Kwan, M.L., Cohn, J.C., Armer, J.M., Stewart, B.R., & Cormier, J.N. (2011). Exercise in patients with lymphedema: A systematic review of the contemporary literature. Journal of Cancer Survivorship: Research and Practice, 5(4), 320–336.

To examine the evidence and produce recommendations for exercise and lymphedema management in female breast cancer survivors

• Databases searched were MEDLINE, CINAHL, Cochrane Library, PapersFirst, ProceedingsFirst, WorldCat, PEDro, National Guidelines Clearing House, DARE, and ACP Journal Club.
• Search keywords were lymphedema, swelling, edema and keywords for exercise, such as physical activity, physical therapy, exercise, strength training.
• Studies were included if they were randomized controlled, cohort, or case-control studies or meta-analyses or systematic reviews.
• Exclusion criteria were not specified. 

A total of 659 references were retrieved. Two authors used the Oncology Nursing Society Putting Evidence Into Practice (PEP) categories of evidence to evaluate the references.

• The final number of studies included was 19.
• The sample size across studies was 912 patients with breast cancer, with a range of 14–242.

Patients were undergoing multiple phases of care.

Resistance exercises were determined to be \"Likely to be effective.\" Aerobic and resistance exercise were rated as \"Benefits balanced with harms,\" though no clear harms were obvious in the review of the studies. Other exercise approaches studied were deemed \"Effectiveness not established.\"

Benefits of exercise have been reported, and this review suggests that current evidence supports the use of resistance exercising.

• The method of evaluating aerobic exercise was not clear.
• Not all studies included use of compression garments during exercise.

Findings support the use of resistance exercise in women with breast cancer for the management of arm lymphedema.