Effect Of Comprehensive Exercise On Lymphedema In Breast Cancer Survivors: A Pilot Study

Abstract

One in nine women are diagnosed with breast cancer. Early diagnosis and better treatments are allowing women to survive longer. With this positive trend, greater attention is being focused on survivorship issues such as lymphedema, which affects 5-30% of patients who have undergone treatment for breast cancer. Previously there was a concern that aerobic exercise and resistance training in the effected arm may cause or worsen lymphedema. Limited studies have provided preliminary evidence to suggest that exercise may be safe. PURPOSE: To examine changes in strength and arm circumferences (as a measurement of lymphedema) in 32 breast cancer survivors before and after undergoing a comprehensive exercise program. METHODS: This retrospective study reviewed results of 32 breast cancer survivors (mean age 51, range 26-76) who voluntarily enrolled in a comprehensive fitness program. Twenty-two percent of the women had lymphedema at baseline. Cancer treatment included a combination of mastectomy (60%), lumpectomy (40%), axillary node dissection (69%), sentinel node biopsy (28%), radiation therapy (69%) and chemotherapy (88%). Participants completed a supervised exercise program 2-3 times per week including aerobic and resistance exercise. Arm circumference (sub-axillary, upper arm and forearm) were obtained at baseline and after an average of 22 weeks (range 12-40 weeks) of training. Pre and post exercise measurements in arm circumference and biceps curl strength were assessed for all women as a group, as well as for subgroups by treatment type, using two-tailed t-tests. Results: Compliance with the training program was excellent (83%). There was no significant increase in arm circumference post exercise for the entire group, nor for any treatment subgroup. Interestingly, the sub-axillary measurement showed a significant decrease in circumference (p=0.05) for the entire group. Biceps strength increased for the entire group as well as for all subgroups (p<0.05). CONCLUSION: Participation in a comprehensive exercise program for breast cancer survivors was well tolerated. The women demonstrated a decrease in sub-axillary arm circumference with concurrent improvements in biceps strength. This study supports the limited body of literature supporting the safety and efficacy of exercise in this population.