Dr. Susan Love Research Foundation | Have Lymphedema? Start Lifting!

For years women who developed lymphedema after breast cancer surgery have been given a long list of things to avoid to help keep their symptoms in check. Typically this list included everything from lifting a child and carrying heavy grocery bags to repetitive arm movements, like scrubbing the tub, and strength training, which many guidelines said "posed the greatest risk" of all.

In the mid-1990s, a small group of breast cancer survivors began challenging this dogma, taking part in progressive resistance training, dragon boat racing, and other exercise programs. And to many people's surprise, not only did these women not develop lymphedema but those who had already developed this arm swelling and discomfort often saw their symptoms improve.

Now, a large clinical trial has confirmed the initial anecdotal evidence and the smaller previous studies that suggested weight lifting was safe for breast cancer survivors with lymphedema. Published in August in the New England Journal of Medicine, this randomized, controlled trial found that twice-weekly progressive weight lifting reduced lymphedema symptoms.

The study included 141 women with lymphedema who had been diagnosed with nonmetastatic breast cancer 1-15 years before the study began, were not actively trying to lose weight, and had "stable" lymphedema, meaning they had not had a new problems in the past three months.

Half of the women were assigned to the group that would take part in progressive weight lifting; the other half were told to continue doing any type of exercise they normally did. A lymphedema specialist evaluated the women's arms at various times throughout the one-year study or if the women reported a change in their symptoms.

Fitness professionals who had been trained in lymphedema treatment determined the proper starting weight for the women based on their current strength, and more weight was gradually added every two weeks over the one-year program as long as the woman reported no changes in her symptoms. All of the women were required to wear custom-fitted compression garments while weight training.

No upper limit was placed on the weight a woman could lift. The upper-body exercises included three sets of 10 repetitions of seated row, chest press, lateral or front raises, bicep curls, and tricep pushdowns, The women also did stretching, a cardiovascular warm-up, and abdominal, back and lower-body exercises.

If a woman developed a flare up in her lymphedema, she continued to do all exercises except for the upper-body exercises. When the lymphedema specialist determined she could resume the upper-body exercises, she started again at the lowest possible weight level.

At the end of the study, the researchers found that the women in the exercise group had increased their strength more than the women in the control group had. Over the one-year period, 19 of the women in the control group and 9 in the exercise group had a flare up.

Furthermore, the number and severity of the symptoms decreased more in the weight-lifting group than in the control group.

Susan says:
This study is another great example of the importance of evidence-based medicine, and the need for us to test any and all assumptions we make about medical care.

For decades, many women who have had an axillary lymph node dissection as part of their breast cancer surgery have feared that they would develop lymphedema or that the lymphedema they had developed would become worse and more disabling. In turn, most of these women followed their doctor's orders and avoided lifting anything heavy. Many also stopped doing things they had previously enjoyed, like tennis, weight lifting, or rowing.

But there are always women who want to push the envelope, and push they did. And because of these women and the researchers who were willing to test the idea that exercise might actually be good, we now know that weight-lifting won't increase your risk of developing lymphedema or make it worse.

Even better, the exercises that these women were doing are not something that can only be done in a clinical trial. They are something that many breast cancer survivors can do. How do you start?

First, you should talk to your doctor and determine that your lymphedema is stable (if you have lymphedema.)
Second, you should meet with an exercise specialist who can teach you the right way to lift weights and determine a proper starting weight. If you live near a YMCA, this is especially easy as the LIVESTSRONG program offered to cancer survivors at YMCAs throughout the country uses the same protocol used in this study.
Third, you should get a custom-fitted compression bandage to wear while weight lifting.
Last, you should have an flare ups evaluated by a lymphedema specialist and not start lifting again until the flare up is over.

Don't let fear of lymphedema keep you from getting the bone-building benefits of weight training!

One more thing: Following these findings, I'll also venture to guess that we'll see women start questioning all the rules about lymphedema as they relate to flying, blood pressure cuffs, drawing blood, and more. Stay tuned!