Brown, J.C., Troxel, A.B., & Schmitz, K.H. (2012). Safety of weightlifting among women with or at risk for breast cancer-related lymphedema: Musculoskeletal injuries and health care use in a weightlifting rehabilitation rrial. The Oncologist, 17(8), 1120–1128.

To compare the risk of musculoskeletal injury in women with or at risk for lymphedema between a weight-lifting program and standard care

Women were randomized to receive twice weekly weight lifting or standard care for one year. Patients in both groups attend one hour of education on lymphedema. Women in the weight-lifting group received twice weekly group-based supervised instruction on proper biomechanics. Sessions lasted 90 minutes and included upper- and lower-body exercises and 10 minutes of aerobics and static stretching. If there were no changes in arm symptoms at a given weight, the weight was increased by 1 lb.  There was no upper limit on maximum weight lifted over one year. Patients with lymphedema wore a custom-fitted compression garment during exercise. Data were compared to weight-lifting injury rate data among a general population.

• The study sample (N = 243) was comprised of female patients with breast cancer.
• Mean age was 55.8 years.
• Time since cancer diagnosis ranged from 39–88 months.
• Fifty-nine percent of patients had stage I disease.
• Eight percent of patients were taking tamoxifen at the time of the study.
• The majority of patients had at least some college education and were White; 37% were Black.

The study took place in the eastern United States.

The study has clinical applicability for late effects and survivorship.

The study used a radonmized controlled trial design with epidemiological analysis comparison.

• Patients completed the International Physical Activity Questionnaire.
• Anthropometric measures were used.
• Strength measurements were taken.
• Patients were interviewed regarding adherence.
• Self-reported healthcare use rates were reported.
• Arm volume was measured via bioimpedence monthly.
• Cirumferences and water displacement volume were measured.

Strength was better in the weight-lifting group at 12 months compared to usual care controls (p = 0.03). Patients with lymphedema had greater odds of a musculoskeletal injury compared to controls (OR 19.9, 95% CI 5.1–77, p = 0.001). Patients at risk for lymphedema in the weight-lifting group did not have higher odds of injury. Injury rate per 1,000 reported exercise sessions among patients who did the weight-lifting was less than weight-lifting injury rates among a comparison group of premenopausal women. Six women in the weight-lifting group reported shoulder injuries, one had a wrist injury, and three had lower-body injury. Healthcare use in the control group was not reported.

Weight lifting in women with and at risk for lymphedema appears to be safe, with no more frequent injury rates than those seen in other women; however, musculoskeletal injuries did occur. This points to the need for supervision and communication with professional healthcare providers when delivering a weight-lifting program.

• The study has a risk of bias because no blinding was done.
• Measurement validity and reliability are questionable.
• No information about any changes in lymphedema were provided in the report (reported elsewhere with main study findings) and healthcare use data was only provided for patients who were involved in weight lifting. 
• Injury findings were not fully discussed, in terms of likelihood of being caused by weight lifting. The method of injury measurement was based on patient recall on a survey done at 12 months—patients may not have remembered all injuries. 
• It is not clear if patients adhered to schedule of weight lifting, and comparable activities in the control group were not described or discussed

Findings suggest that women with or at risk for lymphedema can safely do weight lifting, although, as with women without these problems, musculoskeletal injuries can occur. It appears that shoulder injuries were most common. These results point to the importance of supervision and monitoring by appropriate professionals during any weight-lifting program.