Weight lifting and LE risk: an analysis
This is from a site that does healthcare analysis: it analyzed the JAMA article on the PAL protocol for women at risk, and unlike the hyperbole that's out there: "Weight-lifting SLASHES lymphedema risk" (since that shows up constantly, I can't help but think a PR person put it out there) this is much more balanced:
Progressive Weight Training and the Onset of Lymphedema in Breast Cancer Survivors
Recent data published in the Journal of the American Medical Association suggest that a slowly progressing weightlifting regimen is safe for women who have undergone breast cancer surgery and may even decrease the risk of developing lymphedema. The study was designed to demonstrate the equivalence in lympedema onset between women randomized to a weight lifting intervention group and women allocated to a control group of no exercise. Because the study was powered to determine only if weight lifting had therapeutic efficacy to prevent lymphedema, women with or at risk of lymphedema should speak with their healthcare providers before embarking on an unsupervised exercise program.
The study included 154 women with stable arm lymphedema randomized to a progressive weight training treatment group (n=77) or a control group (n=77). All women had survived unilateral breast cancer for 1 to 5 years, had undergone removal of at least 2 lymph nodes, and had no signs of breast cancer-related lymphedema at the start of the study. Women were ages 36 to 75 years at the start of the study and 61% of the women (n=94) had at least 5 nodes removed. The primary outcome measure was the change in arm swelling at 1 year; women were determined to have developed lymphedema if there was at least a 5% increase in interlimb difference. This study was a follow-up to the Physical Activity and Lymphedema (PAL) trial, which was conducted to determine whether exercise is safe for breast cancer survivors at risk for lymphedema.
The treatment group included 13 weeks of supervised exercise instruction led by certified instructors using free weights and machines followed by twice weekly unsupervised exercise to 1 year. As long as no change in arm measurement was noted, weights were increased for each exercise by the smallest possible increment after 2 sessions of completing 3 sets of 10 repetitions. Fitness trainers called women who missed more than 1 session per week throughout the year. If there was a break in exercise that lasted 1 week or more, the protocol specified that the resistance should be reduced and increased gradually. Participants in the control group were asked to continue their baseline exercise program for the duration of the study and were offered a 1-year fitness center membership with 13 weeks of supervised instruction following study completion.
A total of 134 women completed the study. In the intervention group, 11% developed lymphedema, compared with 17% in the control group. The effect of the weightlifting intervention was intensified in women who had at least 5 lymph nodes excised during surgery; 7% of the women in the intervention group developed lymphedema versus 22% in the control group.
Close to half of all women who undergo surgery to remove multiple lymph nodes near the breast typically develop lymphedema, which can impair arm function and quality of life. The other half may restrict movements of the arm or upper body for fear of developing lymphedema, which is a strategy recommended by some clinical guidelines for breast cancer survivors. The authors caution that while this study does not prove that exercise prevents lymphedema, it should remove concerns that slowly progressive weight lifting or exercise involving the arm or upper body will increase the onset of lymphedema in women who have survived breast cancer.
Schmitz KH, Ahmed RL, Troxel AB, et al. Weight lifting for women at risk for breast cancer-related lymphedema. JAMA. 2010;304(24):2699-2705. Abstract available at: http://jama.ama-assn.org/content/early/2010/12/03/jama.2010.1837. Accessed February 4, 2011.
Kira
Comments
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Thanks, Kira. I appreciate the more balanced report.
Dawn
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Me too! Thanks!
Binney
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bump for nowords
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Thanks for the info...I did find an article on the National Lymhedema Network titled Weight Lifting and Lymhedema: Clearing up Misconceptions by Kathryn Schmitz, PhD MPH Associate Prof. U of Penn that was informative as well...I am not too slick at putting links in here yet...but I think the article is easy to find.
