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Original Investigation
August 15, 2019

Effect of Home-Based Exercise and Weight Loss Programs on Breast Cancer–Related Lymphedema Outcomes Among Overweight Breast Cancer Survivors: The WISER Survivor Randomized Clinical Trial

Author Affiliations
  • 1Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey
  • 2Department of Biostatistics, New York University School of Medicine, New York
  • 3Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
  • 4Department of Hematology/Oncology, Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 5Department of Population and Public Health Sciences, Pennington Biomedical Research Center, Baton Rouge, Louisiana
  • 6Department of Radiology, Harlem Hospital Center, New York, New York
  • 7Department of Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
  • 8Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 9Division of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
  • 10Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
  • 11Department of Social and Behavioral Sciences, Temple University, Philadelphia, Pennsylvania
JAMA Oncol. Published online August 15, 2019. doi:10.1001/jamaoncol.2019.2109
Key Points

Question  Does weight loss and/or home-based exercise improve breast cancer–related lymphedema more than a supervised, facility-based lymphedema care (control) program previously shown to improve the symptoms and exacerbations of lymphedema?

Findings  In this randomized clinical trial of 351 overweight breast cancer survivors with lymphedema, control group, exercise intervention, weight loss intervention, and combined exercise and weight loss intervention status were not associated with significant between-group differences in the 12-month percentage of change in interlimb difference.

Meaning  Current results compared with previous research suggest that breast cancer survivors may find facility-based exercise more useful than home-based lymphedema care for improving the symptoms of lymphedema.

Abstract

Importance  To our knowledge, no randomized clinical trials have assessed the effects of the combination of weight loss and home-based exercise programs on lymphedema outcomes.

Objective  To assess weight loss, home-based exercise, and the combination of weight loss and home-based exercise with clinical lymphedema outcomes among overweight breast cancer survivors.

Design, Setting, and Participants  This randomized clinical trial (Women in Steady Exercise Research [WISER] Survivor clinical trial ) of 351 overweight breast cancer survivors with breast cancer–related lymphedema (BCRL) was conducted in conference rooms at academic and community hospitals and in the homes of participants from March 12, 2012, to May 28, 2016; follow-up was conducted for 1 year from the start of the intervention. Statistical analysis by intention to treat was performed from September 26, 2018, to October 28, 2018.

Interventions  A 52-week, home-based exercise program of strength/resistance training twice per week and 180 minutes of walking per week, a weight loss program of 20 weeks of meal replacements and 52 weeks of lifestyle modification counseling, and a combination of the home-based exercise and weight loss programs.

Main Outcomes and Measures  The 12-month change in the percentage of interlimb volume difference.

Results  Of 351 participants, 90 were randomized to the control group (facility-based lymphedema care with no home-based exercise or weight loss intervention), 87 to the exercise intervention group, 87 to the weight loss intervention group, and 87 to the combined exercise and weight loss intervention group; 218 (62.1%) were white, 122 (34.8%) were black, and 11 (3.1%) were of other races or ethnicities. Median time since breast cancer diagnosis was 6 years (range, 1-29 years). Mean (SD) total upper extremity score changes from the objective clinical evaluation were −1.40 (11.10) in the control group, −2.54 (13.20) in the exercise group, −3.54 (12.88) in the weight loss group, and −3.84 (10.09) in the combined group. Mean (SD) overall upper extremity score changes from the self-report survey were −0.39 (2.33) in the control group, −0.12 (2.14) in the exercise group, −0.57 (2.47) in the weight loss group, and −0.62 (2.38) in the combined group. Weight loss from baseline was −0.55% (95% CI, −2.22% to 1.11%) in the control group, −8.06% (95% CI, −9.82% to 6.29%) in the combined group, −7.37% (95% CI, −8.90% to −5.84%) in the weight loss group, and −0.44% (95% CI, −1.81% to 0.93%) in the exercise group.

Conclusions and Relevance  Study results indicate that weight loss, home-based exercise, and combined interventions did not improve BCRL outcomes; a supervised facility-based program of exercise may be more beneficial than a home-based program for improving lymphedema outcomes.

Trial Registration  ClinicalTrials.gov identifier: NCT01515124

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