Paramanandam, V.S., & Roberts, D. (2014). Weight training is not harmful for women with breast cancer-related lymphoedema: A systematic review. Journal of Physiotherapy, 60, 136–143. 

DOI Link

Purpose

STUDY PURPOSE: To examine if weight-training exercise are safe for women with or at risk of lymphedema after breast cancer and to examine if weight training exercise improves muscle strength, quality of life, and body mass index in patients with breast cancer and lymphedema
 
TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: PubMed, EMBASE, PsycINFO, CINAHL, AMED, Cochrane, PEDro, SPORTDiscus, and Web of Science
 
KEYWORDS: Weight training, lymphedema, and breast neoplasm
 
INCLUSION CRITERIA: (a) Randomized trial that was peer-reviewed and published in English after 2001, (b) women with breast cancer diagnoses with or at risk of developing lymphedema, (c) weight training exercise, (d) lymphedema onset or exacerbation, limb strength, quality of life, and body mass index, (e) sham exercise, light exercise, conservation therapies such as light stretching, no intervention control, only lower body exercise and education 
 
EXCLUSION CRITERIA: Studies involving women with lymphedema following local recurrence or metastasis were excluded. Studies with mixed exercises (apart from warm-ups and cool-downs) were excluded. 

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 333
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Meta-analyses were performed, and narrative syntheses also was used. The Physiotherapy Evidence Database (PEDro) scale was used to evaluate the quality of trials.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 11 
  • TOTAL PATIENTS INCLUDED IN REVIEW = 1,091 
  • KEY SAMPLE CHARACTERISTICS: Women who received either modified radical mastectomies or breast conservation surgery along with different axillary node management
 

Phase of Care and Clinical Applications

PHASE OF CARE: Late effects and survivorship
 
APPLICATIONS: Elder care

Results

Weight training exercise with low to moderate intensity (no trials used high-intensity weight training) and relatively slow progression significantly improved upper limb strength (SMD = 0.93, 95% CI 0.73–1.12) and lower limb strength (SMD = 0.75, 95% CI 0.47–1.04) without increasing arm volume or the incidence of breast cancer-related lymphedema. No significant effects were noted for body mass index (SMD = -0.10, 95% -0.31–0.11). Some aspects of quality of life may have improved with weight training. Participants in all trials used pressure garments and received supervision.

Conclusions

Weight training appeared to be safe and beneficial in improving limb strength and the physical components of quality of life in women with or at risk of lymphedema. Pressure garments, supervision, and limiting the intensity of the weight training may be important, but this could not be confirmed with this review.

Limitations

A potential selection bias of the studies reviewed may exist because no blinding methods were employed among authors and affiliations. Heterogeneity among the studies reviewed limited the scope of the statistical analysis, so a narrative synthesis and meta-analysis were conducted. Heterogeneity may also limit the generalizability of the overall study results.

Nursing Implications

This review indicated that low-intensity exercise was recommended to protect the arm from adverse events. However, supervision and compression garments were featured in the reviewed studies, and their impact and effectiveness need to be confirmed. In addition, no evidence was available to suggest that high-intensity weight training was harmful to the arm. Research efforts need to be made in this area.

Legacy ID

5502