Sisman, H., Sahin, B., Duman, B.B., & Tanriverdi, G. (2012). Nurse-assisted education and exercise decrease the prevalence and morbidity of lymphedema following breast cancer surgery. Journal of B.U.O.N.: Official Journal of the Balkan Union of Oncology, 17(3), 565–569.

To investigate the effect of education and exercises on development and progression of lymphedema

Patients were informed about measures to prevent lymphedema and about exercises. They were given written material prepared by the investigators. No further specifics about the education or exercises is provided.

• The sample (N = 55) was comprised of 1.8% male and 98.2% female patients.
• All patients had breast cancer.
• Ninety-six percent of patients had modified radical mastectomy and 45% had adjuvant radiotherapy.

The study took place in an outpatient setting in Turkey.

The study used a prospective observational design.

Arm circumference was measured.

Authors compared the percent of patients with minimal to severe lymphedema between those who exercised and those who did not over a six-month period; however, only 10 patients were noted to not exercise and sample sizes used in analysis were extremely small per severity group. Some patients who had lymphedema at study entry were stated to have no lymphedema at week 6.

 Results are inconclusive given multiple limitations of the study.

• The study had a small sample size, with less than 100 participants.
• The study had risk of bias due to no blinding, no random assignment, and no control group.
• Measurement and methods are not well described, making the measurment validity and realiablity questionable.
• The study does not provide clear information about node dissection and radiotherapy in relation to lymphedema development, does not fully describe the intervention or any other standard care interventions (e.g., bandanging), and does not describe how severity of lymphedema was determined.
• There was only a single point at which arm circumference was measured, which is a questionable measurement method. 
• Time since surgery was highly varied with a range of 1–105 months.

Study findings are inconclusive regarding the effect of patient education and information to prevent or manage lymphedema in patients with breast cancer.  Findings provide minimal support for use of exercise because of study report limitations.