Schmitz, K.H., Ahmed, R.L., Troxel, A., Cheville, A., Smith, R., Lewis-Grant, L., . . . Greene, Q.P. (2009). Weight lifting in women with breast-cancer-related lymphedema. New England Journal of Medicine, 361(7), 664–673.

To assess the effects of controlled weight lifting for breast cancer survivors with lymphedema

For the first 13 weeks, participants in the intervention group received supervised 90-minutes session twice weekly led by certified fitness professionals employed by the fitness centers, who received three days of training. There was no upper limit on weight lifting. Participants were given a custom-fitted compression garment at 6 and 12 months and were required to wear the garments during weight lifting.

• The study sample (N = 130) was comprised of female patients who had a history of unilateral, nonmetastatic breast cancer 1–15 years before the study.
• Patients were included in the study if they had a body mass index of less than or equal to 50, at least one lymph node removed, and clinical diagnosis of stable breast cancer-related lymphedema.

The study took place at community fitness centers near participants' homes in Philadelphia, PA.

The study used a randomized controlled trial design.

• Lymphedema was measured using water volume displacement.
• Percentage body fat was measured.
• Physical activity level was measured using metabolic equivalent of task.

Weight lifting did not significantly affect the severity of breast cancer-related lymphedema. Weight lifting reduced the number and severity of arm and hand symptoms, increased muscular strength, and reduced the incidence of lymphedema exacerbation. Median attendance at exercise sessions was 79%. The proportion of women who experienced at least 5% increase in limb volume was 17% in the control group and 11% in the weight lifting group. Among women who had five or more lymph nodes removed, 7% in the weight-lifting group and 22% in the control group had more than 5% increase in limb volume.

The results of this study should reduce concerns that weight lifting will worsen arm and hand swelling with lymphedema in breast cancer survivors.

• Evaluations for exacerbations were not completed by a single therapist, although the six lymphedema therapists followed a standardized algorithm for evaluation.
• The study had no blinding.

Nurses need to review current handouts and information regarding exercise therapy. The findings of this study support the potential benefits of a slowly progressive weight-lifting program, with appropriate use of compression garments and close monitoring for arm and hand swelling.