Weight Lifting for Women at Risk for Breast Cancer–Related Lymphedema: A Randomized Trial | Breast Cancer | JAMA | JAMA Network
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1.
Ries LAG, Eisner MP, Kosary CL,  et al.  SEER Cancer Statistics Review. http://seer.cancer.gov/csr/1975_2000. Accessed November 21, 2010
2.
Ahmed RL, Prizment A, Lazovich D, Schmitz KH, Folsom AR. Lymphedema and quality of life in breast cancer survivors: the Iowa Women's Health Study.  J Clin Oncol. 2008;26(35):5689-569619001331PubMedGoogle ScholarCrossref
3.
Cormier JN, Xing Y, Zaniletti I, Askew RL, Stewart BR, Armer JM. Minimal limb volume change has a significant impact on breast cancer survivors.  Lymphology. 2009;42(4):161-17520218084PubMedGoogle Scholar
4.
Shih YC, Xu Y, Cormier JN,  et al.  Incidence, treatment costs, and complications of lymphedema after breast cancer among women of working age: a 2-year follow-up study.  J Clin Oncol. 2009;27(12):2007-201419289624PubMedGoogle ScholarCrossref
5.
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009.  CA Cancer J Clin. 2009;59(4):225-24919474385PubMedGoogle ScholarCrossref
6.
Wilke LG, McCall LM, Posther KE,  et al.  Surgical complications associated with sentinel lymph node biopsy: results from a prospective international cooperative group trial.  Ann Surg Oncol. 2006;13(4):491-50016514477PubMedGoogle ScholarCrossref
7.
Francis WP, Abghari P, Du W, Rymal C, Suna M, Kosir MA. Improving surgical outcomes: standardizing the reporting of incidence and severity of acute lymphedema after sentinel lymph node biopsy and axillary lymph node dissection.  Am J Surg. 2006;192(5):636-63917071198PubMedGoogle ScholarCrossref
8.
Sagen A, Kåresen R, Risberg MA. Physical activity for the affected limb and arm lymphedema after breast cancer surgery. A prospective, randomized controlled trial with two years follow-up.  Acta Oncol. 2009;48(8):1102-111019863217PubMedGoogle ScholarCrossref
9.
Susan G. Komen for the Cure.  Lymphedema. http://ww5.komen.org/BreastCancer/Lymphedema.html. Accessed November 21, 2010
10.
American Cancer Society.  Lymphedema: What Every Woman With Breast Cancer Should Know. http://www.cancer.org/Treatment/TreatmentsandSideEffects/PhysicalSideEffects/Lymphedema/WhatEveryWomanwithBreastCancerShouldKnow/index. Accessed November 21, 2010
11.
Schmitz KH. Balancing lymphedema risk: exercise versus deconditioning for breast cancer survivors.  Exerc Sport Sci Rev. 2010;38(1):17-2420016295PubMedGoogle ScholarCrossref
12.
Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA. Physical activity and survival after breast cancer diagnosis.  JAMA. 2005;293(20):2479-248615914748PubMedGoogle ScholarCrossref
13.
Sternfeld B, Weltzien E, Quesenberry CP Jr,  et al.  Physical activity and risk of recurrence and mortality in breast cancer survivors: findings from the LACE study.  Cancer Epidemiol Biomarkers Prev. 2009;18(1):87-9519124485PubMedGoogle ScholarCrossref
14.
Ahmed RL, Thomas W, Yee D, Schmitz KH. Randomized controlled trial of weight training and lymphedema in breast cancer survivors.  J Clin Oncol. 2006;24(18):2765-277216702582PubMedGoogle ScholarCrossref
15.
Schmitz KH, Ahmed RL, Troxel A,  et al.  Weight lifting in women with breast-cancer-related lymphedema.  N Engl J Med. 2009;361(7):664-67319675330PubMedGoogle ScholarCrossref
16.
Cheville AL, McGarvey CL, Petrek JA, Russo SA, Thiadens SR, Taylor ME. The grading of lymphedema in oncology clinical trials.  Semin Radiat Oncol. 2003;13(3):214-22512903011PubMedGoogle ScholarCrossref
17.
National Lymphedema Network.  Position Statement of the National Lymphedema Network: Topic: Training of Lymphedema Therapists (November 10, 2005). http://www.lymphnet.org/pdfDocs/nlntraining.pdf. Accessed November 21, 2010
18.
Evans SJWDS, Royston P. MINIM: Minimisation Program for Allocating Patients to Treatments in Clinical Trials, Version 1.5. London, England: London Hospital Medical College; 1990
19.
Pocock SJ, Simon R. Sequential treatment assignment with balancing for prognostic factors in the controlled clinical trial.  Biometrics. 1975;31(1):103-1151100130PubMedGoogle ScholarCrossref
20.
Schmitz KH, Troxel AB, Cheville A,  et al.  Physical Activity and Lymphedema (the PAL trial): assessing the safety of progressive strength training in breast cancer survivors.  Contemp Clin Trials. 2009;30(3):233-24519171204PubMedGoogle ScholarCrossref
21.
National Lymphedema Network.  Position Statement of the National Lymphedema Network: Topic: Exercise (May 26, 2005). http://www.lymphnet.org/pdfDocs/nlnexercise.pdf. Accessed November 21, 2010
22.
National Lymphedema Network.  Position Statement of the National Lymphedema Network: Topic: Treatment (August 10, 2006). http://www.lymphnet.org/pdfDocs/nlntreatment.pdf. Accessed November 21, 2010
