Lymphedema (PDQ®): Supportive care - Health Professional Information [NCI] - Overview
Furthermore, there is empirical evidence that upper-body exercise does NOT result in increased onset of lymphedema among breast cancer survivors.[27,28];[23,29,30] The largest of these studies (N = 204) [Level of evidence: I] measured the arms of women before breast surgery with axillary node dissection and randomly assigned participants to one of two rehabilitation programs:
- No activity restrictions (NAR). The women in this group (N = 104) had no restrictions on physical activities that used the affected limb for 6 months postsurgery. The NAR patients followed a supervised program of moderate, progressive resistance exercise training 2 to 3 times per week. The resistance exercises (total exercise time = 45 minutes) included a minimum of 15 repetitions for each exercise, using low resistance (0.5 kg) during the first 2 weeks. The resistance was increased individually for each patient (no upper limit), with the aim of enhancing muscular strength and endurance but always using 15 repetitions per set for each exercise.
- Activity restrictions (AR). The women in this group (N = 100) were instructed to restrict the activity of the affected limb for 6 months postsurgery. The patients were told to avoid heavy or strenuous physical activities such as aerobic or other types of exercise classes that included heavy upper-limb physical activity or work, and to avoid carrying or lifting groceries or other items weighing more than 3 kg.
At the end of 2 years of postsurgical follow-up, the incidence of new lymphedema was 13% in both groups. Of note, the single most important predictor of lymphedema onset in this large study was obesity.
Another large (N = 134 completers) randomized study compared a 1-year weight-lifting intervention with a no-exercise control group for breast cancer survivors who had unilateral disease and at least two lymph nodes removed. No patients had evidence of lymphedema at baseline. A progressive weight-lifting program did not result in an increased incidence of lymphedema. The study was designed as an equivalence trial but noted a lower incidence of lymphedema in the weight-training group (11% vs. 17%, with a significant difference of 7% vs. 22%, for those with five or more lymph nodes removed).