A slowly progressive weight-lifting program may help some breast cancer survivors ease the symptoms of lymphedema, according to a new study from the University of Pennsylvania.

The findings are welcome news to the more than 2.5 million breast cancer survivors in the United States, many of whom have been discouraged from weight-lifting exercise because of concerns it may bring on lymphedema or worsen the swelling they already have.

Lymphedema, or swelling due to the buildup of lymph fluid, can occur at any time after treatment for breast cancer—even many years later. Symptoms include a feeling of tightness in the arm or hand on the same side that was treated for breast cancer, leathery skin texture, heaviness, pain, pitting, and difficulty writing. Many women worry weight-lifting and everyday activities such as picking up their kids or carting around grocery bags can bring on those symptoms.

This study suggests women may be doing themselves a disservice by letting fear keep them from certain activities and exercises.

"If your lymph nodes are removed because of breast cancer treatment, you suffer impairment in your ability to respond to infection, trauma, injury, and inflammation. Exercise improves the body's response to those 4 things," said lead researcher Kathryn H. Schmitz, PhD, MPH, from the Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania.

Evidence that exercise helps

Schmitz and her colleagues recruited 141 women with stable lymphedema and a history of breast cancer. Half were assigned to a controlled, weight-lifting exercise program that met twice weekly for 90 minutes over 13 weeks. The women were required to wear a custom-fitted compression sleeve on the affected arm during exercise and started with low-weight resistance (about 1 to 2 pounds). They were closely monitored for changes in the affected arm. The amount of weight they lifted was increased gradually if the lymphedema symptoms did not worsen.

Over the course of the study, the majority of the women in the weight-lifting group had increased their strength and reduced symptoms of lymphedema. The number of women who saw their swelling increase was about the same in both groups (11% in the weight-lifting group and 12% in the control group). There were no serious side effects reported in either group.

"Our study shows that participating in a safe, structured weight-lifting routine can help women with lymphedema take control of their symptoms and reap the many rewards that resistance training has on their overall health as they begin life as a cancer survivor," Schmitz said.

However, experts are concerned that women will read this study and go out on their own and start lifting weights, potentially doing themselves harm.

Start slowly

"This study demonstrates the importance of exercise after cancer treatment, and it also highlights the importance of doing it safely. Women should talk their doctor before starting any exercise program and start slowly," said Colleen Doyle, MS, RD, American Cancer Society, Director, Nutrition and Physical Activity.

Schmitz also stresses the importance of starting slowly and using proper form.

"Work with a well-trained certified fitness professional to begin weight training. Do not try to start this kind of program on your own. Your trainer should start you with very light weights. If you do that for a week and you aren't seeing any problems, increase your resistance, but do it in very small increments," she says. "Train with a physical therapist or a certified fitness professional who specializes in lymphedema or working with cancer patients."

In February 2009, the American College of Sports Medicine (ACSM) announced a new certification designed specifically for health and fitness professionals interested in working with cancer survivors. It was funded by a grant from the American Cancer Society and developed with experts from both ACSM and ACS.

This specialty certification will allow cancer patients and survivors to find fitness professionals who can help them exercise safely and achieve their exercise goals while they are undergoing treatment and after they have completed treatment.

"Previously, there were no nationwide quality standards for fitness professionals working with cancer survivors. We hope this certification will help point cancer patients to people and organizations sensitive to their needs," said Colleen Doyle, MS, RD, American Cancer Society, Director, Nutrition and Physical Activity.

In addition to regular exercise, it's important to eat right. Doyle recommends aiming for at least 5 or more servings of vegetables and fruits each day, choosing whole grain foods instead of white flour and sugars, and limiting meats that are high in fat.

"One of the most important goals a cancer survivor can set post-treatment is to live a healthy lifestyle," Doyle says.

The research was conducted in partnership with YMCAs in Pennsylvania and New Jersey. The findings are published in the August 13, 2009 issue of The New England Journal of Medicine.

To find a certified trainer in your area, visit American College of Sports Medicine's ProFinder site, or to find out if your local YMCA offers an exercise program for cancer patients, visit the Resource Guide available through the University of Pennsylvania's web site. Heath professionals interested in ACSM/ACS Certified Cancer Exercise Trainer program should visit www.acsm.org.

To learn more about lymphedema, see Lymphedema: What Every Woman With Breast Cancer Should Know.

Reviewed by: Members of the ACS Medical Content Staff

Citation: "Weight Lifting in Women With Breast-Cancer–Related Lymphedema." Published in the August 13, 2009 issue of The New England Journal of Medicine. First author: Kathryn H. Schmitz, PhD, MPH, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania.