New VA Study: Home Based Exercise LE Program

NatsFan

From the VA's Rehabilitation Research and Development Service

Abstract: Abstract-Lymphedema is a debilitating complication following mastectomy, affecting the arm functions and quality of life (QOL) of breast cancer patients. Studies have shown the beneficial effects of upper-limb exercises on lymphedema in clinical settings. However, there is a dearth of evidence regarding the effect of home-based exercises on lymphedema; therefore, we examined the effect of a home-based exercise program on lymphedema and QOL in postmastectomy patients. Thirty-two female postmastectomy lymphedema patients participated in an individualized home-based exercise program for 8 weeks. Arm circumference, arm volume, and QOL (36-Item Short Form Health Survey) were measured before and after the program. Data were analyzed with the use of paired t-tests for circumferential and volumetric measures and Wilcoxon signed ranks tests for QOL. Significance level was set at p < 0.01 with Bonferroni correction (alpha/n = 0.05/5 = 0.01). Analysis showed a statistically significant improvement in the affected upper-limb circumference and volume (~122 mL reduction, p < 0.001) and in the QOL scores (p < 0.001) at the end of the home-based exercise program. The individualized home-based exercise program led to improvement in affected upper-limb volume and circumference and QOL of postmastectomy lymphedema patients. 

Entire article - one neat thing is that they describe the exercise program in detail:http://www.rehab.research.va.gov/jour/11/4810/pdf/gautam4810.pdf

I barely got through my stats class in college decades ago so some of the jargon is way above my level, but it looks like a structured exercise program may benefit BC LE patients.  I'm sure our resident experts can give it a much more thorough review!

kira66715

Mary, Thanks for this--it's heartening to see someone other than Schmitz, and the conclusions were very positive, but they only followed the women for 8 weeks, and although they described the muscle groups exercised in table 1--I couldn't find the actual exercises.

They said they used household objects, but didn't specify weight limits.

Did I miss the description of the exercise program?

carol57

The 8-week-only follow-up is a very good cautionary note.  I do think that any qualified trainer could devise a program that follows the described regimen. 

One great take-away I get from reading this research report is that I should be stopping between exercises to do some belly breathing.  There's no harm in it whatsoever and now that I read it in the study, duh...of course it could be beneficial.  My routine starts with stretching, then core work, then alternating upper and lower weight lifts, followed by lower back work and then a few more stretches.  I'm thinking that I might end the initial stretch routine with belly breathing, and then pause after several of the upper/lower weight lifts for more BB, and then end with it again. 

Mary, thanks for posting this, and Kira, thanks as always for identifying the 'yes, but' precaution.

Carol

NatsFan

Yes, I was referring to Table 1.  You're right - they don't describe the actual exercises, but based on the muscle groups they discuss, I've done enough therapy that I have a pretty decent guess as to what exercise they had them do.  And maybe the weights were specific to each woman? 

But I did think that it's the most specific description of a post LE program I've seen in any research - not that I've read that many articles, but usually I find something general like "the women were given a structured weight program with increasing resistance and repetitions" but they don't describe it in any detail.  This one was pretty detailed compared to that, I think, and might at least provide a starting point for discussion with a PT or even a personal trainer, especially for a women who can't get to a CLT but wants to begin a weight training program in a safe way.   

Binney4

Mary, good find! This one really does sound more down-to-earth than earlier studies -- more doable. The conclusion mentions the study's limitations (no control group, small study, short 8-week duration), but hopefully it will inspire more such research.

I really do like the direction of this study, but I have to comment on the quality of life findings. It showed improved QOL for the women in the study, but I have to wonder, if you took any 32 of us lymphers and actually paid attention to us for eight weeks straight, asked us how we were doing, gave us positive direction for moving forward, and allowed us to feel we were being listened to and that our experience was valid, wouldn't that alone raise our QOL straight through the ceiling?!! You betcha!

We can dream!
Binney

carol57

Just for the heckuva it, I sent the research lead an email asking if there had been any kind of printed exercise directions for the study participants, including any pictographs or photos, and if so, could I have a copy.  If I get a response, I'll post an update here.

Binnie, being paid attention to (concerns being taken seriously) and receiving positive direction for moving forward pretty accurately describe what I think many of us receive from your posts and those of Kira and others.  My QOL thanks all of you!

Carol

kira66715

Binney, there was a great article about why research studies for depression medications have such a robust "placebo" effect (it's close to 50% response rate I think)--it's because the people on the placebo get lots of attention--and that TLC is therapeutic.

I agree that the study seems reasonable and doable.

I'm no exercise whiz like Mary--I need to have the Norton exercises in front of me every morning--seriously--or I don't remember them. And, when the PAL protocol was mistakenly up on the NLN site, I downloaded it, and I've printed it out and stare at it, and it makes no sense to me.

I need detailed directions and maybe a DVD or I just don't get it.

I liked this study, and imagined myself holding a packet of salt (mentioned in the household objects), but really want the hand out.

Also, Mary has provided us with a great list of references at the end of the article--more articles to look at.

Thanks Mary!

Binney4

Mary and all, I'm not understanding in what sense this is a VA study. It's from India, yes? Is the journal it's published in put out by the VA, maybe?
Binney

NatsFan

I just saw that it was published in a VA journal and never looked to see whether it was actually done by the VA - good catch!

On the deep belly breathing - when I'm doing aerobic exercises and breathing heavily, I always try to imagine that my deep breaths are working my lymph system like bellows moving the lymphatic fluid along.   

carol57

And, no surprise, but the study author in India has not responded to my email inquiry about getting a copy of the exercise handouts given to the home-exercise study participants. Too bad, because I would really like to see that.