Contrary to decades of doctors' advice, a new study has found that a weight lifting may not put women at risk for developing lymphedema after breast cancer surgery.
In fact, the study found that lifting weights under supervision may lower women's chances of developing lymphedema, according to results that will be published in an upcoming issue of the Journal of the American Medical Association. Lymphedema is a painful and potentially debilitating swelling of the limbs that occurs when lymph fluid cannot drain from lymph nodes as it does in healthy people.
Breast cancer survivors are often told to avoid lifting children, heavy bags or substantial weight with the arm on the side of their body from which armpit-area lymph nodes were removed. Doctors feared any stress to the arm could trigger lymphedema.
But Katheryn H. Schmitz, an associate professor at the University of Pennsylvania School of Medicine, and other researchers wondered if this advice left women with weakened arms and, ironically, at greater risk for lymphedema when they were not able to avoid lifting a weight.
Schmitz and colleagues followed 154 female cancer patients who had at least two lymph nodes removed in the past five years. Half of the women were randomly chosen to participate in a 13-week supervised weight-lifting program. The other half were not enrolled in the exercise program.
A year later, 11 percent of the women in the weight-lifting group developed lymphedema, compared with 17 percent of the women in the no-exercise group.
“If your maximum capacity of what your arm can handle is lifting your coffee cup, and you find yourself at the last gate at the terminal, and the wheel of your suitcase fell off — you have to carry your suitcase,” the risk of developing lymphedema could be great, Schmitz said. So, she thought, why not see if women who strengthen themselves could avoid the risk.
Women who had five or more lymph nodes removed saw greater benefit from the exercise: 22 percent of these women who were in the no-exercise group developed lymphedema, but just 7 percent of these women in the weight-lifting program developed the condition.
The study supported previous findings by Schmitz that showed the supervised weight-lifting program was helpful for women who had already developed lymphedema.
Why the worry?
Because of lymphedema's potential to be debilitating, many breast cancer patients dread the condition.
“There's a lot we don't know about lymphedema, so because of that, and because it can be so debilitating for women, we erred on the side of being conservative,” in approaching the weight-lifting program, said study researcher Dr. Jennifer Leigibel, a medical oncologist at the Dana-Farber Cancer Institute and an assistant professor at Harvard Medical School.
Doctors typically remove lymph nodes to prevent a tumor from spreading to other parts of the body through the lymphatic system. In recent years, physicians have found that removing only a few key lymph nodes — a procedure called a sentinel node biopsy — can limit the number of lymph nodes that have to be removed. But in some cases, women are still at risk. Schmitz's paper reports that 5 to 7 percent of women who've undergone sentinel node biopsies develop lymphedema.
Concerning the novel weight-lifting program for breast cancer survivors, Leigibel said, “She's really moved this field forward.”
Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society, agreed.
“We have something that's been talked about for decades and taken for gospel truth,” Lichtenfeld said.
“[The study] opens up a whole re-thinking of what recommendations we make to these women, to the millions of women who had breast cancer surgery,” he told MyHealthNewsDaily.
Yet, despite the good news, Leigibel and other breast cancer researchers worry patients could easily injure themselves without weeks of supervision under a certified trainer.
“It's exciting news, in the past women were told you absolutely cannot do certain things, like lift and push and pull this or that,” said Saskia Thiadens, R.N., executive director of the national lymphedema network.
But, Thiadens said, “I can't overemphasize that women really need to work closely with a certified lymphedema therapist who can guide them in the appropriate exercises.”
Schmitz said her next step will be research into weight-lifting programs that are safe and accessible to all women who've undergone lymph node surgery.
“By not using the arm, it's kind of like telling the person who had a heart attack, ‘Never walk fast again, never have sex again, never pick up your kids again.' That doesn't make sense,” Schmitz said.
Instead, she said, “you rehabilitate people.”
Pass it on: Lifting weights, under the watch of a trained supervisor, can lower breast cancer patients risk of lymphedema.