Exercise And Compression Therapy To Improve Lymphedema In Breast Cancer: A Pilot Randomized Controlled Trial

Abstract

Breast cancer related lymphedema (BCRL) is a chronic swelling that may develop in breast, trunk and arm on the side of the surgery. More than one in five women with breast cancer develop BCRL. Recent studies in BCRL have demonstrated that resistance exercise can improve symptoms and quality of life without worsening the lymphedema. Few studies, however, have controlled for the use of a compression garment during or following exercise. Moreover, no studies have explored the potential of combining resistance exercise with therapeutic strategies to help reduce arm lymphedema volume. We hypothesize that a progressive resistance exercise program that incorporates compression therapy and follows the decongestive exercise sequence (DPRE) has the potential to reduce arm lymphedema volume. PURPOSE: To investigate the feasibility of a 12-week DPRE with compression therapy among women with BCRL. METHODS: A randomized controlled pilot trial was conducted involving 20 women with stable BCRL, recruited through the Cross Cancer Institute in Edmonton, Canada. As per standard of care, all women were required to wear their day-time compression sleeve daily for 12 hours. Women were randomly assigned to one of three groups: (i) Standard care: home decongestive exercise regimen (n=6), (ii) DPRE plus use of a daytime compression sleeve during exercise (n=7), and (iii) DPRE plus use of an adjustable compression wrap (AC) garment during exercise (n=7). Approval was obtained from the Health Research Ethics Board. Feasibility outcomes were analyzed descriptively. Due to the pilot nature of the study and the small sample size, no inferential analyses were performed. RESULTS: Feasibility data demonstrate high study completion (95%), attendance (94%) and adherence to prescribed protocol of DPRE program (97%). A mean reduction in arm lymphedema volume of 35 mls (-5.1%) was observed in the DPRE with day-time sleeve group and a 45 mls (-6.7%) in the DPRE with AC group. In contrast, a mean increase of 68 ml (+14.6%) was observed in the standard care group. CONCLUSION: DPRE with use of compression is feasible and shows promise in reducing arm lymphedema volume. A large-scale RCT is being conducted to examine the efficacy of this program on arm lymphedema volume, with the addition of imaging techniques to further inform changes to tissue composition.