Medscape Article on Weightlifting/LE

Medscape put out a nice article summarizing the JAMA article and SABC presentation by Katie Schmitz, IMO

I'm going to put it in the post, as I'm not sure if you need a subscription:

From Medscape Medical News
Weightlifting May Not Increase Risk for Lymphedema in Breast Cancer Survivors
Laurie Barclay, MD

---Educational Item---
December 17, 2010 - A slowly progressive weightlifting program for breast cancer survivors does not increase the risk for lymphedema, according to the results of a randomized controlled equivalence trial reported online December 8 in the Journal of the American Medical Association.

"Breast cancer survivors at risk for lymphedema alter activity, limit, activity, or both from fear and uncertainty about their personal risk level, and upon guidance advising them to avoid lifting children, heavy bags, or other objects with the at-risk arm," write Kathryn H. Schmitz, PhD, MPH, from the University of Pennsylvania School of Medicine and Abramson Cancer Center in Philadelphia, and colleagues. "Such guidance is often interpreted in a manner that deconditions the arm, increasing the potential for injury, overuse, and, ironically, lymphedema onset. Adherence to these precautions may limit physical recovery after breast cancer and, for some women, result in lost employment."

The goal of the study was to compare onset of lymphedema after a 1-year weightlifting intervention vs a no-exercise control group among survivors at risk for breast cancer-related lymphedema (BCRL) who were enrolled in the Physical Activity and Lymphedema trial.

Between October 1, 2005, and February 2007, a total of 154 women surviving 1 to 5 years after diagnosis of unilateral breast cancer, with at least 2 lymph nodes removed and without clinical signs of BCRL at study entry, were recruited from the Philadelphia metropolitan area. Age range at study entry was 36 to 75 years.

Participants were randomly assigned to a control group receiving no exercise, or to a weightlifting intervention, which included a gymnasium membership and 13 weeks of supervised instruction followed by 9 months of unsupervised exercise. Study endpoints included incident BCRL, defined as increased arm swelling during the 12-month period with at least a 5% increase in interlimb difference, and clinician-determined BCRL onset. The equivalence margin was considered to be a doubling of lymphedema incidence.

Follow-up data were collected through August 2008, with 134 participants completing follow-up evaluation at 1 year. In the weightlifting group, 8 (11%) of 72 women experienced incident BCRL vs 13 (17%) of 75 in the control group (cumulative incidence difference [CID], -6.0%; 95% confidence interval [CI], -17.2% to 5.2%; P for equivalence = .04).

In the subgroup of women who had removal of at least 5 lymph nodes, incident BCRL occurred in 7% (3/45) in the weightlifting intervention group and in 22% (11/49) in the control group (CID, -15.0%; 95% CI, -18.6% to -11.4%; P for equivalence = .003). One woman in the weightlifting group and 3 in the control group had onset of clinician-defined BCRL (1.5% vs 4.4%; P for equivalence = .12).

"In breast cancer survivors at risk for lymphedema, a program of slowly progressive weightlifting compared with no exercise did not result in increased incidence of lymphedema," the study authors write.

Limitations of this study include lack of testing of superiority of weightlifting, necessitating additional research before it can be shown that weightlifting prevents lymphedema.

"The majority of breast cancer survivors do not have lymphedema; however, they alter the use of their arms and upper body activities out of fear of developing lymphedema," the study authors conclude. "The findings from our trial should help clarify clinical advice to patients who have completed breast cancer treatment regarding the safety of resuming or beginning a weight lifting program. ... [E]ven with the finding of no harm, our results combined with previously published results for women with breast cancer-related lymphedema suggest that the many health benefits of weight lifting should now become available to all breast cancer survivors."

The National Cancer Institute and the National Institutes of Health supported this study. BSN Medical provided in-kind support in the form of custom-fitted compression garments and the fitness centers where the weightlifting intervention was delivered discounted membership fees for study participants (YMCA of Philadelphia and Vicinity; Sisters in Shape; the Family YMCA of Burlington County, New Jersey; and the Community YMCA of Eastern Delaware County). The study authors have disclosed no relevant financial relationships.

JAMA. Published online December 8, 2010. Abstract

I think this is very clear, that the goal is to support careful strenghtening, and it does not appear to harm us--weightlifting is not treatment for LE, nor has it definitely been proven to prevent LE (the small group of women with >5 nodes may just be spurious)--but we don't need to be aftraid to use our arms, as long as we do it in a thoughtful way.

Here's the link:

http://www.medscape.com/viewarticle/734429

Kira