23.
National Lymphedema Network.  Position Statement of the National Lymphedema Network: Topic: Lymphedema Risk Reduction Practices (March 2008). http://www.lymphnet.org/pdfDocs/nlnriskreduction.pdf. Accessed November 21, 2010
24.
National Lymphedema Network.  Position Statement of the National Lymphedema Network: Topic: Lymphedema Risk Reduction Practices (2005). http://www.lymphnet.org/lymphedemaFAQs/positionPapers.htm. Accessed November 21, 2010
25.
Craig CL, Marshall AL, Sjöström M,  et al.  International physical activity questionnaire: 12-country reliability and validity.  Med Sci Sports Exerc. 2003;35(8):1381-139512900694PubMedGoogle ScholarCrossref
26.
Subar AF, Thompson FE, Kipnis V,  et al.  Comparative validation of the Block, Willett and National Cancer Institute food frequency questionnaires.  Am J Epidemiol. 2001;154(12):1089-109911744511PubMedGoogle ScholarCrossref
27.
King TI II. The effect of water temperature on hand volume during volumetric measurement using the water displacement method.  J Hand Ther. 1993;6(3):202-2048401801PubMedGoogle ScholarCrossref
28.
Dodds RL, Nielsen KA, Shirley AG, Stefaniak H, Falconio MJ, Moyers PA. Test-retest reliability of the commercial volumeter.  Work. 2004;22(2):107-11015004344PubMedGoogle Scholar
29.
Norman SA, Miller LT, Erikson HB, Norman MF, McCorkle R. Development and validation of a telephone questionnaire to characterize lymphedema in women treated for breast cancer.  Phys Ther. 2001;81(6):1192-120511380275PubMedGoogle Scholar
30.
Fleck S, Kraemer W. Designing Resistance Training Programs. 2nd ed. Champaign, IL: Human Kinetics; 1997
31.
Barnard KL, Adams KJ, Swank AM, Mann E, Denny DM. Injuries and muscle soreness during the one repetition maximum assessment in a cardiac rehabilitation population.  J Cardiopulm Rehabil. 1999;19(1):52-5810079421PubMedGoogle ScholarCrossref
32.
Shaw CE, McCully KK, Posner JD. Injuries during the one repetition maximum assessment in the elderly.  J Cardiopulm Rehabil. 1995;15(4):283-2878542534PubMedGoogle ScholarCrossref
33.
Schrenk P, Rieger R, Shamiyeh A, Wayand W. Morbidity following sentinel lymph node biopsy versus axillary lymph node dissection for patients with breast carcinoma.  Cancer. 2000;88(3):608-61410649254PubMedGoogle ScholarCrossref
34.
Radak Z, Chung HY, Koltai E, Taylor AW, Goto S. Exercise, oxidative stress and hormesis.  Ageing Res Rev. 2008;7(1):34-4217869589PubMedGoogle ScholarCrossref
35.
Johansson K, Tibe K, Weibull A, Newton RC. Low intensity resistance exercise for breast cancer patients with arm lymphedema with or without compression sleeve.  Lymphology. 2005;38(4):167-18016515225PubMedGoogle Scholar
36.
Courneya KS, Segal RJ, Mackey JR,  et al.  Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial.  J Clin Oncol. 2007;25(28):4396-440417785708PubMedGoogle ScholarCrossref
37.
McKenzie DC, Kalda AL. Effect of upper extremity exercise on secondary lymphedema in breast cancer patients: a pilot study.  J Clin Oncol. 2003;21(3):463-46612560436PubMedGoogle ScholarCrossref
38.
Torres Lacomba M, Yuste Sánchez MJ, Zapico Goñi A,  et al.  Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: randomised, single blinded, clinical trial.  BMJ. 2010;340:b539620068255PubMedGoogle ScholarCrossref
39.
National Lymphedema Network.  Position Statement of the National Lymphedema Network: Topic: Exercise for Lymphedema Patients (2008). http://www.lymphnet.org/lymphedemaFAQs/positionPapers.htm. Accessed November 21, 2010
40.
Schmitz KH, Courneya KS, Matthews C,  et al; American College of Sports Medicine.  American College of Sports Medicine roundtable on exercise guidelines for cancer survivors.  Med Sci Sports Exerc. 2010;42(7):1409-142620559064PubMedGoogle ScholarCrossref
Original Contribution
December 22 2010

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

Author Affiliations

Author Affiliations: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine and Abramson Cancer Center, Philadelphia (Drs Schmitz and Troxel and Mss Lewis-Grant, Bryan, and Williams-Smith and Mr Chittams); Department of Dermatology, University of Minnesota Medical School, Minneapolis (Dr Ahmed); Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota (Dr Cheville); and Department of Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine, Philadelphia (Drs Cheville and Smith).

JAMA. 2010;304(24):2699-2705. doi:10.1001/jama.2010.1837
Abstract

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: NCT00194363

Trial Registration Published online December 8, 2010. doi:10.1001/jama.2010.1837

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