A randomized cross-over trial to detect differences in arm volume after low- and heavy-load resistance exercise among patients receiving adjuvant chemotherapy for breast cancer at risk for arm lymphedema:study protocol

BACKGROUND: In an effort to reduce the risk of breast cancer-related arm lymphedema, patients are commonly advised to avoid heavy lifting, impacting activities of daily living and resistance exercise prescription. This advice lacks evidence, with no prospective studies investigating arm volume changes after resistance exercise with heavy loads in this population. The purpose of this study is to determine acute changes in arm volume after a session of low- and heavy-load resistance exercise among women undergoing adjuvant chemotherapy for breast cancer at risk for arm lymphedema. METHODS/DESIGN: This is a randomized cross-over trial. Participants: Women receiving adjuvant chemotherapy for breast cancer who have undergone axillary lymph node dissection will be recruited from rehabilitation centers in the Copenhagen area. Intervention: Participants will be randomly assigned to engage in a low- (two sets of 15–20 repetition maximum) and heavy-load (three sets of 5–8 repetition maximum) upper-extremity resistance exercise session with a one week wash-out period between sessions. Outcome: Changes in extracellular fluid (L-Dex score) and arm volume (ml) will be assessed using bioimpedance spectroscopy and dual-energy x-ray absorptiometry, respectively. Symptom severity related to arm lymphedema will be determined using a visual analogue scale (heaviness, swelling, pain, tightness). Measurements will be taken immediately pre- and post-exercise, and 24- and 72-hours post-exercise. Sample size: A sample size of 20 participants was calculated based on changes in L-Dex scores between baseline and 72-hours post exercise sessions. DISCUSSION: Findings from this study are relevant for exercise prescription guidelines, as well as recommendations regarding participating in activities of daily living for women following surgery for breast cancer and who may be at risk of developing arm lymphedema. TRIAL REGISTRATION: Current Controlled Trials ISRCTN97332727. Registered 12 February 2015. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12885-016-2548-y) contains supplementary material, which is available to authorized users

Do Women with Breast Cancer–related Lymphoedema Need to Wear Compression While Exercising? : Results from a Systematic Review and Meta-analysis

Purpose of Review: To undertake a systematic review and meta-analysis to evaluate the effects of wearing compression versus no compression during a single bout of exercise, and during an exercise intervention, for those with breast cancer-related lymphoedema (BCRL). A multiple database search was undertaken to identify eligible randomised controlled trials (RCTs) and non-RCTs involving those with BCRL. The primary outcome variable was lymphoedema and pooled statistics were calculated using standardised mean differences (SMDs) within or between compression and no compression groups. Recent Findings: Six eligible studies were identified and rated as either moderate (n = 5) or strong (n = 1) quality. No within-group change in lymphoedema was observed after a single bout of exercise or after an exercise intervention period with compression (SMD = − 0.08 [95% CI = − 0.36, 0.21]; and SMD = − 0.20 [95% CI = − 0.63, 0.22], respectively) or without compression (SMD = 0.05 [95% CI = − 0.23, 0.34]; and, SMD = − 0.17 [95% CI = − 0.56, 0.22], respectively). There was also no between-group difference found post-exercise (single bout or intervention period) between those exercising with and without compression (SMD = − 0.08 [95% CI = − 0.28, 0.12]). Summary: There appears to be no consistent benefit or adverse effect of wearing compression for BCRL during a single exercise bout or an exercise intervention period

The Effect of Exercise for the Prevention and Treatment of Cancer-Related Lymphedema : A Systematic Review with Meta-analysis

Introduction The purpose of this systematic review and meta-analysis was to evaluate the effects of exercise on (i) the prevention of cancer-related lymphedema (CRL) and (ii) the treatment of CRL, lymphedema-associated symptoms, and other health outcomes among individuals with CRL. Methods An electronic search was undertaken for exercise studies measuring lymphedema and involving individuals at risk of developing or with CRL. The Effective Public Health Practice Project Quality scale was used to assess study quality, and overall quality of evidence was assessed using the Grading of Recommendation, Assessment, Development and Evaluation approach. Meta-analyses were performed to evaluate effects of exercise on CRL incidence, existing CRL status, lymphedema-associated symptoms, and health outcomes. Results Twelve studies (n = 1955; 75% moderate-high quality) and 36 studies (n = 1741; 58% moderate-high quality) were included in the prevention and treatment aim, respectively. Relative risk of developing CRL for those in the exercise group compared with the nonexercise group was 0.90 (95% confidence interval (CI), 0.72 to 1.13) overall and 0.49 (95% CI, 0.28 to 0.85) for those with five or more lymph nodes removed. For those with CRL in the exercise group, the standardized mean difference (SMD) before to after exercise of CRL was-0.11 (95% CI,-0.22 to 0.01), and compared with usual care postintervention, the SMD was-0.10 (95% CI,-0.24 to 0.04). Improvements after intervention were observed for pain, upper-body function and strength, lower-body strength, fatigue, and quality of life for those in the exercise group (SMD, 0.3-0.8; P < 0.05). Conclusions Findings support the application of exercise guidelines for the wider cancer population to those with or at risk of CRL. This includes promotion of aerobic and resistance exercise, and not just resistance exercise alone, as well as unsupervised exercise guided by symptom response

Heavy-Load Lifting: Acute Response in Breast Cancer Survivors at Risk for Lymphedema

Purpose Despite a paucity of evidence, prevention guidelines typically advise avoidance of heavy lifting in an effort to protect against breast cancer-related lymphedema. This study compared acute responses in arm swelling and related symptoms after low- and heavy-load resistance exercise among women at risk for lymphedema while receiving adjuvant taxane-based chemotherapy