I did spend a portion of time, not doing much of the things I enjoy, like huge baking projects and serious gardening and other things out of fear that I would trigger it...I never seemed to find a balance between doing too little or too much...the periodic rest breaks and raising my arm on pillows several times a day ... seemed like I got conflicting info from several sources and was not sure what to follow...at this point in my life...I want my arm back more than I want the new boob that DIEP is going to give me....balance, balance...trying to find that balance...thanks ladies for the input.
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Nowords--balance is key, and I sure strive for it, and don't always achieve it.
Conflicting advice and LE seem to go hand in hand.
Although Katie Schmitz clarified her findings on the NLN site, when she came out with the new JAMA article, about women at risk and weight lifting, she put on her site that "women with more than 5 nodes out, weight lifting reduces the incidence of lymphedema by 70%." It was a sub-group, the study wasn't powered to look at that, and taken literally, then weight lifting should be prescribed for all women with >5 nodes out--and her study didn't show that was safe.
She wants women with LE and at risk for LE to be "liberated" but she has to acknowledge that her studies are small, and only powered to look at harm with weight lifting-- not cure, not prevention.
We're all different, and some women on these boards do great with weight lifting, but she needs to adhere to the "do no harm" adage, and advise caution, IMO.
I'd love to be liberated, but one pound pink Barbie dream weights caused my forearm to swell. Just did.
Kira
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A question: I know they say there is not a dumb question, but this one might be ... and I ask that you don't throw arrows at me for asking!
I'm working with a trainer right now and we're doing LIGHT weights and doing it slowly. Yesterday after my session with her ... even with my gloves on, I could tell my fingers swelled up. I did about an hour of cardio afterward because that usually helps the swelling, but when I finally took my gloves off hours later, my fingers were still swollen.
Things are better today and they are back down. My question is this: is it OK if you swell a little and then it goes down? I know next time, I should definitely take it easy and do a little less. But if I calculate everything I do on whether or not I swell ... I seriously couldn't a drink a cup of hot tea ... hot tea makes my finger swell, taking a shower makes my finger swell, driving makes my fingers swell, even walking makes my fingers swell. I couldn't do anything! Seriously.
I hate this d@*% condition or whatever you call it.
Does my question make sense? Is a little swelling OK when weight lifting if it goes away later?
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Dawn, I hope Tina answers also, because she worked with a trainer, and she flared a bit, and just modified what she did and it got better.
I think, IMO, that if it goes down, and you are aware and try to modify it, you're doing all the right things.
In the weight lifiting studies, if women WITH LE flared, they backed down a bit and then slowly progressed.
I think your question is really important--we're all striving for balance here, and I think what you're doing makes sense.
Kira
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Dawn, you and Kira are exactly right about finding a balance when it comes to exercise. I also get "swelly" from cardio, so I do that on off days from the weight lifting. It's easier that way for me to monitor the effect the weights are having on my body. You will have to see what works for you and modify appropriately. What I have found interesting, is that if I do just the right level of weight lifting, my "normal" swelling will often decrease. Also, if I've had an increase in swelling from salty food, it will often decline after lifting.
I was told to do the weightlifting exercises twice weekly, with 48 hrs in between sessions. She told me to stay at the same weight for two to four workouts. She was referring mainly to the upper body exercises, and in my case certain torso moves, as I have truncal LE. She said I could work out my legs as much as I wanted.
My trainer's attitude was that if I swelled a little and it went down the next day, then it was okay. If the swelling didn't go down and continued to swell the next time I exercised, then the plan was to back down on the weight until the swelling was under control and the lower weight didn't cause a flare.
Increasing weights by one pound increments sounds crazy, but the goal is to limit inflammation. Anytime a muscle is challenged to lift greater weight, there are small tears, which cause inflammation. Inflammation can lead to flares. So, if we baby step the increase in weights, or back down a pound when we sense swelling that doesn't diminish, we eventually can be successful in building greater strength over time. Patience is key, especially for those of us gals who have previously been gym rats. The main thing is we DO need to work these muscles, because if we stop using them, then it takes even less to cause inflammation and a flare.
