Study: Research suggests exercise is safe for breast cancer patients at risk for lymphedema
This study is about:
How exercise affects (swelling in the arm or hand) that can occur after breast cancer treatment.
Why is this study important?
Over the years, research on the relationship of exercise to has had mixed results; some studies suggested that exercise could cause cancer patients to develop or make their current worse, while other studies found that a gradual exercise program helps patients with .
After 6 months of resistance exercise training, the extent of did not change significantly.
What does this mean for me?
This study suggests that women who have been treated for breast cancer can perform moderate-intensity exercise (including aerobic and strength exercises) without developing or making their existing worse. However, as other research studies in the literature contradict these findings, more work is needed to fully understand the relationship between exercise and development. Breast cancer survivors and women who have had mastectomy should report any symptoms of to their health care providers, and consult with them before beginning any type of exercise program.
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Paskett, ED, Le-Rademacher, J, Oliveri, J, et al. “Prevention of in women with breast cancer (BC); Results of CALGB (Alliance) 70305." Abstract 104 from Cancer Survivorship Symposium Advancing Care and Research, presented January 27, 2017.
Runowicz CD, Leach CR, Henry NL, et al. “American Cancer Society/America Society of Clinical Oncology Breast Cancer Survivorship Care Guideline.” Journal of Clinical Oncology 2016; 34(6): 611-635, February 2016. “Weight lifting in women with breast-cancer-related .”
Schmitz K, Ahmed R, Troxel A, et al. “Weight lifting in women with breast-cancer-related .” New England Journal of Medicine 2009; 361(7): 664–673.
Simonavice E, Kim JS, and Panton L. “Effects of resistance exercise in women with or at risk for breast cancer-related .” Supportive Care Cancer. Published online first on Aug. 11, 2016.
This article is relevant for:
People with, or at high risk for lymphedema after breast cancer
This article is also relevant for:
people with breast cancer
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IN DEPTH REVIEW OF RESEARCH
, a swelling of the arm or hand due to lymph node damage, is an adverse side effect that often occurs after breast cancer treatment. Currently there is no cure for . Patients who develop this condition can ultimately experience symptoms such as changes in sensation in the arms, a greater feeling of fatigue, and decreased quality of life. Other side effects of breast cancer treatment include decreased bone health and increased fat mass. Strength or resistance exercises can help patients to improve their bone health and weight gain that may occur. However, some research suggests that resistance exercise may cause patients to develop or make it worse.
Emily Simonavice and colleagues from the School of Health and Human Performance in George College and State University and other institutions studied the effect of resistance exercise in women who were treated for breast cancer; their results were published in the journal Supportive Cancer Care. This is one of several recent studies that suggests that strength exercise is safe for breast cancer survivors and does not cause or make existing worse.
Researchers of this study wanted to know:
How does exercise affect in women who have been treated for breast cancer?
Population(s) looked at in the study:
- Study participants included 25 women who:
- had breast cancer between stages 0-III
- completed all primary treatments (surgery, radiation, and/or chemotherapy) at least 6 months before the study started
- Initially, 27 women began the study, but two dropped out due to clinical complications unrelated to . However, data from these women while they were in the study were collected and included in the results.
- Three of the women already had when the study began.
- Each woman had 2-hour, moderate resistance exercise training sessions per week, which included an aerobic warm-up and exercises targeting all major muscle groups (such as chest presses, leg presses, biceps curls).
- The presence and/or extent of was determined by measuring each woman’s arm circumference every two weeks.
- After 6 months of resistance exercise training the extent of did not change significantly.
These findings are preliminary because this study did not include a control group. Although all of the women included in the study performed the moderate resistance training, the researchers could not compare between women who did and did not exercise (no information was available regarding the arm circumference changes of breast cancer survivors who did not exercise over the same period). It was also a relatively small study: just 27 women. Additionally, the study included only 3 women who already had lymphedema; too small to generalize the findings to all women with . Another reason that this study cannot be generalized is because participants had different combinations of surgery, radiation, chemotherapy, and lymph node dissection (not all women had all four treatments). Finally, the study also looked only at breast cancer survivors. The effects of exercise on previvors after risk-reducing mastectomy due to a mutation in or other gene that affects cancer risk is not addressed by this study.
This study suggests that women who have been treated for breast cancer can exercise without developing or making their worse. Because of the study’s limitations, however, more work needs to be done to fully understand the relationship between exercise and . Other researchers have explored this area—a 2009 paper in the New England Journal of Medicine by Dr. Kathryn Schmitz from the University of Pennsylvania School of Medicine showed that breast cancer patients with existing who did resistance exercise had greater improvements in the severity of their self-reported symptoms compared to patients who did not exercise. Another recent report of preliminary findings presented at the Cancer Survivorship Symposium Advancing Care and Research in 2017 found no difference in the rates of between breast cancer patients who exercised and those who did not.
