Jeffs, E., & Wiseman, T. (2012). Randomised controlled trial to determine the benefit of daily home-based exercise in addition to self-care in the management of breast cancer-related lymphoedema: A feasibility study. Supportive Care in Cancer, 21, 1013–1023.

To compare a home-based exercise program plus standard lymphedema self-care with self-care alone in the management of breast cancer-related lymphedema

Women were randomly assigned to self-care alone or self-care plus exercise groups. Self-care consisted of compression hosiery, skin care, and general activity. Regular hand pumping during any activity involving a closed handgrip was included as standard care. The exercise program combined a series of gravity resistive isotonic arm exercises in a specific sequence to simulate manual lymphatic drainage. Patients were assessed at baseline and at 4,12, and 26 weeks. Patients were instructed to do exercises taught daily for 10–15 minutes and provided pictures and written directions for the exercises.

• N  = 23      
• MEAN AGE =65
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: All had breast cancer
• OTHER KEY SAMPLE CHARACTERISTICS:  Patients' duration of lymphedema ranged from 32–146 months.

• SITE: Single site  
• SETTING TYPE: Home   
• LOCATION: United Kingdon

• PHASE OF CARE: Late effects and survivorship

• Randomized, controlled trial

• Adherence to regimen evaluated via self report to open ended questions
• Limb volume measurement with perometer optoelectronic measure
• QuickDASH-9 questionnaire
• Range of shoulder motion measured with goniometer

Out of 85 potential participants, only 23 consented to participate. Analysis showed significant arm volume reduction in the intervention group, no significant reduction in the control group, and no significant arm volume changes between groups by the end of the study. There was no improvement in quality of life or range of motion. Both groups reported high adherence to usual self care measures. Fifty-five percent of the intervention group reported adherence to daily exercise use.

The exercise intervention appeared to have a positive effect in terms of limb volume lymphedema reduction. The study sample was likely too small to detect significant differences between groups at the end of the study.  Adherence to the exercise regimen was moderate.

• Small sample (< 30)
• Risk of bias (no blinding)
• Unintended interventions or applicable interventions not described that would influence results
• Questionable protocol fidelity
• Other limitations/explanation: The intervention group had lower severity of lymphedema at baseline. Authors state they excluded patients with a history of non-adherence, but even with this exclusion only slightly more than half of those assigned to the exercise intervention used it consistently.

Findings suggest that the exercise intervention used here in combination with standard lymphedema self-care may be beneficial in reducing arm lymphedema. This group of patients had long standing lymphedema, which can be more difficult to impact, so the approach may have promise. Findings suggest, however, that not a lot of patients wanted to participate in this, and that only about half actually completed the exercise as prescribed. Findings point to the challenge of maintaining patient adherence to such regimens and the need to develop effective strategies to support and facilitate patient adherence.