al. Upper extremity impairments in women with or without lymphedema following breast cancer treatment. J Cancer Surviv. 2010;4(2):167–78. doi: 10.1007/s11764-010-0118-x.PubMedCrossRefGoogle Scholar
  52. 52.
    Ware Jr JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473–83.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Prue Cormie
    • 1
    Email author
  • Kate Pumpa
    • 2
  • Daniel A. Galvão
    • 1
  • Elizabeth Turner
    • 3
  • Nigel Spry
    • 1
    • 4
    • 5
  • Christobel Saunders
    • 6
    • 7
  • Yvonne Zissiadis
    • 1
    • 8
  • Robert U. Newton
    • 1
  1. 1.Edith Cowan University Health and Wellness InstituteEdith Cowan UniversityJoondalupAustralia
  2. 2.National Institute of Sports StudiesUniversity of CanberraBruceAustralia
  3. 3.Faculty of Health ClinicUniversity of CanberraBruceAustralia
  4. 4.Radiation OncologySir Charles Gairdner HospitalNedlandsAustralia
  5. 5.Faculty of MedicineUniversity of Western AustraliaCrawleyAustralia
  6. 6.General SurgerySir Charles Gairdner HospitalNedlandsAustralia
  7. 7.School of SurgeryUniversity of Western AustraliaCrawleyAustralia
  8. 8.Genesis Cancer CareWembleyAustralia

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