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Strength Training After Breast Surgery

by Margaret Snow, MD

“…weightlifters had fewer swelling flare-ups, and on average, reported their symptoms as somewhat less bothersome…”

Lymphedema is fluid buildup and swelling that develops in a limb or other part of the body when the lymphatic system that ordinarily carries fluid back to the heart is disrupted. This disruption may be congenital or caused by surgery, trauma, or radiation. A common byproduct of breast cancer treatment, lymphedema may affect the arm on the same side of the breast that is treated with surgery or radiation. The swelling and impaired lymph function can cause pain, infection, and loss of arm mobility. Overuse or injury can cause lymphedema to flare up, and arm swelling may worsen over time.

Patients with lymphedema have traditionally been advised to avoid heavy exertion and weightlifting in the arm or on the side affected by lymphedema. However, experts know that weightlifting is an effective strategy to use muscle and build strength so the arm or affected limb will be less prone to injury. Previously, small studies suggested weightlifting as a safe strength-building regimen in these patients. Kathryn H Schmitz, PhD, from Abramson Cancer Center at the University of Pennsylvania, conducted the Physical Activity and Lymphedema (PAL) Study to definitively answer the question of weightlifting safety in lymphedema patients.

The study recruited women who developed lymphedema after treatment for unilateral breast cancer. Each patient was carefully measured by specially-trained physical therapists before the study and throughout. The researchers also collected surveys of patient symptoms. The 141 patients were divided into two groups: an exercise group and a control group that did no exercise. The exercise group worked out at local YMCAs with fitness trainers who had undergone three days of training with Dr. Schmitz to learn how to work with breast cancer survivors with lymphedema. Both groups of patients were fitted with custom lymphedema sleeves; the exercise group was asked to use the sleeves whenever they performed the recommended armstrengthening, trunk and leg exercises. The weight was gradually increased with a focus on building strength.

The PAL study found that patients who participated in the weightlifting program increased their strength when compared to the control patients. Women who lifted weights did not have any more swelling than the control patients who did not exercise. In fact, they had fewer swelling flare-ups, and on average, reported their symptoms as somewhat less bothersome after a year compared to the control patients.

Because none of the measures of lymphedema severity were worse in the exercise group than in the control group, the authors concluded that the study “reduced the concerns that weightlifting would worsen arm and hand swelling…and supports the potential benefits” of a weightlifting program for breast cancer survivors with lymphedema.

As a result of the study, Dr. Schmitz and her colleagues developed the Physical Activity and Lymphedema (PAL) Weight Training Program. The program should not be undertaken unless you have completed supervised sessions with a physical therapist to learn how to do the upper body exercises properly. You can learn more about the program at lymphnet.org.

Dr. Margaret Snow is a previvor and a Physical Medicine and Rehabilitation physician who enjoys golfing and photographing birds. She serves as FORCE’s West Michigan Outreach Coordinator.

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