Like much of traditional advice about exercise for cancer patients, it now appears that advice about strength training for breast cancer patients with post-surgery lymphedema, and those at risk for lymphedema, was simply wrong. Lymphedema is a buildup of fluid in the arms of breast cancer patients who have had lymph nodes in their arms removed as part of the diagnostic process for breast cancer. The absence of the lymph nodes impedes circulation of lymphatic fluid, and the consequent fluid accumulation causes arm swelling and substantial discomfort. As we begin Breast Cancer Awareness Month, we’d like to look at the new thinking about strength training in lymphedema that is emerging from multiple research studies.
As many as 40% of breast cancer patients experience lymphedema. Risk factors for lymphedema include having more than 5 lymph nodes removed, radiotherapy to the armpit area, high body weight at diagnosis and blood draws from the affected arm (advice to avoid such blood draws is still accurate). Traditional counseling about lymphedema has asked patients to avoid any kind of strenuous exercise involving the surgery arm. But this denies women the benefits of upper body strength training, which is an important component of exercise programs, especially as women grow older.
Now a body of research questions that advice and, in fact, shows that strength training doesn’t raise risks of lymphedema, may improve the resulting arm swelling, and offsets deterioration in physical function in breast cancer patients. A newly published review article in the Journal of Strength and Conditioning Research analyzed results of 6 randomized trials involving over 800 breast cancer patients, and found that breast cancer patients can, in fact, perform arm strength training exercises that are sufficient to significantly improve arm strength without triggering lymphedema.
One of the first studies in this area was published back in 2009. Researchers found that breast cancer patients who had had at least 2 lymph nodes removed in surgery could go through a slowly progressive weight-lifting program without experiencing lymphedema. This was true for both women who had more than 5 nodes removed, and those with fewer nodes. A key feature here was slowly progressing the weight training program: the women were all given gym membership, with 13 weeks supervised instruction followed by 9 months of exercising on their own. They started with light weights and only slowly moved to the heavier weights that could truly improve their arm strength. A followup study found that half as many patients in the strength training group as in the control group experienced a deterioration in physical function during the exercise period. Deteriorating physical function is especially concerning in an era where most women live for many years after breast cancer diagnosis. It is linked to injuries, bone fractures, disability and even mortality. This shows the importance of allowing lymphedema patients access to the benefits of strength training.
A study just published in Integrative Cancer Therapies, the peer-reviewed journal edited by Dr Block, analyzes the dynamics of progressive weight-lifting more closely to distinguish any possibilities of tissue injury. Lymphedema patients participated in weight-lifting sessions of three different intensities. Low-intensity sessions involved light weights that the patients could lift a maximum of 20 times. Medium-intensity sessions involved heavier weights that they could only lift 12 times. High-intensity sessions were with weights that they could only lift 8 times at most. The patients performed 3 sets of 6 different weight-lifting exercises with these weights; sessions were separated by at least a week to allow for recovery (weight training should not be done more than 2-3 times a week in any case). Before and after each session, researchers measured arm swelling, lymphedema symptoms, and markers of inflammation and muscle damage. They found that none of the sessions, regardless of intensity, caused changes in inflammation or muscle damage, and there were no changes in arm swelling or severity of lymphedema symptoms. We feel that this implies that even patients who already have lymphedema can carefully use strength training under proper instruction from a physical therapist or trainer – of course, being willing to move down to lower-intensity sessions should any sign of worsening symptoms appear.
Cancer patients used to be uniformly told to “rest.” We’ve long argued that such inactivity was a prescription for worse cancer outcomes, and now research is proving this to be the case. Physical activity of many kinds is being shown to benefit cancer patients, and weight training for breast cancer patients at risk for lymphedema is only one example of this trend. We urge all breast cancer patients whose surgeries included lymph node removal to meet with a trainer or physical therapist, and start on an individualized weight training program. The benefits are yours to claim!