Balancing painful swelling with a desire to exercise.

Author:Berger, Susan
 
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For almost 20 years, the prevailing wisdom among most doctors has been that breast cancer survivors at risk of contracting lymphedema--a debilitating, irreversible swelling of one or both arms--should avoid most upper-body exercise or lifting anything heavier than five pounds. For many women, the stem warnings meant they could not shop for groceries or even carry their children. Running and walking were safe, but anything that taxed the arms was considered dangerous.

Women living with lymphedema received the same advice because of the concern that stressing their upper bodies would exacerbate their swelling, pain and stiffness.

But a study at the University of Minnesota that was released this week contradicts decades of restriction. It found that slow, progressive weight training did not increase the onset of lymphedema in breast cancer survivors who had had lymph nodes removed, nor did it worsen the symptoms of longtime suffers.

"While current clinical guidelines say that this type of exercise may be harmful, our research indicates that it is indeed safe," said Kathryn Schmitz, an author of the study and an assistant professor in epidemiology at the Abramson Cancer Center at the University of Pennsylvania. "More research is needed to know whether exercise prevents lymphedema, but there physiologic reasons to believe that it might."

The study, the largest and longest randomized one to date to examine how upper body exercise affects breast cancer survivors at risk of contracting lymphedema, was published online Monday in the Journal of Clinical Oncology.

The exercise group only increased how much they hoisted with their arms in the smallest increments possible. After six months of twice-weekly workouts, the 23 weight lifters found no difference in arm circumference and reported fewer symptoms than the 22 women in the control group.

"Doctors aren't telling women not to lift anything because they want to hold women back," Dr. Schmitz said. "It is because lymphedema is one of the most poorly understood, hated and feared side effects of breast cancer treatment and they don't want to see women suffer. There is a need for caution, but we have thrown the baby out with the bath water."

Of the roughly two million-breast cancer survivors in the United States, 30 percent have lymphedema, estimated Dr. Joseph Feldman, the medical director of the Lymphedema Treatment Center at Evanston Northwestern Healthcare in Evanston, III.

Research has only begun to...

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