Kim do, S., Sim, Y.J., Jeong, H.J., & Kim, G.C. (2010). Effect of active resistive exercise on breast cancer-related lymphedema: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 91(12), 1844–1848.

To investigate the effects of complex decongestive physiotherapy with and without active resistive exercise on volume reduction of the upper limb and improvement of quality of life (QOL) in patients with breast cancer-related lymphedema

Patients were randomly assigned to the active resistive exercise (ARE) group or the the nonactive resistive exercise group. Both groups received complete decongestive physiotherapy (CDPT) led by a physical therapist once a day, five days a week, for two weeks. The nonactive resistive exercise group then continued self-administered CDPT for another six weeks. The ARE group performed shoulder stretching exercises followed by using dumbbells for 15 minutes while wearing a compression stocking or multilayer bandage.

• The study sample was comprised of 40 patients.
• Mean age of the ARE group was 50.5 years and for the nonactive resistive group 50.9 years.
• Patients were included in the study if they had a greater than 2 cm circumference difference between the affected and normal arm or had lymphedema diagnosed via lymphoscintigraphy.
• Patients were excluded from the study if they were aged 70 years or older; had cancer recurrence within six months from time of entering study; had lymphedema in both arms; had vascular disease; had any neurologic signs, such as decreased motor power, sensory changes, or decreased deep tender reflexes; or could not communicate

The study took place in an outpatient setting at Kosin University Gospel Hospital in Korea.

The study has clinical applicability for late effects and survivorship.

The study used a randomized controlled trial design.

• Circumference was measured every 3 cm before and after eight weeks of treatment to determine limb volume.
• QOL was measured using the 36-Item Short Form Health Survey Version 2 (SF-36v2) before treatment and after eight weeks of treatment.
   

Both groups showed significantly reduced volumes after treatment, but the difference between the reduced volume in the distal arm and that of the total arm was not significant. The ARE group showed a significantly reduced volume in the proximal arm. Although CDPT  is described as manual lymphatic drainage, compression therapy, and remedial exercise, description of the remedial exercises does not identify whether or not a compression garment or multilayer bandages were worn. Patients in the ARE group wore a compression stocking or a multilayer bandage to avoid aggravation of the lymphedema in the shoulder and arm while doing exercises.

Both groups had reduced QOL demonstrated by baseline values on the SF-36v2. After treatment, patients in the ARE group showed significant improvements in the SF-36v2 categories of physical functioning, role-physical, body pain-general and mental health. The nonactive resistive exercise group experienced improvements in physical functioning, role-physical, body pain, and mental health. By comparison, the ARE group showed significant improvements in role-physical and general health as compared with the nonactive resistive exercise group.
 

ARE demonstrated volume reduction in the proximal arm, with no statistically significant reduction in the distal or overall measurement. More robust research focusing on the relationship between resistive exercise and lymphedema is needed.

• The study had a small sample size (N < 100).
• No binding was done for the study.
• Findings not are not generalizable.
• The study does not indicate if patients are male or female.
• The age range of participants exceeds the exclusion criteron of older than 70 years, indicating that the sample size was potentially even smaller.

Exercise, including ARE, appear to be beneficial for patients with BCRL.  It is important to note that all participants in this small study received CDPT, with self-administration techniques included. Nurses should encourage patients to speak with a therapist experienced in CDPT prior to initiating an exercise program.