Results of the Physical Activity and Lymphedema Trial, presented at the annual San Antonio Breast Cancer Symposium, show that slowly progressive weightlifting has no significant adverse impact on arm swelling among breast cancer survivors with lymphedema, in fact resulting in fewer lymphedema flares and improvement in symptoms. Lymphedema is characterized by painful fluid retention and arm swelling. The trial was designed to assess the impact of a one-year weightlifting intervention on lymphedema onset and worsening compared to no exercise among breast cancer survivors. Long standing advice for breast cancer survivors with and at risk for lymphedema is that they should avoid lifting anything heavier than five pounds after they finish treatment. Survivors have also been advised against upper body exercise, preventing them from obtaining the established health benefits of weightlifting. The study included 141 breast cancer survivors with stable arm lymphedema and 154 survivors at risk for lymphedema as of study enrollment. Women in the treatment group were provided a gym membership and 13 weeks of supervised instruction, after which they were unsupervised for the remaining nine months of the trial. The instruction consisted of 90-minute biweekly small group classes led by certified fitness professionals who taught safe techniques for both upper- and lower-body weightlifting using free weights and machines. Weight was increased slowly for each exercise as long as participants had no adverse changes in arm symptoms. An essential element of the trial was that any women with lymphedema was required to wear a well-fitted compression garment while weightlifting. Women in the untreated control group, who did not change their normal physical activity level during the trial, were given the weightlifting intervention after study completion. The study measured change in arm swelling at the one-year mark (comparing changes in both affected and unaffected arms), as well as onset and exacerbations of lymphedema, lymphedema symptoms such as pain, tingling, or numbness, and muscle strength.

Among the women who entered the study with lymphedema, the fraction who experienced a 5% or greater increase in arm swelling was found to be similar in the treatment (11%) and control (12%) groups. Women with lymphedema in the weightlifting intervention group also had greater improvements in self-reported lymphedema symptom severity and a lower rate of lymphedema exacerbations (14%) compared with the control group (29%). Among the women who entered the study without lymphedema, a greater fraction of the control (17%) than the treatment group (11%) women experienced the onset of lymphedema during the study period. Among higher risk women (those who had at least five lymph nodes removed), 22% of the untreated control women developed lymphedema compared to 7% of the weightlifting group. The authors conclude that slowly progressive weightlifting had no significant adverse impact on arm swelling among breast cancer survivors with lymphedema, and resulted in a reduced incidence of lymphedema flares and improvement in symptoms. In breast cancer survivors at risk for lymphedema, a regimen of slowly progressive weightlifting did not result in increased new onset of lymphedema compared with no intervention. Women with five or more lymph nodes removed during breast cancer surgery who performed weightlifting were less likely to experience increases in arm swelling.