Abstract

Resistance exercise and breast cancer related lymphedema – a systematic review update

Timothy Hasenoehrl, Mohammad Keilani, Stefano Palma & Richard Crevenna. Disability and Rehabilitation, 2020, 42:1, 26-35.

Background: Purpose of this systematic review update was analyzing resistance exercise (RE) intervention trials in breast cancer survivors (BCS) regarding their effect on breast cancer-related lymphedema (BCRL) status. Articles published until 31 September 2017 were included.

Methods: A systematic literature search was conducted utilizing PubMed, MEDLINE, and EMBASE databases. Included articles were analyzed regarding their level of evidence and their methodological quality using the Cochrane risk of bias tool.

Results: Altogether, 23 articles could be included of which 16 were independent RE intervention studies and seven additional articles. Lymphedema assessment was so heterogeneous that conduction of a thorough meta-analysis regarding lymphedema status was still impossible. In all but one study, which reported a small but methodologically weak increase in arm volume, no negative effects of RE on BCRL was recorded.

Conclusions: RE seems to be a safe exercise intervention for BCS and not to be harmful concerning the risk of lymphedema. Lymphedema assessment methods that allow for a qualitative analysis of arm tissue composition should be favored.

Main findings

• Qualitative analysis of the currently available literature revealed, then that evaluating the development of BCRL by comparing circumference measurements between the affected and unaffected side is not enough.
• Different development of subcutaneous tissue, but in contrast to the prior assumption, noticed different muscle growth rates between the affected and unaffected arm.
• The number of resistance exercise (RE) intervention trials that were published since May 2015 has increased significantly. However, due to heterogeneous assessment techniques and presentations of LE-status in the currently available literature, there is still not enough data to conduct a thorough meta-analysis about the development of BCRL. On the other hand, the results published since then indicate that the summarizing assumptions of earlier reviews – particularly that RE is not harmful for women with BCRL can be supported. Future research should focus on the distinctive effects of various RE intensities and routines on the long-term as well as on the question if use of compression during RE has any effect on the status of the BCRL.