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

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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References

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  3. Rymal C. Lymphedema management in patients with lymphoma. Nurs Clin North Am. 2001;36(4):709–34.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  8. Velanovich V, Szymanski W. Quality of life of breast cancer patients with lymphedema. Am J Surg. 1999;177(3):184–7. discussion 8.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  10. Courneya KS, Friedenreich CM, editors. Physical activity and cancer. Recent results in cancer research. London: Springer; 2011.

    Google Scholar 

  11. Galvao DA, Newton RU. Review of exercise intervention studies in cancer patients. J Clin Oncol. 2005;23(4):899–909.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  20. Ahmed RL. Randomized controlled trial of weight training and lymphedema in breast cancer survivors. J Clin Oncol. 2006;24(18):2765–72.

    Article  PubMed  Google Scholar 

  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. 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.

    Article  PubMed  Google Scholar 

  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. Lieber RL. Skeletal muscle structure, function and plasticity: the physiological basis of rehabilitation. 3rd ed. Philadelphia: Lippincott Williams & Williams; 2010.

    Google Scholar 

  25. Gashev AA. Physiologic aspects of lymphatic contractile function: current perspectives. Ann N Y Acad Sci. 2002;979:178–87. discussion 88–96.

    Article  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  31. Fry AC. The role of resistance exercise intensity on muscle fibre adaptations. Sports Med. 2004;34(10):663–79.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  37. Borg G. Borg's perceived exertion and pain scales. Champaign, IL: Human Kinetics; 1998.

    Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

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Acknowledgements

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.

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Authors and Affiliations

  1. Edith Cowan University Health and Wellness Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia

    Prue Cormie, Daniel A. Galvão, Nigel Spry, Yvonne Zissiadis & Robert U. Newton

  2. National Institute of Sports Studies, University of Canberra, University Drive, Bruce, ACT, 2617, Australia

    Kate Pumpa

  3. Faculty of Health Clinic, University of Canberra, University Drive, Bruce, ACT, 2617, Australia

    Elizabeth Turner

  4. Radiation Oncology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA, 6009, Australia

    Nigel Spry

  5. Faculty of Medicine, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia

    Nigel Spry

  6. General Surgery, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA, 6009, Australia

    Christobel Saunders

  7. School of Surgery, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia

    Christobel Saunders

  8. Genesis Cancer Care, 24 Salvado Rd, Wembley, WA, 6014, Australia

    Yvonne Zissiadis

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  1. Prue Cormie
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Correspondence to Prue Cormie.

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Appendix 1

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Table 5 Baseline and post-intervention (3 months) scores for all outcome measures
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Cormie, P., Pumpa, K., Galvão, D.A. et al. Is it safe and efficacious for women with lymphedema secondary to breast cancer to lift heavy weights during exercise: a randomised controlled trial. J Cancer Surviv 7, 413–424 (2013). https://doi.org/10.1007/s11764-013-0284-8

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  • DOI: https://doi.org/10.1007/s11764-013-0284-8

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