Weight Lifting for Women at Risk for Breast Cancer–Related Lymphedema
Authors: Kathryn H. Schmitz, Rehana L. Ahmed, Andrea B. Troxel, Andrea Cheville, Lorita Lewis-Grant, Rebecca Smith, Cathy J. Bryan, Catherine T. Williams-Smith, Jesse Chittams
Journal: JAMA (2010)

ORE THAN 2.4 MILLION breast cancer survivors live in the United States. 1 Lymphedema ranks high among their concerns because it causes swelling and discomfort, impairing arm function and quality of life 2,3 and increasing health care costs. 4Lymphedema remains a frequent complication among survivors, despite lymphatic-sparing procedures such as sentinel lymph node biopsy.Of the 61% of patients who undergo sentinel lymph node biopsy, 5% to 7% develop breast cancer-related lymphedema. 5,6However, one-third of patients with breast cancer require complete axillary dissection, 5 which is associated with 13% to 47% incident lymphedema. 7,8reast cancer survivors at risk for lymphedema alter activity, limit activity, or both from fear and uncertainty about their personal risk level, and upon guidance advising them to avoid lift-Context Clinical guidelines for breast cancer survivors without lymphedema advise against upper body exercise, preventing them from obtaining established health benefits of weight lifting.Objective To evaluate lymphedema onset after a 1-year weight lifting intervention vs no exercise (control) among survivors at risk for breast cancer-related lymphedema (BCRL). Design, Setting, andParticipants A randomized controlled equivalence trial (Physical Activity and Lymphedema trial) in the Philadelphia metropolitan area of 154 breast cancer survivors 1 to 5 years postunilateral breast cancer, with at least 2 lymph nodes removed and without clinical signs of BCRL at study entry.Participants were recruited between October 1, 2005, and February 2007, with data collection ending in August 2008.Intervention Weight lifting intervention included a gym membership and 13 weeks of supervised instruction, with the remaining 9 months unsupervised, vs no exercise. Main Outcome MeasuresIncident BCRL determined by increased arm swelling during 12 months (Ն5% increase in interlimb difference).Clinician-defined BCRL onset was also evaluated.Equivalence margin was defined as doubling of lyphedema incidence.Results A total of 134 participants completed follow-up measures at 1 year.The proportion of women who experienced incident BCRL onset was 11% (8 of 72) in the weight lifting intervention group and 17% (13 of 75) in the control group (cumulative incidence difference [CID], -6.0%; 95% confidence interval [CI], -17.2% to 5.2%; P for equivalence=.04).Among women with 5 or more lymph nodes removed, the proportion who experienced incident BCRL onset was 7% (3 of 45) in the weight lifting intervention group and 22% (11 of 49) in the control group (CID, -15.0%; 95% CI, -18.6% to -11.4%; P for equivalence=.003).Clinician-defined BCRL onset occurred in 1 woman in the weight lifting intervention group and 3 women in the control group (1.5% vs 4.4%, P for equivalence=.12). ConclusionIn breast cancer survivors at risk for lymphedema, a program of slowly progressive weight lifting compared with no exercise did not result in increased incidence of lymphedema.