Finding runs counter to standard advice doctors have given for years
WEDNESDAY, Aug. 12 (HealthDay News) -- Lifting weights can help prevent flare-ups of lymphedema, a painful swelling of the arm that often occurs after breast cancer surgery, new research shows.
The finding runs counter to what women have been told for years -- that they should avoid stressing the arm during strength training or other exercise because muscle strain can cause lymphedema to worsen.
The study is published in the Aug. 13 issue of the New England Journal of Medicine.
Researchers divided 141 breast cancer survivors who had lymphedema into two groups. One group did twice-weekly weight training using slowly increasing weights for 13 weeks. Afterward, they were told to continue the exercises unsupervised for 39 weeks. The other group was told to maintain their normal exercise and activity regimen.
About 11 percent of the weight-lifting group and 12 percent of the control group had an increase of 5 percent or more in limb swelling, according to the study, not a significant difference.
Yet the weight-lifting group had greater improvements in self-reported severity of lymphedema symptoms, an improvement in upper- and lower-body strength and a lower incidence of lymphedema exacerbations.
About 14 percent of the weight-lifting group experienced a flare-up compared to 29 percent of those in the control group, according to a certified lymphedema specialist who examined the participants.
"We found that twice-weekly, slowly progressive strength training does not increase the likelihood of swelling and decreases the likelihood of flare-ups," said study author Kathryn Schmitz, an associate professor of epidemiology at the University of Pennsylvania School of Medicine in Philadelphia.
In the past, advice to women about dealing with lymphedema has been confusing, Schmitz noted. Standard advice has been to keep the skin clean and moisturized, be careful when clipping nails, wear compression sleeves to prevent swelling or to do gentle, therapeutic exercises to promote lymphatic drainage.
Earlier epidemiological studies found a link between arm injuries or muscle strain and flare-ups, Schmitz said.
"They were extremely well-meaning guidelines that said to avoid stressing the arm," Schmitz said. "What that translated into was advice to avoid lifting anything like grocery bags, children or even a purse."
Not only did this make life more difficult, the lack of activity meant the arm muscles weakened, making muscle strains and other injuries more likely.
"What I'm suggesting is that if women slowly, progressively make themselves stronger, they will be less likely to overuse the arm because they have trained the arm," Schmitz said.
Up to 62 percent of women treated for breast cancer develop lymphedema, an accompanying editorial noted.
A study in the March 16 online issue of the Journal of Clinical Oncology found that women who develop lymphedema fare worse than women without the condition and have higher out-of-pocket medical costs after radiation and surgery.
Women with lymphedema report a lower quality of life, higher levels of anxiety and depression, an increased likelihood of chronic pain and fatigue and greater difficulty functioning socially and sexually, according to the study. Lymphedema also boosted two-year, postoperative medical costs.
In an accompanying editorial, Wendy Demark-Wahnefried, a professor in the department of behavioral science at the University of Texas MD Anderson Cancer Center in Houston, noted that making progressive resistance training a standard part of post-cancer care could help to lower those costs and improve women's lives.
"The significance of the study is that women who have had breast cancer surgery or radiation treatment have been told that they shouldn't lift any weight and to avoid repetitive motions. As a result, we have a generation of women who have almost become incapacitated," Demark-Wahnefried said. "They've been leery to lift groceries or their children, or fail to go back to jobs due to the risk of lymphedema. This study helps to lift some of that concern."
For some of the women in the study, the weight-lifting regimen, which was done at YMCAs in the Philadelphia area with fitness instructors who had received a three-day training in lymphedema care, left them feeling fitter than even before they had cancer, Schmitz said.
The American Cancer Society has more on lymphedema.
SOURCES: Kathryn Schmitz, Ph.D., M.P.H., associate professor, epidemiology, University of Pennsylvania, Philadelphia; Wendy Demark-Wahnefried, Ph.D., R.D., professor, department of behavioral science, University of Texas MD Anderson Cancer Center, Houston; Aug. 13, 2009, New England Journal of Medicine
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