Weight-training for lymphedema

Did you know . . .

That weight-lifting exercise is actually GOOD for lymphedema?  For years we’ve been advising to avoid weight-lifting exercises as they were thought to potentially exacerbate lymphedema.  The 2005 National Lymphedema Network guidelines for risk reduction, treatment, and exercise of lymphedema state that strength training is the type of exercise the “poses the greatest risk to individuals with lymphedema”.  However, recent studies not only debunk this theory, but show that upper body strength training can actually reduce lymphedema exacerbations.

Lymphedema after breast cancer treatment is characterized by swelling, discomfort, and impairment of arm/hand function.  It is objectively defined as a 10% or more difference in circumference or volume of the affected arm compared to the other, or as the presence of pitting edema or distortion of the normal arm and hand architecture.  It is caused by removal or destruction of the axillary lymphatics that function to drain interstitial fluid from the arm.  In other words, the lymphatics serve as the wastewater plumbing system for the rain runoff.  Thus, anything that increases fluid buildup (heavy rain storm) can pose a risk of overwhelming the damaged lymphatic system, causing “flooding”.  Things that increase interstitial fluid buildup include things that cause more fluid to leak out of the blood vessels (like infection).  Things that decrease interstitial fluid buildup include things that increase the tissue pressure (like compression garments).  Furthermore, the lymphatic flow can be stimulated by muscle and respiratory movement, or by manual lymphatic drainage.

So, the concern with exercise was that it would increase swelling by causing an increase in fluid buildup.  Patients were told to avoid carrying heavy objects (which may well still apply) and avoid weight lifting exercises.  However, a number of controlled trials have now been performed to test whether this theoretical concern about lymphedema exacerbation is actually true in real life.  Several studies showed that carefully conducted weight-training programs did NOT exacerbate lymphedema in patients who did not already have lymphedema.  But the pivotal study, meaning the one that really answers the question once and for all, was one that was published in the New England Journal of Medicine in August 2009 (K.H. Schmitz et al, NEJM 361(7):664-73, 2009).

In this study, 141 breast cancer survivors who had been diagnosed with lymphedema were randomized to a weight-training program conducted under conditions of careful supervision or to a control group that did not have weight-training.  The primary question of the study to was see whether weight-training exercise worsened lymphedema in those who were already known to be at the highest risk.  The study found that, not only did the exercise program not increase swelling of the arm, it actually resulted in fewer lymphedema exacerbations in the women who were in the weight lifting program vs. those who were not.  Furthermore, troublesome lymphedema symptoms were less in the group that did the weight-training program than those who did not.  Finally, there was significantly improved strength (upper and lower body) in those who participated in the weight-lifting program.

So does this mean that we should all pick up weight training programs?  Probably.  But a word of caution.  Remember the advertisements “Do not try this at home”?  (Yeah, I know, I haven’t watched TV since I was a kid).  The weight training programs that these studies used were taught and supervised by certified trainers, and conducted under the watchful eye of certified lymphedema therapists.  In other words, be careful about what you do and how you do it to make sure that you are not doing something that CAN injure your arm or not getting attention for possible lymphedema flare-ups.  Get started at a gym with knowledgeable trainers, or join a program that specializes in breast cancer survivors.

That’s why New Life After Cancer has organized a fall workshop series “Arm Yourself Against Lymphedema” that will teach a weight-lifting program that you can continue on your own at home after the 6-week course, provided with the instruction and exercise equipment you need.  For more information, check out our workshops (www.newlifeaftercancer.org) or email .(JavaScript must be enabled to view this email address).  You can also find out more about available exercise programs in your region from your local cancer center, or through the NC Comprehensive Cancer network if in North Carolina.  Finally, Lance Armstrong’s Livestrong works with YMCAs across the country to provide weight-training programs for breast cancer survivors.  Remember, you do not have to be a victim to fear of lymphedema; there are things that you can do to reduce your risk and relieve the symptoms.  Let’s work those biceps!

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