Guerreiro Godoy Mde, F., Oliani, A.H., & Pereira de Godoy, J.M. (2010). Active exercises utilizing a facilitating device in the treatment of lymphedema resulting from breast cancer therapy. German Medical Science: GMS e-Journal, 8, Doc31.

To determine the effectiveness of an assistive mobile flexion bar during exercise to reduce arm volume in patients diagnosed with lymphedema related to breast cancer treatment

Participants were randomly selected, and all participants received the intervention. Participants received a single one hour of active exercising split into 12-minute sections with 3 minutes of flexion bar use between each section. The flexion bar is a T-shaped apparatus, the vertical bar remains fixed (10 cm away from the patient on a tabletop), and the horizontal bar rotates (30 cm above the tabletop) to allow extension and flexion of arm muscles. All of the participants wore a compression sleeve on the affected limb. The participants independently performed the exercise routine, and the sole purpose of the interventionist was to control the time of exercise intervals and to help participants maintain proper posture and spinal alignment.

• The study sample (N = 21) was comprised of female patients with breast cancer who were diagnosed with arm lymphedema.
• All patients had radiotherapy postoperatively and were 2–12 years postoperative.

The study took place at a rehabilitation facility in Brazil.

Patients were undergoing active lymphedema treatment.

The study used a prospective trial design.

• Water displacement measured limb volume before and after the flexion bar intervention.
• Participants' arm volume was measured before and after each exercise session.

The participants initial mean volume was 2,089.9 ml. After the exercise session, the mean final volume decreased to 2,023.0 ml. The study used a paired t-test with an alpha error of 5% as acceptable. The results concluded in a mean loss of 66.9 ml (p < 0.001). There was a significant reduction in limb volume, using active exercises with a facilitating device (mobile flexion bar).

The trial suggests that the use of an apparatus mobile flexion bar may improve the efficacy of lymphedema reduction by myolymphokinetic exercises. Active exercises are beneficial to patients with lymphedema because it promotes muscle contraction and lymphatic drainage. The study has its risks for bias based on the small sample size and the lack of a control group.

• The sample size was small, with less than 30 participants.
• The time in years from surgery is a large range.
• The study has a risk of bias because of no control group, blinding, or random assignment.

Because of the statistical significance of the findings of the study, it is important for nurse researchers to repeat the study using a more rigorous study design. If the experiment were repeated as a randomized controlled trial with a larger sample size, the results would be more generalizable. It would also be interesting to compare the use of a mobile flexion bar to active exercise without the use of a facilitating device to determine the necessity.