Post-Operative Resistance Training for Early Breast Cancer Survivors Is Not Associated with Increased Prevalence of Lymphedema.
Authors: Kilbreah S. , Refshauge K. , Beith J. , Ward L. , Simpson J. , Lee M. 
Published: December 2010

Abstract
Introduction: Women treated for early breast cancer are routinely advised against lifting heavy objects on the affected side as it may precipitate lymphedema (LE). Women often therefore report that their arm feels weak. As part of a single-blinded randomised trial, we investigated whether an exercise program that included resistance training, commencing 4 weeks post-operatively, was associated with higher prevalence of LE.Methods: Women (mean age: 52.5 ± 11.7 y) who had undergone either axillary node dissection (AND; n=94) or sentinel node biopsy (SNB; n=62) in combination with mastectomy (n=74) or wide local excision (n=82) within the previous 4 weeks for unilateral early stage breast cancer were randomised to an exercise group (79) or usual care group (n=77). Women were stratified for axillary surgery (AND or SNB) and treatment site. The exercise group received a weekly supervised program that comprised resistance training and passive stretching for muscles about the shoulder. The muscles targeted for resistance training included the flexors, abductors, external rotators and horizontal flexors. Women completed two sets of 8 to 12 repetitions for each muscle group. For weekly supervised sessions, the resistance was provided by free weights; for the home program, women were provided with an appropriate grade of elastic Thera-Band®. Each week, the exercises were monitored, and progressed as required, aiming to achieve 'Hard' (15) on the 6 – 20 Borg Effort Scale. Presence of swelling was assessed by self-report, and by circumferential measurements at 10 cm-intervals, commencing at the ulnar styloid and by bioimpedance spectroscopy. Women in the usual care group received advice regarding active stretching.Results: Following an 8-week exercise program, women in the exercise group were not more likely to have LE or changes suggestive of LE. The results for women who had undergone AND are shown in Table 1; results are similar for women who underwent SNB. At baseline, more women in the exercise group had signs and symptoms indicative of LE but at 8 weeks, they had similar or fewer signs.Table 1. Prevalence of lymphoedema in women treated with AND Usual Care Exercise Baseline (n=46)8 weeks (n=44)Baseline (n=48)8 weeks (n=46)SELF REPORTED a) on exertion6 (13)4 (9)6 (12)4 (9)b) During ADL's2 (4)1 (2) 1 (2)c) Consistent, minor disability10 (22)3 (7)13 (26)7 (15)d) Consistent, major disability 4 (8)1 (2)ARM CIRCUMFERENCE (&gt;2cm interlimb diff) a) 1 measure &gt;2 cm1 (2)5 (11)8 (16)3 (7)b) 2+ measures &gt;2 cm2 (4)3 (7) 5 (11)BIOIMPEDANCE SPECTROSCOPY a) Above interlimb ratio cut-off5 (11)11 (25)5 (106 (13)b) &gt;10 % change from baseline to week 8 5 (11) 3 (7) Conclusion: An 8-week resistance training program for women at risk of LE did not result in greater numbers of women having measures associated with LE than those who did not participate in the training program. Weakness, following surgery for breast cancer, can commence early as 4 weeks post-operatively. Women will be re-assessed in 6 months to determine whether the low prevalence of LE in the exercise group is maintained.Acknowledgements: Cancer Council NSW for funding.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1057.