Effects of weight-lifting or resistance exercise on breast cancer-related lymphedema: A systematic review
Ausanee Wanchai a, *, Jane M. Armer b. International Journal of Nursing Sciences 6 (2019) 92-98
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Effects of weight-lifting or resistance exercise on breast cancer-related lymphedema: A systematic review
Ausanee Wanchai a, *, Jane M. Armer b. International Journal of Nursing Sciences 6 (2019) 92-98
The purpose of this systematic review was to identify the effects of weight-lifting or resistance exercise on breast cancer-related lymphedema. Published articles written in English were retrieved from electronic databases, including ScienceDirect, PubMed, Scopus, and CINAHL databases. Hand-searches for unpublished papers were also completed. Content analysis was used to examine articles that met the inclusion criteria. Among 525 searched papers, 15 papers met the inclusion criteria: 13 trials evaluated weight-lifting or resistance exercise alone and two trials evaluated weight-lifting or resistance exercise plus aerobic exercise. The results of the review showed that no arm volume change was observed for either exercise modality. In addition, six included studies showed that weight-lifting or resistance exercise did not cause lymphedema or adverse events in patients at risk of breast cancer-related lymphedema. For patients with breast cancer-related lymphedema, six studies reported that change of swelling outcome measures were not significantly different between the weight-lifting or resistance exercise group and the control group. However, three included studies reported that volume of arm was significantly more reduced in the weight-lifting or resistance exercise group than those in the control group. The findings suggest that supervised resistance exercise may be safe, feasible, and beneficial in patients with breast cancer-related lymphedema or at risk for breast cancer-related lymphedema. However, the limitation of small sample size implies that further research is needed to confirm these findings.
Main findings
- This systematic review was conducted to provide the most up-to-date findings regarding the effects of weight-lifting exercise on BCRL within time range dates ranging from 2007 to 2017.
- Based on the 15 articles meeting criteria for inclusion in this review, resistance exercise alone or resistance exercise plus aerobic exercise appears to be a potentially effective procedure for patients at risk of BCRL and patients with BCRL. The systematic review showed that resistance exercise might reduce limb volume or did not increase lymphedema incidence in patients with BCRL and did not increase the risk of developing lymphedema in patients at risk of BCRL.
- Regarding the effects of resistance exercise plus aerobic exercise, the results of this systematic review show that it appears to be safe to perform this type of exercise for women with BCRL or women at risk of BCRL. However, caution should be mentioned as these findings are based on small sample size and only two RCTs were included in the review. So, although results indicated that the combination of resistance exercise plus aerobic exercise was safe in the majority of patients, more rigorous studies with larger sample size are needed. Moreover, whether resistance plus aerobic exercise is better for the health outcomes of patients with BCRL than resistance exercise alone is still unanswered. Randomized controlled trials are needed to identify this question.
- In terms of manual and mechanical resistance exercises, the study results report that they both did not significantly affect change of arm volumes.
- Although the results showed that BCRL could be prevented or improved by resistance exercise, no long-term follow-up was performed. So we cannot conclude whether the effects could be maintained or even be enhanced over time.
- Moreover, as this systematic review focused more on women with or at risk of BCRL, a future systematic review is needed to perform subgroup analysis for women such as those with or without radiotherapy.
- Based on this systematic review, it can be concluded that resistance exercise is beneficial for effective lymphedema management among patients with BCRL and women at risk of BCRL. However, performing resistance exercise should be supervised by certified lymphedema therapists or physical, occupational, or massage therapists or nurses trained in oncology and lymphedema case. More importantly, resistance exercise should be used as a supplement or complement to traditional lymphedema treatment, and not as a sole therapy.
