Weightlifting and Breast Cancer-Related Lymphedema

Although weightlifting reduced the need for lymphedema treatment by 50% compared with standard treatment in breast cancer survivors who participated in the Physical Activity Lymph­edema (PAL) trial, weightlifting is not without its own risks. A retrospective analysis of the PAL trial found that the rate of injury was higher in the weightlifting group compared with controls (Brown JC, et al. Oncologist. 2012; 17:1120-1128).

Among women assigned to weight­lifting, about 1 in 5 met with a healthcare provider and either stopped or modified their weightlifting program due to injury.

The study included 295 breast cancer survivors with or at risk for lymphedema; 147 were randomized to a weightlifting program. The intervention was continued for 1 year. Nine women in the weightlifting group reported 10 musculoskeletal injuries that impaired activities of daily living for at least 1 week (8 injuries were in women with lymphedema and 2 in women at risk for lymphedema). The cumulative incidence of musculoskeletal injuries in the weightlifting group among women with lymphedema was 10.2 per 100 breast cancer survivors and 3.4 per 100 breast cancer survivors among women at risk for lymphedema.

The results of this analysis suggest that patients need to be informed about both the risks and benefits of exercise, and in particular, weightlifting. Clini­cians and staff members who suggest weightlifting to breast cancer survivors because of its established benefits need to have the resources to promote integration of this or any physical rehabilitation program into supportive care, wrote the authors.

Since injury can occur during the first year of weightlifting, health fitness experts need to know the best way to modify exercise programs based on the needs of each patient. The exercises used in PAL were modified based on each individual’s needs. This type of intervention rests on interdisciplinary collaboration, the authors emphasized.

The PAL weightlifting intervention was delivered after the health fitness professionals who were going to teach weightlifting to participants underwent a 3-day training course. Important aspects of the PAL weightlifting intervention that helped to ensure its successful delivery include preparticipation evaluations by physical therapists, patient education, ongoing surveillance by health fitness professionals for changes in symptoms that required intervention, staff resources for health fitness professionals, use of lymphedema compression garments, and periodic review of injury and other event rates through the clinical trial protocol.

“Clinicians should refer breast cancer survivors to physical therapists with specific training in oncology or highly trained health fitness professionals (ie, certified cancer exercise specialists),” the authors wrote.