Weight Lifting May Not Increase Lymphedema Risk Among Breast Cancer Survivors

It may be safe for breast cancer survivors to lift weights, including upper-body exercises, without increasing risk for lymphedema. These results were reported in the Journal of the American Medical Association.

Lymphedema refers to swelling of the arm due to an accumulation of lymph fluid. It commonly affects women who have had axillary (underarm) lymph nodes removed for the staging of early breast cancer. The extensive removal of lymph nodes (known as axillary lymph node dissection) is more apt to cause lymphedema than the removal of only a small number of nodes (known as a sentinel lymph node biopsy), but lymphedema can occur following either procedure.

Because of concern that upper-body exercise may increase the risk of developing lymphedema or worsen existing lymphedema, breast cancer survivors are sometimes advised to avoid heavy lifting and other upper-body exercises. These recommendations, however, are based on little evidence.

Determining whether weight lifting is safe for breast cancer survivors is important because this type of exercise can provide important benefits, including an increase in bone density.

To determine whether breast cancer survivors may perform upper-body weight-lifting exercises without increasing risk for lymphedema, researchers compared lymphedema incidence between women who lifted weights and women who did not. Participants had completed treatment one to five years prior to the study and had at least two lymph nodes removed. None had clinical signs of lymphedema when the study began.

Those in the weight-lifting group were given gym memberships and 13 weeks of weight-training instruction. Instruction was provided twice a week and involved very gradual increases in the amount of weight used. After 13 weeks, women in the weight-lifting group continued their exercise programs for nine months without instruction. The remainder of study participants performed no exercise. When the study was completed, women in the no-exercise group were offered a one-year gym membership with 13 weeks of instruction.

At one year the following results were available for 134 participants:

11% of participants in the weight-lifting group experienced incident breast cancer-related lymphedema (determined by an increase in arm swelling of 5% or greater during 12 months) compared with 17% in the no-exercise group.In the weight-lifting group, among women who had five or more lymph nodes removed, 7% experienced incident breast cancer-related lymphedema versus 22% in the no-exercise group.

The researchers concluded that slowly progressive weight lifting does not increase the incidence of lymphedema among women who have been treated for breast cancer. Weight lifting is known to have many health benefits, and it may be safe for many breast cancer survivors to perform this type of exercise. It remains important, however, that all exercise programs are first discussed with a doctor.

Reference: Schmitz KH, Ahmed RL, Troxel AB, et al. Weight lifting for women at risk for breast cancer-related lymphedema. JAMA [early online publication]. December 8, 2010.

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Predicting Risk of Lymphedema in Breast Cancer

Researchers have developed a tool that considers several patient and treatment characteristics in order to predict the risk of lymphedema after axillary lymph node dissection (removal of several under-the-arm lymph nodes) for breast cancer. These results will be presented at the 2011 Breast Cancer Symposium.????

Lymphedema refers to swelling due to an accumulation of lymph fluid. Women with breast cancer may develop lymphedema in an arm after axillary lymph nodes are removed. More extensive removal of lymph nodes (known as axillary lymph node dissection) is more apt to cause lymphedema than the removal of only a small number of nodes (known as a sentinel lymph node biopsy), but lymphedema can occur following either procedure.??

Roughly one-third of women who undergo axillary lymph node dissection develop lymphedema. Tools to help manage lymphedema include manual lymphatic drainage, use of compression bandages and garments, training in skin and nail care (in order to reduce the risk of infection), and instruction in exercises.???

Among women who undergo axillary lymph node dissection, it’s been uncertain why some women develop lymphedema and others don’t. In order to predict which women are at highest risk of lymphedema, researchers explored how lymphedema risk varied by patient characteristics and type of cancer treatment.?

Factors that were linked with lymphedema risk included age, body mass index, infusion of chemotherapy into the arm on the same side of the body as the breast cancer, extent of lymph node removal, location of the radiotherapy field, postoperative seroma (fluid build-up), infection, and early edema (swelling). An initial estimate of lymphedema risk can be obtained prior to surgery, and risk estimates can then be modified based on information collected after surgery.?

The statistical models had an accuracy of more than 70% for the prediction of lymphedema. Although these models continue to be refined, they could eventually provide important tools for counseling and managing women before and after axillary lymph node dissection.???

Reference: Bevilacqua JLB, Kattan MW, Yu C et al. Nomograms for predicting the risk of arm lymphedema after axillary dissection in breast cancer. Paper presented at: 2011 Breast Cancer Symposium; September 8-10, 2011; San Francisco, CA. Abstract 8.?

Posted September 12, 2011

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