Cormie, P., Pumpa, K., Galvao, D.A., Turner, E., Spry, N., Saunders, C., … Newton, R.U. (2013). Is it safe and efficacious for women with lymphedema secondary to breast cancer to lift heavy weights during exercise: A randomised controlled trial. Journal of Cancer Survivorship, 7, 413–424.

To compare the effects of high and low weight load resistance exercise on lymphedema severity, symptoms, physical function and quality of life in women with breast cancer

Patients were randomly assigned to one of three groups: high load resistance exercise, low load resistance exercise, or a wait list usual care control group. Both exercise programs involved six exercises targeting the major upper body muscle groups. Intensity was moderate to high on the Borg scale. Sessions were done for 60 minutes once per week for three months and were supervised by an exercise physiologist. Patients chose whether or not to wear compression garments during exercise. Patients were instructed to maintain usual self care and activity.  Outcome measures were obtained at baseline and at three months post intervention.

• The study consisted of 60 patients with a mean age of 57 years.
• The sample was 100% female.
• Time since diagnosis ranged from an average of 5.9 years in the high load group to 9.5 years in control patients.
• The majority of patients (97%) had surgery. Overall, a mean of 15.4 lymph nodes were removed.
• The amount of patients who had received radiotherapy was 85%.
• Most patients had grade I or II lymphedema.

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

This study has clinical applicability for late effects and survivorship.

This was a single-blind, randomized controlled trial.

The following measurement tools were used.

• Bioimpedance
• Dual energy x-ray absorption measurement
• Arm circumference measurement
• Disability of the arm, shoulder, and hand questionnaire (DASH)
• Brief Pain Inventory (modified)
• Functional Assessment of Chronic Illness-Breast cancer (FACT-B)
• European Organization for Research and Treatment of Cancer (EORTC) Quality of Life (QOL) questionnaire
• Short Form Health Survey (SF-36)
• Hand dynamometry for grip strength
• Maximal muscle endurance testing

No lymphedema exacerbations or adverse events were reported. No differences across groups were found in change of swelling outcome measures or symptom severity. A nonsignificant trend toward greater improvement in grip strength was noted. Significant improvement was reported in upper body muscle endurance in both exercise groups compared to controls (p=.001). Physical functioning measurement showed significant improvement in both exercise groups compared to controls, in which the measure showed decline (p = 0.04). A fourth of the patients used compression garments during exercise.

Findings showed that women with breast cancer-related lymphedema can safely lift weight at both low and high relative load. Moderate- to high-intensity exercise may be beneficial to improve physical functioning.

• The sample size was small with fewer than 100 patients.
• A risk of bias exists because the study did not have an appropriate attentional control condition.

This study adds to the growing body of evidence that weight lifting and high or low load resistance exercise can be safe for patients with lymphedema. Of note, the evidence in this area includes only supervised weight lifting.