Tina
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Kira and Tina - Thank you!
Tina, it is very interesting to me that you swell with cardio because I do too ... I thought that was weird. Why in the world? I find, though, that the next day is the pay off for the cardio. Hadn't thought about alternating cardio and weights ... that makes sense too.
*Sigh* It also makes a lot of sense about going slow and backing off ... but that is so hard after being a previous gym rat.
So appreciate your wisdom and you sharing your experience!
Appreciate you all!
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Dawne, I was always a swelly person when it came to cardio - even prior to BC surgery. My rings would always be tight after. Same thing during hot weather. I asked my LE therapist about this, and she confirmed that some people even without a compromised lymphatic system can swell more than others during exercise and heat. So for me, it's hard to know whether I'm swelling because that's what I've always done, or if it is LE related. I tend to err on the side of caution, because it's hard to not worry about swelling once you have LE. I figure if I don't add any weight for several days, what's the big deal? There's no race, just a goal to improve. Now if I could just get myself to be consistent when it comes to working out!!!
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Tina - My fingers would always swell too when I walked and did cardio before BC too. It's true, it's hard to tell. The big difference for me now, though, is, the swelling doesn't go down or it takes hours or sometimes a couple of days to go down after. I emailed my trainer and told her last night that we'll have to slow down on the arms ... makes me sad, but it makes me sadder to have the LE progress.
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bump
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Question: I did my exercises until now with no weights whatsoever. Adding dumbbells of 1-2 lbs, would that be risky? I don't intend to lift weights, just to tone my muscles that have been so wasted during this surgeries-chemo-surgeries journey.
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Day - I would only do it if you have a glove and a sleeve. And I would start out super slow. Like 1 set of 10 reps. Do the stretches and the other preventative measures as well.
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My LE MD told me to always wear my sleeve/glove when exercising. I'm using 3lb weights but before my surgery I was using 10lbs. 3lbs feels like nothing.
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lago - I so know what you're talking about! I too was using 10-12lbs ... the 3lbs does indeed feel like nothing. Grrrrr! But that belongs on another thread!
At least we're doing something ...
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My attempts at weight-lifting on my own have thus far been unsuccessful. I started with 1/2 pound weights and over the course of 6 months went up to 2 lb weights. Even with 1 lb. weights, my upper arm felt heavier, and by 2 lb. weights, I was measurably larger. My hunch is it is the repetitive motion, more than the weight. That said, I would like to try again, this time with professional supervision. Is there a list somewhere of places that are using the PAL protocol? KS1
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KS1 - I don't know but I'd be interested in knowing of such places too.
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You have to email Katie Schmitz, and ask for the protocol, and they'll only give it out to a qualified trainer, not a survivor.
http://www.penncancer.org/physical-activity-and-lymphedema/
Tina got a trainer to help her do it at home.
Good luck, personally, just lifting the 1 lb weights for OT wasn't good for my arm--and I agree, I think it was the repetitions.
Kira
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I've been working out with a personal trainer and thought we were using light-enough weights. It triggered lymphedema (which I had not had before). This has been a pain to clear up.
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Amanda, that stinks! I hope it's clearing up and you have a good therapist.
The push to encourage women with LE and at risk for LE to weight lift came from a desire to remove limitations, but even on the PAL site, the findings are over-stated (weight lifting doesn't cure or prevent LE) and personal experience has shown--even in the studies--that it just isn't a good exercise for some women.
We've had a number of women post that weight lifting, and the Livestrong program at the YMCA haas triggered their LE.
And also a number of women who do well with it.
For me, just using 1 lb weights for rehab of a broken hand, and she wanted 20 reps in three exercises, twice a day, triggered my old tennis elbow and caused me to swell.
Hope things are better for you now--that you have good therapy and compression garments, and can modify your exercise routine.
Kira
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