Schmidt, T., Berner, J., Jonat, W., Weisser, B., Röcken, C., Van Mackelenbergh, M., & Mundhenke, C.W. (2017). Influence of arm crank ergometry on development of lymphoedema in breast cancer patients after axillary dissection: A randomized controlled trial. Journal of Rehabilitation Medicine (Stiftelsen Rehabiliteringsinformation), 49, 78–83. 

To study the safety and effectiveness of training with a mechanical arm crank on lymphedema development after axillary node dissection

Patients were randomized to usual care or supervised training sessions with an arm crank. The training group had exercises for strength and endurance for 60 minutes twice weekly for 12 weeks. The training involved either passive motorized training, motor supported self-training, or training by patient-generated power alone. The training modality used depended on patient performance. Study outcome measures were obtained before and after study-related training.

• N = 49   
• MEAN AGE = 57
• FEMALES: 100%
• CURRENT TREATMENT: Not applicable
• KEY DISEASE CHARACTERISTICS: Breast cancer. All underwent axillary node dissection, and the majority had postoperative radiotherapy.

• SITE: Single site   
• SETTING TYPE: Outpatient    
• LOCATION: Germany

PHASE OF CARE: Late effects and survivorship

Randomized, controlled trial

• Body mass index
• Bioelectric impedance analysis (BIA)
• Arm circumference measurement
• Muscular strength—isometric capacity testing for latissimus dorsi and pectoralis muscles 
• European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-20 (EORTC QLQ C-30)
• Borg scale for effort during training sessions

An increase in lean body mass was observed in patients in the training group (p = 0.017) and decrease in body fat (p = 0.009). Muscular strength increased in both groups. No significant differences existed between groups in arm volume changes. Both groups showed a significant reduction in arm volume from baseline to the end of the study (p < 0.01).

No increase in lymphedema volume was reported with the training provided with the arm crank. This training did not improve lymphedema management compared to usual care.

• Small sample (< 100)
• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• No description of usual care

The findings showed no increase in lymphedema with arm training using a mechanical training device. The use of this device appeared to be safe but was no more effective for arm volume reduction than whatever was provided as usual care.