Malicka, I., Stefańska, M., Rudziak, M., Jarmoluk, P., Pawłowska, K., Szczepańska-Gieracha, J., & Woźniewski, M. (2011). The influence of Nordic walking exercise on upper extremity strength and the volume of lymphoedema in women following breast cancer treatment. Isokinetics and Exercise Science, 19(4), 295–304.

To examine the effect of Nordic walking on upper-extremity strength and lymphedema

Participants were randomly assigned to the walking group or the control group, who did not participate in any rehabilitation program. The program consisted of two hour-long sessions each week for eight weeks. Sessions involved a 10-minute warm up and 40 minutes of Nordic walking at 85% of maximum heart rate, followed by 10 minutes of stretching and relaxation exercises.

• The study sample was all female with a mean age of 62.8 years.
• Patients had undergone radical mastectomy (79%) or breast-conserving surgery (21%). Mean time since surgical treatment was 7.6 years.
• Most patients had received adjuvant therapy, chemotherapy, radiation therapy, or hormonal therapy.
• No axillary dissection was reported.
• Only 34% of patients had lymphedema.

The study took place in an outpatient setting in Poland.

• Patients were undergoing long-term follow-up care.
• The study has clinical applicability for late effects and survivorship.

The study used a randomized controlled trial design.

• An isokinetic dynamometer was used to test muscle strength.
• Lymphedema volume was evaluated by measuring circumferences of both upper extremities with use of a tape measure at five levels.

A variety of changes in muscle strength were observed. No differences were found between groups in arm volume results.

The study did not provide any evidence that Nordic walking improved lymphedema.

• The sample size was small, with fewer than 100 patients.
• The authors did not indicate if exercise was done alone or in groups. 
• Only a third of patients had lymphedema.
• High variability existed in the sample of time since surgery, which would be expected to influence observance of lymphedema. 
• No other lymphedema risk factors were reported, and use of other prevention or treatment strategies were not discussed.
• The study was not blinded.

The study had several methodologic weaknesses and did not provide strong evidence either for or against the effects of Nordic walking on lymphedema after breast cancer treatment.