Heavy weightlifting safe for women with lymphedema, study suggests

Women with lymphedema — swelling in the arm caused by the surgical removal of lymph nodes or by damage to the lymph nodes from radiation therapy for breast cancer — may perform upper-body strength training exercises with light and heavy weights, without worsening swelling or other lymphedema symptoms, Australian researchers say.

Background

Lymphedema is caused by the buildup of lymph fluid, a substance that helps the body fight infection. Once lymph nodes are removed by surgery or damaged by radiation, remaining lymph nodes may no longer be able to effectively drain lymph fluid from that area of the body, leading to symptoms including swelling, pain, tingling, and aching — usually in the arm, hand, breast or torso. The risk of developing lymphedema depends on the treatment received for breast cancer, but it is estimated that the condition affects 10 to 50 percent of women treated.

Often, women with lymphedema of the arm are advised to rebuild muscle strength in their arms through low-resistance exercise with lighter weights only. Yet, research has shown that improving arm strength through exercise may help with draining excess lymph fluid from the area and with the overall function of the arm. For this study, the trial team assessed the safety and benefit of lifting heavier compared with lighter weights.

Design

Sixty-two women from Perth and Canberra, Australia, were enrolled in the study between June and December 2010. All women had been diagnosed with breast cancer at least 1 year before joining and were diagnosed with lymphedema, defined as at least a 5 percent increase in size between the affected and unaffected arm, at the greatest point of swelling that could be seen.

At baseline, before participants were randomly assigned to one of three groups, investigators took measurements of each woman’s arms to compare to measurements taken once the study was completed. The groups were:

• Heavy weightlifting with usual lymphedema self-care
• Light weightlifting with usual lymphedema self-care
• No weightlifting; usual lymphedema self-care only

Both weightlifting groups participated in two 60-minute sessions each week for 3 months in groups of 8 to 10 people. The exercise programs involved:

• 10-minute low-level aerobic warm-up and stretching
• Six exercises to work the chest, back, shoulders, upper arms and forearms
• Two exercises to work the major muscle groups of the lower body
• 5-minute cool down of low-level aerobic exercise

In the heavy weightlifting group, participants:

• used weights that were between 75 to 85 percent of the heaviest weight they could comfortably lift 6 to 10 times
• performed 6 to 10 repetitions per set
• performed 1 to 4 sets per exercise in the program

In the light weightlifting group, participants:

• used weights that were between 55 to 65 percent of the heaviest weight they could comfortably lift 15 to 20 times
• performed 15 to 20 repetitions per set
• performed 1 to 4 sets per exercise in the program

The weight used was increased by 5 to 10 percent if a participant was able to complete more repetitions per set than defined in the program, without lymphedema symptoms worsening.

Whether a woman wore a lymphedema sleeve during the program was her choice; each woman was required to decide before the exercise program began and to continue to use or not use the sleeve throughout.

Extent of swelling, symptom severity, physical function of the arm and quality of life were assessed at baseline and after the program ended at 3 months.

Results

After 3 months, there were no significant differences in swelling or severity of symptoms between the three trial groups. Physical function of the arm differed in that those assigned to the two weightlifting groups improved their arm strength compared with the group assigned to usual lymphedema care only. Quality of life only differed in areas related to arm strength and arm function, with improvements in the weightlifting groups compared with the usual care group, and in areas related to the improvement of general health, such as pain, social functioning, and mental health.

What this means for you

This study suggests that you may safely be able to perform upper-body strength exercises as a woman with lymphedema. Training these muscles may also improve your muscle strength, endurance, and some aspects of quality of life. However, studies in larger groups of people are needed before researchers can determine that weightlifting is safe for all women with lymphedema.

It is important to note that the women who participated in this study were in generally good physical health and had an interest in exercise programs before the study began. If you are interested in strength training, talk with your doctor about any health concerns you may have and about safe ways to start an exercise program. If you never participated in strength training before, consider working with a physical trainer or taking a group class to learn about form and safety.

Cormie, P, Pumpa, K, Galvão, D, et al. Is it safe and efficacious for women with lymphedema secondary to breast cancer to lift heavy weights during exercise: a randomised controlled trial. Journal of Cancer Survivorship. 2013;7(3): 413-424.