Breast Cancer, Lymphedema and Weight-Lifting


A recent New England Journal of Medicine article addressed the effects of a supervised program of wight lifting and it's effects on the incidence of "events" with lymphedema, and contrary to popular thinking, patients had fewer events and greater improvements in their sense of well being.
Tradidional clinical practice has advocated strict limitations on physical activity for women who have lymphedema or who are at risk for developing it.  This study presents welcome news regarding the management of lympgedema, a complication that can have  significant impact on the physical, psychological, and finacial well-being of breast cancer survivors.  Schmitz and colleagues at the University of Pennsylvania have conducted the largest randomized controlled trial addressing the effects of controlled weight lifting in women with stable lymphedema.  Their well-designed study has numerous strengths. 
The study population was diverse with regard to race, education, and occupation.  The randomized groups were well balanced with regard to stage, number of nodes removed, radiation history, and degree of lymphedema.  Only patients with stable lymphedema were elligible; most patients were approximately seven years out from their initial diagnosis. The investigators were rigorous in the assessment and measurement of lymphedema. 
This trial does have some weaknesses, which the authors address, sucha as the effects of the lack of blinding as to treatment assignment potenially leading to observer and reporting bias.  The duration of the study (12 months) is one of its strengths, but participation in the weight-lifting program declined over time, so that by the final quarter of the study, the median rate of exercise attendance was 75%.  However, while this could have a potential effect upon the proportion of women with a change in limb swelling or symptoms at the 12-month point, the study also demonstrated that the women in the weight-lifting group had fewer lymphedema exacerbations throughout the course ofthe study.
In summary, the widely representative demographics, excellent methodology, and replicable community center-based exercise program model used in this trial support the generalizability and widespread applicability of the study findings.  Its results have been widely disseminated in the popular press. However, it should be emphasized that the benefits of weight lifting were seen in the context of carefully-planned initial evaluation, intruction, and supervision.  Breast cancer survivors with lymphedema should be encouraged to participate in such structured weight-lifting programs, rather than try this on their own without such support.
Schmitz KH, Ahmed RL, Troxel A, Cheville A, Smith R, Lewis-Grant L, Bryan CJ.