Those suffering from breast cancer related lymphedema (BCRL) should remain active by engaging in an exercise program. Research demonstrates that participation in the correct type of physical activity can enhance lymphatic flow, lower risk of cancer recurrence by keeping weight under control, and result in improved quality of life.
What type of exercise is safe when suffering with lymphedema?
“I used to work out and lift weights before undergoing a mastectomy. Now what am I supposed to do? My surgeon has not been able to give me any specific direction,” states Robin, a breast cancer survivor.
In the past, confusion existed among patients and their healthcare providers regarding safe exercise protocols for those suffering from BCRL. Patients were advised to avoid resistance to their affected arm. Due to recent research, we now know that proper exercise can be beneficial vs. harmful if performed correctly.
Today, exercise prescription for BCRL may include three different types: decongestive, aerobic, and resistive.
Decongestive exercises are an essential component in the treatment and maintenance of lymphedema. They should be performed while wearing compression on the affected extremity in the form of a compression sleeve and/or bandages. These active, non-resistive exercises are designed to promote lymphatic flow through muscle pump action. The lymphatics rely on this muscle pump action to move lymphatic fluid back to the bloodstream. Decongestive exercises, coupled with deep diaphragmatic breathing, works to promote return of lymphatic fluid back to the bloodstream.
“Can I go back to playing tennis tournaments as I did before my surgery?” asks Amy, a four year survivor suffering with BCRL.
Many breast cancer survivors suffering with lymphedema wonder if they can return to their previous level of aerobic exercise. Aerobic exercise generally entails movement of larger muscle groups in a repetitive fashion. The benefits of participation in an aerobic exercise program include weight control, improvement in cardiac function, improving circulation, and increasing strength/endurance. However, it is important to note that certain aerobic exercise/activity may increase the risk of swelling in the affected arm. These “at risk” activities include tennis, golf, racquetball, or any activity requiring the affected limb to take force.
However, it is equally important to validate the importance of these previously enjoyed activities in the survivor’s life, and that foregoing participation may cause a decreased sense of happiness or well being. To this regard, it is important to perhaps modify vs. eliminate the activity to reduce risk. As long as the individual suffering with BCRL is under the care of a certified lymphedema therapist, wears compression during the activity, and does not experience pain or discomfort, it is permissible to participate. I generally advise my patients to continue with their previously enjoyed aerobic sport, including tennis, but to perhaps modify the activity to reduce risk. For example, reducing the amount of time spent on the court, or playing 9 holes of golf vs. 18 may help reduce risk.
As with resistive exercise, the key to safe aerobic exercise is gradual progression in duration and intensity; wearing of compression on the affected arm; and avoidance of pain/overstrain.
“Can I lift weights if I have lymphedema in my arm?” asks Susan, a 15 year breast cancer survivor.
Resistive training exercise in those suffering from or at risk of BCRL was a widely debated topic until the publication of a study by Dr. Kathryn Schmitz and her colleagues. This article published August 13, 2009 in the New England Journal of Medicine examined the effects of weight lifting in women with breast cancer related lymphedema. As a result of this study, we now know that resistive training can be safe for those suffering with BCRL as long as progression is slow and steady. As a rule, compression in the form of garments or short stretch bandages should always be worn during resistive exercise.
Resistance training can increase strength, control weight, and provide weight bearing to fight osteoporosis. Typically resistance exercise is repetitive. Gradual progression is necessary to avoid additional swelling in the limb and to prevent injury. When undertaking a resistive training program, it is important to take into account prior level of fitness and individualize the program to the participant’s ability.
In conclusion, exercise is an important part of lymphedema care. Exercise prescription should be obtained by the treating lymphedema therapist in order to provide a safe and beneficial program. Exercise is proven to be helpful not only for its positive physical effects, but for the psychological benefits as well.