All women who undergo breast surgery and/or radiation to treat breast cancer or reduce the risk of breast cancer are at risk for lymphedema; having axillary lymph node dissection increases that risk.
Current breast cancer survivorship care guidelines from the American Cancer Society and the American Society of Clinical Oncology recommend that health care providers refer patients with arm swelling or other symptoms of to a specialist who can recommend appropriate treatment. These guidelines also note that more research is required to develop clear evidence-based recommendations to prevent after breast surgery and/or radiation. Patients concerned about should discuss symptoms with their health care providers to determine what treatment or prevention measures are best for them.
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The National Comprehensive Cancer Network has guidelines on prevention. According to NCCN:
- Limbs should be measured pretreatment on both sides to establish a baseline. Ideally, measurement should be performed by specialists.
- People at risk for should be informed about the following:
- Signs of including swelling, tightness, heaviness, or pain on the side of treatment.
- Signs of infection in the treated area and the the importance of notifying their healthcare providers if they see any of these signs.
- Progressive weight training and physical activity has not been shown to worsen and may improve symptoms. Survivors with, or at risk for should speak with a expert before starting strength or resistance training.
- Air travel, blood pressure measurement, and blood draws have not been proven by to cause or worsen . More research is needed. Until then, if possible blood draws and blood pressures should be done on limbs that are not at high risk.
- Providers should ask their patients about any changes or symptoms of at each visit.
NCCN has guidelines for people diagnosed with . NCCN recommends that healthcare providers:
- Rule out recurrence of cancer.
- Refer patients to a certified specialist if available to assess, and plan treatment .
- Treatment should include:
- Survivor education on self-care management.
- Compression garments.
- Supervised exercise.
- Manual lymphatic drainage.
- Physical activity and exercise recommendations should be tailored to each person's abilities and preferences.
- People should try to engage in some physical activity daily; this may include:
- taking the stairs.
- walking more.
- Each week, people should try to achieve the following:
- At least 150 minutes of moderate-intensity exercise, with an ideal goal of 300 minutes, 75 minutes of vigorous activity or a combination of the two.
- Two to three sessions of strength/resistance training that include all of the major muscle groups (chest, shoulders, arms, back, core and legs).
- Stretch major muscle groups at least two days per week.
- Avoid sitting or lying down for long periods and other prolonged sedentary behavior.
- I recently completed breast cancer treatment; am I ready for an exercise program?
- I had breast surgery to treat breast cancer; what types of exercises are right for me?
- Am I at risk for after breast surgery or radiation?
- What are the symptoms of ?
- What should I do if I notice swelling in my arm or hand?
- Are there ways to reduce the adverse symptoms of ?
The following are studies are looking at prevention or treatment of .
- NCT01521741: Analysis of Symptoms and in Patients Following Treatment for Breast Cancer. The objective of this study is to determine the level of symptoms, functional disability, and changes in quality of life that breast cancer patients experience from changes in their arm(s) during and after treatment for breast cancer.
- NCT01336790: International Lymphatic Disease and Registry. The purpose of the National Lymphatic Disease and Registry is to collect health information in order to study the disease classification, natural history, and impact of Lymphatic Disease, and Related Disorders and its treatments and medical outcomes.
- NCT03861975: Exploring the Efficacy and Feasibility of the LymphaTech Scanner for Breast Cancer-Related Screening. This research will assess arm edema using the LymphaTech Scanner, and a comprehensive self-report questionnaire in patients who have been diagnosed with invasive breast cancer or .
- NCT04241341: Does Immediate Lymphatic Reconstruction Decrease the Risk of After Axillary Lymph Node Dissection? The researchers are doing this study to see if having immediate lymphatic reconstruction after axillary lymph node dissection (ALND) can decrease the development of , a side effect of ALND.
The following resources can help you locate an expert near you.
- The Lymphology Association of North America (LANA) has a database which allows people to search for specialists by location.
- The National Network has a database of clinics.
Some symptoms of may be managed by other experts.
- The American Physical Therapy Association's ChoosePT.com website allows you to search for a physical therapist by specialty in your area.
Other ways to find experts
- Register for the FORCE Message Boards and post on the Find a Specialist board to connect with other people who share your situation.
- The National Cancer Institute (NCI)-designated comprehensive cancer centers have specialists to manage the symptoms and side effects from cancer prevention or treatment.
The YMCA has a free program called Livestrong at the YMCA. This program includes a free 12-week membership and fitness training with certified exercise experts. You can search by zip code for a program near you.
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