Ahmed, R.L., Thomas, W., Yee, D., & Schmitz, K.H. (2006). Randomized controlled trial of weight training and lymphedema in breast cancer survivors. Journal of Clinical Oncology, 24(18), 2765–2772.

To examine associations between exercise and lymphedema in breast cancer survivors

The study and all protocols were approved by the University of Minnesota.

• The sample was comprised of (N = 85) breast cancer survivors recruited from October 2001 to June 2002.
• The randomized intervention group (n = 42) included 23 patients who underwent axillary dissection.
• The randomized control group (n = 43) included 23 patients who underwent axillary dissection.
• All participants gave signed informed consent.

The study was conducted in the great Minneapolis-St. Paul, MN, metropolitan area.

A randomized controlled trial

Lymphedema was measured three ways: arm circumference measurements, self-reported symptoms, and symptoms of lymphedema.

Arm circumference

• Arm circumference measurements were taken on both arms at the level of the metacarpophalangeal joints, just distal to the ulnar styloid process, 10 cm distal to the midpoint of the lateral epicondyle, and 10 cm proximal to the midpoint of the lateral epicondyle.
• During arm circumference measurements, participants lay prone with their arms at their sides and elbows straight. A cloth measuring tape was placed around the arm so that there was no slack and no indentation of the tissue. Participants who wore compression sleeves removed them one hour before measurements were taken. The mean of two measurements was used. The outcome measure was the calculated difference in each circumference measure between the ipsilateral and contralateral arms.

Self-reported symptoms

• A validated survey measured self-report of lymphedema diagnosis, symptoms, and treatment over the past three months.The survey had a specificity of 0.90 and sensitivity of 0.86–0.92 for diagnosing lymphedema (difference in arm circumferences 2 cm), compared with clinical assessment by a physical therapist with training in lymphedema.
• Symptoms of lymphedema included whether or not a participant had noticed that her hand, lower or upper arm on the side of the cancer was larger than the side of the opposite arm and if the difference was mild, moderate, or severe.
• Other symptoms included altered fine motor function, puffiness, swelling, and/or pain of the hand or arm.

Symptoms of lymphedema

• A participant was a self-reported “incident” case of lymphedema if she self-reported a clinician diagnosis of lymphedema at six months but not at baseline.
• A patient was a self-reported “prevalent” case if she self-reported a clinician diagnosis of lymphedema.
• A participant was considered to have lymphedema symptoms if she reported any lymphedema symptoms in the survey.

• After dropouts and loss to follow-up, 78 women completed baseline and six-month measurements of arm circumference.
• A twice-a-week weight training for a period of six months did not increase arm circumference measurements or exacerbate symptoms of lymphedema in survivors of breast cancer compared with nonintervention controls.

• Six months may not have adequately captured acute or transient changes in circumferences or symptoms that may result from exercise.
• Researchers did not measure change in volume, which is correlated with circumference measures but may be more sensitive to change.
• Few of the women randomly selected at baseline had lymphedema.