Breast Cancer Lymphedema Treatment
CR Magazine: Collaberation – Results

By Ibby Caputo

A Pound of Good

Study finds weight training benefits women with hand and arm swelling

By Ibby Caputo

For women whose breast cancer treatment included lymph node removal or radiation therapy, weight lifting has long been considered a dangerous activity. That’s because these women are often at risk of developing lymphedema—hand and arm swelling caused by inadequate drainage of lymph fluid. The swelling can vary in its severity from cases that are mild and barely recognizable to others that are extremely painful and significantly limit the use of the affected arm.

“Lymphedema is the most feared complication we have for breast cancer surgeries … because it affects women’s quality of life,” says Kimberly Van Zee, a breast surgical oncologist at Memorial Sloan-Kettering Cancer Center in New York City. There is little evidence-based research on the causes of lymphedema; yet survivors are often given a long list of things to avoid doing with the at-risk arm. “For years people were told not to wear a purse on that shoulder, not to lift the neighbor’s baby,” basically, not to lift anything weighing more than 5 pounds, says Van Zee.

Now, the largest randomized, controlled trial to date to assess the safety of weight lifting among breast cancer survivors suggests that weight lifting may actually be more beneficial than risky. Published in the Aug. 13, 2009, issue of the New England Journal of Medicine, the study found that breast cancer survivors with lymphedema who lift weights are less likely to experience a worsening of symptoms than survivors who do not lift weights. In the study, breast cancer survivors in the weight-lifting group worked with trained fitness instructors at local YMCAs and community fitness centers for 13 weeks. Twice a week, they attended 90-minute classes, gradually increasing weight-resistance training and the number of sets they lifted. They then continued the routine for the next 39 weeks without a trainer’s supervision. Participants were custom-fitted for a compression garment to be worn on the affected arm during exercise.

“We were trying to show that weight lifting wouldn’t make lymphedema worse,” says epidemiologist Kathryn Schmitz, who is an exercise physiologist and lead author of the study. “What we found out was that it made symptoms better and exacerbation less likely.”

These findings could empower survivors to become fitter and stronger, says breast cancer survivor Christina Koenig, whose breast cancer surgery in 2001 included the removal of multiple lymph nodes, putting her at increased risk for lymphedema. “My world of health possibilities is opening up a little bit,” says Koenig, the director of communications and media relations at the patient advocacy organization Breast Cancer Network of Strength, formerly known as Y-ME National Breast Cancer Organization. But, she adds, “Just because a study came out, it doesn’t mean programs exist and that there are standards and guidelines.” Resources and support services to help survivors with strength-building exercises need to be more widely available, she says.

And even if there are guidelines in place, Van Zee notes, “There have to be more [physical] therapists or personal trainers who know how to carefully help these women do weight lifting.”

To address these concerns, the study’s researchers used a weight-training regimen that is available in select YMCA centers across the country in partnership with the Lance Armstrong Foundation, and trained the athletic trainers working with the participants in lymphedema management. According to the Lance Armstrong website, YMCA-based weight-training programs for cancer survivors are now available in at least 19 cities throughout the country, with the goal to expand them to 150 cities in 2010.

The bottom line for survivors, says Koenig, is “to work on a program with a physical therapist who has experience with lymphedema.”

To learn more about the Lance Armstrong programs at the YMCA visit: