Cormie, P., Galvao, D.A., Spry, N., & Newton, R.U. (2013). Neither heavy nor light load resistance exercise acutely exacerbates lymphedema in breast cancer survivor. Integrative Cancer Therapies, 12, 423–432.

To examine the acute impact of upper-body resistance exercise on lymphedema symptoms in women with breast cancer-related lymphedema

After four sessions of exercise to familiarize patients with exercise routines over a two-week period, patients were instructed to perform five upper-body resistance exercises. Both low- and high-load exercises involved moderate to high intensity. Patients were to complete two sets of all exercises. High-load sessions involved lifting as much weight as possible for 6-8 repetitions. Low-load exercises involved lifting as much weight as possible for 15–20 repetitions. Load was prescribed and progressed individually. Patients were randomly assigned to which load condition was performed first, and then, after a 10–12 day washout period, crossed over to the other load condition. An exercise physiologist supervised all sessions.  Participants chose whether or not to wear compression garments during exercise. Study outcome measures were obtained prior to exercise, immediately after exercise, and at 24 and 72 hours after exercise. Patients were instructed to maintain usual self-care management and physical activities.

• The study reported on 17 patients.
• Mean age was 61.2 with a range of 52.1–70.3.
• The sample was 100% female.
• All patients had breast cancer-related clinical diagnosis of lymphedema. All had surgical treatment with an average of removal of 13 lymph nodes. Most of patients (88%) had received previous radiation therapy.
• Participants were generally overweight or obese.
• Average time since diagnosis was 5.4 years.
• Average arm circumference difference was 18.7% (SD = 11.9).

This was a single-site, outpatient study conducted in Australia.

This study has clinical applicability for late effects and survivorship.

The study used a randomized crossover design.

The following tools were used.

• Impedance spectorsopy
• Dual energy X-ray absorption
• Arm circumference measurements
• Brief Pain Inventory
• Visual analog scale (VAS) for pain, heaviness, and tightness

No significant differences were observed in lymphedema measures of affected arms across most time points in the study, and no differences were found between high- and low-load conditions. No significant changes were found in arm volume or circumference, and no differences were found between load conditions. No significant differences were found in severity of pain, heaviness, or tightness across all study time points.

Neither low- nor heavy-load resistance upper-body exercises had any acute impact on lymphedema symptoms.

• The sampel size was small with fewer than 30 patients.
• Use of compression garments during exercise varied. Other activities were not described. 
• This study only looked at short-term, acute effects; longer-term effects with ongoing resistance exercise are not known.

Findings showed that prescribed and supervised moderate- to high-intensity, upper-body exercise with low and high loads did not acutely exacerbate lymphedema. Traditional conservative guidelines have recommended avoidance of excessive upper-body exercise with resistance or weight to avoid exacerbation of lymphedema. Findings from this study suggest this may not be necessary. Of note, however, is that exercise done here was supervised and only examined immediate acute effects.  Long-term chronic response needs to be examined.