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

Kira Bloomquist, Peter Oturai, Megan L Steele, Lis Adamsen, Tom Møller, Karl Bang Christensen, Bent Ejlertsen, and Sandra C Hayes. Medicine & Science in Sports & Exercise, Publish Ahead of Print 2017

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

Kira Bloomquist, Peter Oturai, Megan L Steele, Lis Adamsen, Tom Møller, Karl Bang Christensen, Bent Ejlertsen, and Sandra C Hayes. Medicine & Science in Sports & Exercise, Publish Ahead of Print 2017

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 of lymphedema while receiving adjuvant taxane-based chemotherapy.

Methods This is a randomized, cross-over equivalence trial. Women receiving adjuvant taxane based chemotherapy for breast cancer who had undergone axillary lymph node dissection (n=21) participated in low- (60-65% 1 repetition maximum (RM), two sets of 15-20 repetitions) and  heavy-load (85-90% 1RM, three sets of 5-8 repetition) upper-extremity resistance exercise separated by  a one-week wash-out period. Swelling was determined by bioimpedance spectroscopy and dual energy x-ray absorptiometry, with breast cancer-related lymphedema symptoms (heaviness, swelling, pain, tightness) reported using a numeric rating scale (0-10). Order of low- versus heavy-load was randomized. All outcomes were assessed pre-, immediately post-, and 24- and 72-hours post-exercise. Generalized estimating equations were used to evaluate changes over time between groups, with equivalence between resistance exercise loads determined using the principle of confidence interval inclusion.

Results The acute response to resistance exercise was equivalent for all outcomes at all time points irrespective of loads lifted, with the exception of extracellular fluid at 72-hours postexercise with less swelling following heavy-loads (estimated mean difference -1.00, 95% CI 3.17 to 1.17).

Conclusion Low- and heavy-load resistance exercise elicited similar acute responses in arm swelling and breast cancer-related lymphedema symptoms in women at risk for lymphedema receiving adjuvant taxane-based chemotherapy. These represent important preliminary findings, which can be used to inform future prospective evaluation of the long term effects of repeated exposure to heavy-load resistance exercise.

Main findings

  • Small sample size.
  • No adverse events related to exercise (i.e. sprains or strains) were reported. However, two (11%) participants were advised to seek evaluation by a lymphedema therapist at the end of the study period as L-Dex scores had exceeded ten.
  • The authors conclude the findings of this study support the hypothesis that acute changes in extracellular fluid, arm volume and BCRL related symptoms were similar irrespective of whether low- or heavy-load upper extremity resistance exercise was performed during adjuvant taxane-based chemotherapy in women with axillary lymph node dissection.
  • This is the first study to prospectively investigate lymphatic response to resistance exercise with heavy loads (85-90% 1RM, for 5-8 repetitions) in breast cancer survivors at risk of developing BCRL.