Singh, B., Disipio, T., Peake, J., & Hayes, S.C. (2016). Systematic review and meta-analysis of the effects of exercise for those with cancer-related lymphedema. Archives of Physical Medicine and Rehabilitation, 97, 302–315.

DOI Link

doi: 10.1016/j.apmr.2015.09.012

Purpose

STUDY PURPOSE: To examine the effects of exercise on cancer-related lymphedema and associated symptoms, and to determine if wearing compression during exercise is needed for individuals with lymphedema

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: CINAHL, Cochrane, EBSCOhost, MEDLINE, PubMed, ProQuest Health and Medical Complete, ProQuest Nursing and Allied Health Source, ScienceDirect, and SPORTDiscus

INCLUSION CRITERIA: Randomized and nonrandomized controlled trials and single-group, pre-post studies published in nine databases in English before January 1, 2015. Used the PICO (participants, intervention, comparator, and outcome) framework: P: participants with clinically diagnosed, cancer-related upper or lower limb lymphedema; I: a form of exercise (“resistance-based” [i.e., weightlifting, resistance exercise, or resistance training]), “aerobic-based,” or “other exercise”; C: studies comparing exercise with either no exercise, a different mode of exercise, usual care, or other intervention, and single-group studies with no comparison intervention or studies in which exercise was performed with compression compared to without compression; O: studies involving the assessment of lymphedema (limb swelling) with or without lymphedema-related symptoms of the affected limb

EXCLUSION CRITERIA: Studies comprised solely of participants considered at risk for lymphedema or without a clinical diagnosis of lymphedema, studies that involved exercise in addition to other interventions (the effects of exercise could not be isolated), and studies with a component of complete decongestive therapy-based exercise

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 3,517 studies evaluating the effects of exercise for cancer-related lymphedema, 1,256 studies evaluating the effects of compression use during exercise for cancer-related lymphedema

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Effective Public Health Practice Project Quality Assessment Tool

Sample Characteristics

FINAL NUMBER STUDIES INCLUDED = 21 (exercise) and 4 (compression and exercise) studies met inclusion criteria.
TOTAL PATIENTS INCLUDED IN REVIEW = Not clearly described
SAMPLE RANGE ACROSS STUDIES: Exercise studies (unclearly reported): five studies (sample sizes < 15), nine studies (sample sizes 15–30), four studies (sample sizes 31–60), and three studies (sample sizes > 61); studies with compression and exercise: four studies (sample size range: 18–31)
KEY SAMPLE CHARACTERISTICS: Women with unilateral breast cancer-related lymphedema, male and female participants with lower limb lymphedema

Phase of Care and Clinical Applications

PHASE OF CARE: Late effects and survivorship

APPLICATIONS: Palliative care

Results

Although exercise did not result in a worsening of lymphedema and associated symptoms of the affected limb, no statistically significant effect of exercise on lymphedema or related symptoms existed. Subgroup analyses for exercise mode (aerobic, resistance, mixed, and other) and intervention duration (> 12 weeks or 12 weeks) showed consistent results, that is, no effect on lymphedema or associated symptoms. Too few studies existed to conduct a meta-analysis for evaluating the effect of compression during regular exercise.

Conclusions

Exercise appeared to have no effect on lymphedema and associated symptoms in individuals with secondary limb lymphedema. However, the findings indicate that individuals with secondary limb lymphedema can safely perform exercise without experiencing a worsening of lymphedema or related symptoms. Insufficient evidence exists to support or disprove the current clinical recommendation to wear compression garments during regular exercise. In addition, injuries from exercises do occur, which were reported in several studies, yet the review did not mention the injuries.

Limitations

No quality evaluation
Low sample sizes
The majority of study samples had stable, mild, unilateral breast cancer-related lymphedema and were likely to be physically active before study participation.

Nursing Implications

Given the health benefits of exercise on the overall quality of life of survivors, the findings from this review and meta-analysis suggest that nurses can educate cancer survivors with limb lymphedema to conduct progressive/supervised regular exercise, which likely will not worsen lymphedema or associated symptoms. However, injury does occur with exercise, so reporting it is important, but the review did not mention potential injury with exercise.

Legacy ID

6128