Is it safe and efficacious for women with lymphedema secondary to breast cancer to lift heavy weights during exercise: a randomised controlled trial

Resistance exercise has great potential to aid in the management of breast cancer-related lymphedema (BCRL); however, little is known regarding optimal exercise prescription. The pervasive view is that resistance exercise with heavy loads may be contraindicated, disregarding the dose-response relationship that exists between the load utilised in resistance exercise and the magnitude of structural and functional improvements. No previous research has examined various resistance exercise prescriptions for the management of BCRL. This study compared the effects of high load and low load resistance exercise on the extent of swelling, severity of symptoms, physical function and quality of life in women with BCRL. Sixty-two women with a clinical diagnosis of BCRL (> 5 % inter-limb discrepancy) were randomly assigned to a high-load resistance exercise (n = 22), low-load resistance exercise (n = 21) or usual care (n = 19) group. Participants in the experimental groups completed a 3-month moderate- to high-intensity resistance exercise program in which the load of the exercises was manipulated from 10-6 repetition maximum (75-85 % of one repetition maximum [1RM]) for the high-load group or from 20-15 repetition maximum (55-65 % 1RM) for the low-load group. Outcome measures included the extent of swelling in the affected arm, symptom severity, physical function and quality of life. There were no differences between groups in the extent of affected arm swelling or severity of symptoms. The change in muscle strength, muscle endurance and quality of life-physical functioning was significantly greater in both high-load and low-load groups compared with the control group (p < 0.040). Change in quality of life-physical function was significantly associated with the change in symptom severity and muscle strength. No lymphedema exacerbations or other adverse events occurred during this trial. Women with BCRL can safely lift heavy weights during upper body resistance exercise without fear of lymphedema exacerbation or increased symptom severity. Women with breast cancer-related lymphedema can be informed that appropriately prescribed and supervised upper body resistance exercise is safe and can aid in the management of lymphedema through improvements in physical function and quality of life.