SAN ANTONIO—Weightlifting can significantly reduce the likelihood that breast cancer patients will develop lymphedema after they complete treatment, according to results of the Physical Activity and Lymphedema trial reported at the 33rd annual San Antonio Breast Cancer Symposium.
The investigators say that their findings undermine clinical guidelines for breast cancer survivors without lymphedema that advise against upper body exercise after their treatment has been completed. Most breast cancer survivors are instructed not to lift anything weighing more than 5 pounds.
Kathryn Schmitz, PhD, at the University of Pennsylvania School of Medicine in Philadelphia, and colleagues randomized 154 breast cancer survivors to a weightlifting intervention group or to a nonintervention group.
All women had breast cancer within the past 5 years and had at least two lymph nodes removed and no clinical signs of breast cancer–related lymphedema.
Previous randomized trials of weightlifting safety in breast cancer survivors have been limited by their small sample size and short duration, said Schmitz, who is an associate professor of epidemiology and biostatistics. In addition, some of them have included lymphedema as a secondary outcome.
Women in the intervention group were given a free membership to a community health center where they attended twice-weekly, 90-minute classes led by certified fitness professionals who taught them how to perform upper and lower body weightlifting using both free weights and machines. Weight was increased in small increments for each exercise if patients experienced no change in arm symptoms. After 13 weeks of supervised exercise, women in the intervention group exercised without supervision for the remaining 9 months of the trial and underwent routine monitoring for changes in arm circumference.
The control group only received the intervention after the study completion.
Lymphedema is a frequent complication in breast cancer survivors, Schmitz noted. Of the 61% of patients who undergo sentinel lymph node biopsy, 5% to 7% develop breast cancer–related edema. However, one third of breast cancer patients need complete axillary dissection, which is associated with a 13% to 47% incidence of lymphedema.
Lymphedema not only causes swelling and discomfort but it also limits arm function and reduces quality of life, she added.
She also pointed out that avoiding activities like upper body exercise might dissuade patients from performing regular exercise, which might prevent cancer recurrence and improve survival.
In the present trial, the primary outcome measure was the change in arm swelling at 1 year, as measured by water volumetry of the affected and unaffected arms.
The results revealed that the weightlifting regimen decreased the risk of lymphedema by 35%. That is, 11% of women in the weightlifting treatment group developed lymphedema versus 17% of women in the control group, who did not alter their normal physical activity regimen.
The analysis also showed that the weightlifting intervention had a more pronounced effect in the subgroup of women with five or more lymph nodes removed. This subgroup had a nearly 70% risk reduction, with 22% of control patients developing lymphedema compared with 7% in the treatment group.
Schmitz emphasized that women with lymphedema or at risk for the condition should consult with their physician before resuming or starting a weightlifting program.
“The multiple health benefits of weightlifting should become available to all breast cancer survivors,” she said
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