# Exercise as it relates to Disease/Breast Cancer Related Lymphoedema and Resistance Exercise

Breast Cancer Related Lymphoedema (BCRL) is a possible long term side effect of breast cancer treatment. Lymphoedema (or Lymphedema) is a chronic build up of lymph fluid caused by partial or complete obstruction of lymph nodes. Risk factors for developing BCRL include:
   * biopsy of axillary (arm pit) lymph nodes
   * removal or axillary lymph nodes
   * radiation therapy
   * obesity
   * tumour stage
Damage to the axillary lymph nodes during cancer treatment can impair or decrease the function of lymph vessels draining lymph from the arm to be returned to the blood stream. This can result in a build-up of fluid in the arm, chest or breast. Once the condition presents it is incurable and treatments focus on controlling the volume of swelling and infections.

## Resistance Exercise

Breast Cancer patients often avoid use of the affected limb out of fear of worsening the symptoms of BCRL. While this intends to reduce harm it can lead to a reduction in quality of life from further complications including:
   * Increased risk of injuring the weakened limb
   * Decreased physical recovery
   * Decreased muscle mass
   * Decreased bone density
   * Increased body weight
   * Decreased employment prospects
These issues can make everyday tasks like picking up a child difficult and greatly impacts on the long term health of the woman.

### Benefits of Resistance Exercise

Recent research has reduced concerns and shown resistance type exercises to not increase lymphoedema and to be safe for patients with BCRL while providing considerable health benefits. Resistance exercise has been shown to:
   * Control the severity of BCRL
   * Increase lymph flow
   * Decrease the number and severity of BCRL sypmtoms
   * Increase strength
   * Control body fat
Consideration should also be given to the psychological health benefits of resistance exercise including:
   * Improved self esteem
   * Improved self confidence
   * Improved social interactions
This research may indicate it is unreasonable to recommend breast cancer patients completely avoid physical activity and lifting loads equivalent to everyday tasks. This may include:
   * carrying a small bag of groceries
   * hanging washing
   * pushing a stroller
Promising research is being undertake to determine the best type of resistance exercises for BCRL patients with results to be published shortly.

### Considerations and Precautions

While research has shown the safety of resistance type exercises some care and planning needs to be taken:
   * discuss physical activity with your doctor to determine what may be appropriate.
   * ensure infections and exacerbations of lymphoedema are under control.
   * stop any activity which causes swelling or pain in the limb.

## External links

* www.livestrong.org Physical Effects of Cancer: Lympoedema

## References

* 1 2 3 4 5 "Study explores best exercise for breast cancer survivors" Author: Claudia Doman. Retrieved from http://www.canberra.edu.au/faculties/health/news
* 1 2 3 4 5 6 7 8 9 10 11 Schmitz, K.H., Ahmed, R.L., Troxel, A., Cheville, A., Smith, R., Lewis-Grant, L.,Bryan, C.J.,Williams-Smith, C.T & Greene, Q.P., 2009, “Weight Lifting in Women with Breast-Cancer–Related Lymphedema”, N Engl J Med 2009; vol 361, pp664-673 (August 13, 2009) http://www.nejm.org/doi/full/10.1056/NEJMoa0810118#t=articleMethods
* 1 2 3 Lane, K., Worsley, D. & McKenzie, D. 2005, "Exercise and the Lymphatic System: Implications for Breast-Cancer Survivors, Sports Med. vol.35(6), p461-471
* ↑ Livestrong.org - Physical Effects of Cancer: Lympoedema http://www.livestrong.org/Get-Help/Learn-About-Cancer/Cancer-Support-Topics/Physical-Effects-of-Cancer/Lymphedema