Changes in arm tissue composition with slowly progressive weightlifting among women with breast cancer-related lymphedema

Xiaochen Zhang, Justin C. Brown, Electra D. Paskett, Babette S. Zemel, Andrea L. Cheville, Kathryn H. Schmitz. Breast Cancer Res Treat (2017) 164:79–88

Click to read the abstract

ABSTRACT

Changes in arm tissue composition with slowly progressive weightlifting among women with breast cancer-related lymphedema

Xiaochen Zhang, Justin C. Brown, Electra D. Paskett, Babette S. Zemel, Andrea L. Cheville, Kathryn H. Schmitz. Breast Cancer Res Treat (2017) 164:79–88

BACKGROUND:

Studies in breast cancer-related lymphedema (BRCL) have exclusively examined total arm volume, but not the specific tissue composition that contributes to total volume. We evaluated baseline differences in arm tissue composition [fat mass, lean mass, bone mineral content (BMC), and bone mineral density (BMD)] between the affected and unaffected arms in women with BRCL. We compared changes in arm tissue composition and self-reported lymphedema symptoms after 1 year of weight-lifting versus control.

METHODS:

We utilized data from physical activity and lymphedema trial that included 141 women with BRCL. Arm tissue composition was quantified using dual-energy X-ray absorptiometry. The severity of lymphedema was quantified using self-report survey. Weight-lifting was performed at community fitness facilities.

RESULTS:

At baseline, the affected arm had more fat (∆ = 89.7 g; P < 0.001) and lean mass (∆ = 149.1 g; P < 0.001), but less BMC (∆ = -3.2 g; P < 0.001) and less BMD (∆ = -5.5 mg/cm2; P = 0.04) than the unaffected arm. After 12 months of weight-lifting, composition of the affected arm was improved: lean mass (71.2 g; P = 0.01) and BMD (14.0 mg/cm2; P = 0.02) increased, arm fat percentage decreased (-1.5%; P = 0.003). Composition of the unaffected arm was only improved in lean mass (65.2 g; P = 0·04). Increases in lean mass were associated with less severe BCRL symptoms.

CONCLUSIONS:

Among women with BRCL, slowly progressive weight-lifting could improve arm tissue composition. Changes in arm tissue composition predict changes in symptom burden. Investigating the combined effects of exercise and weight loss on arm tissue composition and BCRL symptoms may provide additional insight into the benefits of lifestyle modification on lymphedema biology.

Main findings

  • Weight training exercise significantly improves lean body mass and muscular strength.
  • Weight-lifting could also attenuate the decline of appendicular skeletal muscle mass.
  • Upper body function and strength are also improved with weight-lifting, and these outcomes might be particularly important for breast cancer survivors.
  • Despite no change in overall arm volume, a twice weekly slowly progressive weight-lifting program resulted in a significant improvement in the fat and lean tissue composition, of the lymphedematous limb.
  • Improvement of lean mass from weight-lifting intervention was associated with reduced severity of lymphedema symptoms, and the decrease in arm fat percentage was associated with a reduction of arm volume.