Lymphedema Research on Acupuncture

Thanks, Hildy!

Carol, the abstract is here:
http://www.ncbi.nlm.nih.gov/pubmed/23439658

The article I downloaded by PDF after a google search was another risk reduction myth-buster rant called "Setting the Record Straight: Exercise and Lymphoedema" that was more than a bit over the top. Just don't get this agenda. Exercise is of course helpful--for a lot more than LE--but when exercise pros skip over the top of the precautions to make such wide claims we're back to Square One with educating doctors (not to mention patients).

So I'm grateful all over again for your work on the exercise documents for both patients and professionals. You rock!

The acupuncture study concludes that it may be helpful for women who have access to no other therapy interventions, which I consider a strange conclusion indeed. It's unfortunately true that there are too many women with little or no access to treatment, but then where are they going to get acupuncture? Better to focus on improving provisions for treatment for everyone who needs it. And on that front we have a LONG way to go!
Binney

Definitely worth it, Hildy! And much appreciated! We thrive on these kinds of discussions here.

I wasn't referring to the study as being bad--I haven't even read it yet. Just that the spin-offs from studies like this get out of hand.

Some people take off on their "myth busting" agendas by overstating the findings and underemphasizing the protections that should be in place. For some reason I don't understand, ever since Katy Schmitz's first weight-lifting exercise study was published there's been a push in some quarters to debunk risk reduction measures. I can appreciate the enthusiasm, but the direction it takes is dangerous. Too often our health-care providers read these kinds of rants (like I found so easily) and don't do the hard work of analyzing the study itself, and then they tell their patients to go out there and exercise without offering any guidelines for easing into it. Then when LE develops, it's a nasty surprise. We've also had problems with some employers hearing of these things and then telling their employees with LE that they should be able to lift any weight and so remove job protections that should be in place. Too many people with their own agendas!

Please do feel welcome to keep us informed, Hildy.
Hugs,
Binney

Today I read the studies Hildy sent me, and two study topics were particularly interesting: acupuncture and weight training.

Acupuncture: There were two studies, and a variety of related articles and editorials, about acupuncture for individuals with LE. The studies' intervention periods (i.e. the weeks of acupuncture treatment) were very short and had small participation, and follow-up was just a few months. Both studies were careful to acknowledge that more rigorous research is needed, and indeed one study seems to be an exploratory study that was used to define parameters for a random controlled trial of acupuncture as LE treatment, for which enrollment is finishing up, at Memorial Sloan Kettering. In both studies, the conclusion is that administering acupuncture does not provoke any adverse LE reactions (although I think one study always administered the needles in a non-affected part of the body). Furthermore, one study noted improved quality of life from the treatment, and the other went so far as to observe measurable swelling reductions, and these reductions seemed to hold true for several weeks after treatment.  They measured only at two spots on the arm, and I don't recall any way the researchers had to control for lots of different potential LE influences and treatment factors during the weeks after acupuncture, so that study is far from perfect.  My take: it's very encouraging, and even if the random controlled trial does not find LE treatment results, preliminary results suggest that individuals who wish to use acupuncture to treat other conditions can probably do so safely.  I'll look forward to what is learned from the larger trial, and if they show that there's a lymphedema treatment benefit from acupuncture, that will probably prompt more follow-up research, and wouldn't it be great to have another tool in our LE toolbox?

The weight-lifting study was very small (17 women with LE after BC) and very short. They taught the women five upper-body weight lifting exercises before the official study started, and then half the women were asked to lift very heavy weights with just a few repetitions (6-8), while the other women lifted lighter weights for more repetitions (up to 20).  They checked for any LE response after 24 hours, and then again 72 hours after the exercise session.  Then, they waited 10-12 days, and the two groups traded exercise type, so those who had lifted heavier weights now lifted lighter weights with more reps, and vice versa. They were checked again at 24 and 72 hours.  Sleeve wear was optional, and only 3 women wore sleeves during their exercise sessions.  For both forms of exercise (light weights/high reps and heavy weights/low reps), the study observed no 'significant' LE impact, using bioimpedence measures, circumference measures, and reported symptoms. 

The study purpose was to find out if lifting light/hi rep vs. heavy/low rep makes a difference in the body's response to weight lifting, and they found no significant responses at all. That's their conclusion; they published a person-by-person graph that shows each woman's individual responses, and I did not take the time to study these to see the range of individual outcomes.  I'm willing to accept that the women's arms did not, indeed, flare significantly after either type of exercise, so this is encouraging and interesting. However, they note that the amount of weight each woman lifted was individualized, and the study was done with an exercise physiologist who no doubt customized the amount of weight according to each person's ability to tolerate.  Lifting light/hi reps and lifting heavy/fewer reps are both ways to work a musle to exhaustion, but I suspect that 'exhaustion' didn't happen in this study, because it would take more than one or two sessions to figure out what that maximum weight could be for each woman.  The authors acknowledge that more study is needed.  

What I do find interesting in the weight lifting study is that they are questioning the need / PAL recommendation to start at the lightest possible weight when starting a lifting program. This study points out that it is well understood that the heavy/few-rep method builds muscle faster than the light/more-reps approach, and in effect they were trying to see if there's any difference in lymphedema response using one method or the other; and they found no difference. But what the study cannot do is to generalize its results to the population of women with LE after breast cancer.

To say that 'Neither Heavy nor Light Load Resistance Exercise Acutely Exacerbates Lymphedema in Breast Cancer Survivor' (the title of the study report) is a very, very broad statement after testing just one session of heavy and one session of light lifting, on just 17 people! By 'acute' I think they mean 'immediate', so fair enough on the results of the women studied for that very short exercise experience during that tiny window of time. I do think that the PAL guidelines are conservative, but that's a very sound approach considering that using very light weights and working up slowly to heavier weight goes get us our strength results eventually, and few women will have an exercise physiologist or certified trainer at their side every single time they pick up a dumbbell or sit at a weight machine.

Binney's concern that the study title invites generalization and dangerous advice is spot on.  Which is too bad, considering that what the study showed does indeed invite some further research to see if the helpful PAL guidelines can be tinkered with, safely, to meet the needs of lots of women who would love a speedier journey back to athletic-caliber strength, for sport and for daily work and life. But for now, I sure wouldn't recommend picking up 40 lbs or launching into a pushup or a plank or a downward dog, unless you've taken the slow-but-sure route to build the strength you need to do so!

I'll issue a disclaimer that I did not take notes while reading, so my discussion points here are from memory, and it's possible I misstate a study detail or two. I read on my tiny laptop on an airplane and am typing on a tiny keyboard with a small screen...not so simple to re-read studies as I add my two cents about them here.

Hildy, thanks so much for sending me these studies!

Carol

 Sleeve wear was optional...

What ???!

Sorry I am reading this so late- I find this to be the most disturning part of the study!  Talk about throwing caution to the wind- First, do no harm!  (grrrrr!)  Umpteen ladies with DX LE lifting weights and not wearing compression ?! wrong thread...grrrrr!

*ACUPUNCTURE BEADS
I came across this on Dr Oz- looks very interesting,.  I wonder  where the lymphatic system would appear on the ear/ body part in terms of these beads.  I'd love to see a study of LE and these beads done.

http://www.doctoroz.com/videos/relieve-stress-acupuncture-beads#cmpid=raoz0411?eid=1010682324&memberid=13423377