Monday, December 20, 2010

Weight Lifting, Breast Cancer, and Lymphedema

Last August, Kathryn Schmitz, PhD, MPH and colleagues published the results of their study Weight Lifting in Women with Breast-Cancer–Related Lymphedema in the New England Journal of Medicine.  They have now published a similar study in the Archives of Internal Medicine (see full reference below).

While the NEJM article focused on breast cancer survivors with lymphedema, the Archives article focuses on breast cancer survivors without lymphedema.

The new study adds weight for the need to change historic dogma which cautions breast cancer patients to avoid weight training after a mastectomy and or axillary dissection.

As noted by Schmitz, etc (bold emphasis is mine):

Breast cancer survivors at risk for lymphedema alter activity, limit activity, or both from fear and uncertainty about their personal risk level, and upon guidance advising them to avoid lifting children, heavy bags, or other objects with the at-risk arm.

Such guidance is often interpreted in a manner that deconditions the arm, increasing the potential for injury, overuse, and, ironically, lymphedema onset.

Adherence to these precautions may limit physical …. Furthermore, activity avoidance may deter survivors from performing regular exercise, which may prevent cancer recurrence and improve survival.

The randomized controlled equivalence trial (Physical Activity and Lymphedema trial) enrolled 154 breast cancer survivors (only 134 completed the study)  1 to 5 years post-unilateral breast cancer with at least 2 lymph nodes removed and without clinical signs of lymphedema.  Recruitment took place between October 1, 2005, and February 2007, with data collection ending in August 2008.

Participants in the weight lifting intervention group (n = 72)received a 1-year membership to a community fitness center near their homes. For the first 13 weeks, women were instructed twice weekly during 90 minute sessions on safe performance of exercises in groups of 2 to 6 survivors.

Upper body exercises (seated row, supine dumbbell press, lateral or front raises, bicep curls, and triceps pushdowns) were performed with dumbbells or variable resistance machines. Lower body exercises (leg press, back extension, leg extension, and leg curl) were performed with variable resistance machines. Three sets of each exercise were performed at each session, 10 repetitions per set.

After 13 weeks, participants continued twice weekly unsupervised exercise to 1 year. Weight was increased for each exercise by the smallest possible increment after 2 sessions of completing 3 sets of 10 repetitions with no change in arm symptoms.

Participants in the control group (n = 75) were asked to not change baseline level of exercise during study participation and were offered a 1-year fitness center membership with 13 weeks of supervised instruction following study completion.

Fewer women experienced incident BCRL onset in the weight lifting intervention group (11%, 8 of 72) compared to the control group (17%, 13 of 75).

The difference was even greater among women with 5 or more lymph nodes removed:  7% (3 of 45) in the weight lifting intervention group and 22% (11 of 49) in the control group.

Once again, this is a small group, but I lean more and more towards allowing motivated patients to begin weight-lifting with a slow, progressive program.   They should learn proper technique.  They should wear their custom-fit compression garment during all exercise sessions.

Weight-lifting has been shown to decrease bone loss which is important in these women as in all women.  Having more strength can also aid in everyday activities like carrying bags of groceries or carrying children/grandchildren.

 

 

REFERENCE

Weight Lifting for Women at Risk for Breast Cancer–Related Lymphedema: A Randomized Trial; Kathryn H. Schmitz, Rehana L. Ahmed, Andrea B. Troxel, Andrea Cheville, Lorita Lewis-Grant, Rebecca Smith, Cathy J. Bryan, Catherine T. Williams-Smith, Jesse Chittams; JAMA. Published online December 8, 2010. doi:10.1001/jama.2010.1837

Weight Lifting in Women with Breast-Cancer–Related Lymphedema; New England Journal Medicine, Vol 361 (7):664-673, August 13, 2009; Kathryn H. Schmitz, Ph.D., M.P.H., Rehana L. Ahmed, M.D., Ph.D., Andrea Troxel, Sc.D., Andrea Cheville, M.D., Rebecca Smith, M.D., Lorita Lewis-Grant, M.P.H., M.S.W., Cathy J. Bryan, M.Ed., Catherine T. Williams-Smith, B.S., and Quincy P. Greene

…….

Related Posts

Lymphedema (December 5, 2007)

ARM Technique (October 15, 2008)

Weight Lifting Good for Breast Cancer Patients  (August 19, 2009)

1 comment:

Elaine Schattner, M.D. said...

Ramona, Thanks for covering this! Yes, there are a lot of women out there who've been told to limit arm exercises after breast cancer surgery, who don't have lymphedema. I'm among them. I swim with all strokes, and have started with light weights. It feels great -