Weight Lifting for Women at Risk for Breast Cancer–Related Lymphedema: A Randomized Trial

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) amon...

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Published in:JAMA : the journal of the American Medical Association 2010-12, Vol.304 (24), p.2699-2705
Main Authors: Schmitz, Kathryn H, Ahmed, Rehana L, Troxel, Andrea B, Cheville, Andrea, Lewis-Grant, Lorita, Smith, Rebecca, Bryan, Cathy J, Williams-Smith, Catherine T, Chittams, Jesse
Format: Article
Language:English
Subjects:
Aged
Biological and medical sciences
Breast cancer
Breast Neoplasms - surgery
Disease prevention
Female
General aspects
Gynecology. Andrology. Obstetrics
Humans
Lymph Node Excision - adverse effects
Lymphedema - etiology
Lymphedema - prevention & control
Mammary gland diseases
Medical sciences
Middle Aged
Risk
Skin plastic surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Survivors
Treatment Outcome
Tumors
Weight Lifting
Weightlifting
Womens health
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Summary: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, AND PARTICIPANTS 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 MEASURES Incident BCRL determined by increased arm swelling during 12 months (≥5% 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). CONCLUSION In 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. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00194363Published online December 8, 2010. doi:10.1001/jama.2010.1837
ISSN:0098-7484
1538-3598
DOI:10.1001/jama.2010.1837