From Our 2010 Archives

Weight Lifting May Be OK After Breast Cancer Surgery

Study: Weight Lifting Not Associated With Increased Risk of Arm Swelling

By Charlene Laino
WebMD Health News

Reviewed by Laura J. Martin, MD

Dec. 8, 2010 (San Antonio) -- Contrary to what's been thought, a program of weight lifting may not increase the risk for arm swelling caused by lymphedema in breast cancer survivors. This is according to a new study performed by the same researchers who previously found that weight lifting may help breast cancer patients who already have lymphedema in their arms to gain strength.

Lymphedema is buildup of fluid that causes swelling. It can be a lasting side effect of removing lymph nodes during breast cancer surgery.

To avoid developing the condition or making it worse, the vast majority of the 2.4 million breast cancer survivors in the U.S. are typically advised against lifting children, heavy bags, or anything else weighing more than 5 pounds.

But the studies challenge such advice.

The findings "do not mean women can just go out, buy a set of weights and start their own rehabilitation program," says researcher Kathryn Schmitz, PhD, MPH, associate professor of epidemiology and biostatistics at the University of Pennsylvania School of Medicine.

What "breast cancer survivors should do is go to their physician and insist on getting a prescription for physical therapy. The physical therapist can evaluate them and develop a safe weight lifting program," Schmitz tells WebMD.

The new study was presented at the San Antonio Breast Cancer Symposium and published online in the Journal of the American Medical Association.

Weight Lifting and Lymphedema

The study involved about 150 breast cancer survivors who had their cancer diagnosed one to five years previously. All had two or more lymph nodes removed, and none had signs of lymphedema when they entered the study.

Arm measurements were taken throughout the one-year study. A woman was considered to have lymphedema if her affected arm swelled by 5% or more.

Eleven percent of 72 women in the weight lifting group had their affected arm swell by 5% or more vs. 17% of 75 women who did not change their normal physical activities.

Among women who had five or more lymph nodes removed during breast cancer surgery, 7% of 45 women in this group had arm swelling of 5% or more, compared with 22% of 49 women who did not lift weights. This translates to a 70% reduction in risk, Schmitz says.

Women in the weight lifting group were given a one-year membership to a local fitness center. For 13 weeks, they attended small, twice-weekly, 90-minute classes led by certified fitness professionals who taught them safe techniques for weight lifting using both free weights and machines. Weight was increased slowly for each exercise if the women had no arm symptoms including swelling, pain, tingling, or numbness.

For the remainder of the study, the women exercised on their own while being monitored for any change in symptoms.

The rest of the women weren't asked to start weight training, and they got a one-year pass to a health club only when the study ended.

Any woman who developed lymphedema was given a custom-fitted compression garment for their affected arm and was required to wear it if performing weight lifting exercises.

Some Breast Cancer Survivors Still Get Arm Swelling

Some women are going to develop lymphedema even if they follow a well-designed weight lifting program, Schmitz cautions. "A reduction in risk does not mean total prevention."

Alphonse Taghian, MD, PhD, chief of breast radiation oncology at Massachusetts General Hospital in Boston, tells WebMD that he thinks the study will have "a great impact."

"This will change the way we counsel women, who are usually afraid of using their affected arm. They don't have to be afraid," says Taghian, who was not involved in the study.

That said, "women have to be careful so [lifting] won't cause harm," he says.

But another expert in cancer and exercise cautions that further study is needed before any advice to avoid lifting heavy objects can be changed.

Lee W. Jones, PhD, scientific director of the Duke Center for Cancer Survivorship at Duke Comprehensive Cancer Center, tells WebMD that while the study is "a step in the right direction," the number of women studied was "small and the number of patients who actually developed lymphedema was especially small," he says.

Lymphedema: What's at Risk

Studies have shown that the one-third of breast cancer survivors who have had multiple lymph nodes removed are at greatest risk of lymphedema, with as many as 47% of these women developing the condition.

Of the 61% of women who undergo less invasive sentinel lymph node biopsies and have only one or two nodes removed, up to 7% develop lymphedema.

"This is a real-life concern that often limits their ability to work, play with their kids, even lift up all those holiday bags this season," Schmitz says.

Insurance co-pays generally cover the cost of five to 10 physical therapy sessions, Schmitz says. If you don't have insurance, cost varies widely, but is typically in the range of $75 to $100 per session.

SOURCES: San Antonio Breast Cancer Symposium, San Antonio, Dec. 8-12, 2010.Kathryn Schmitz, PhD, MPH, associate professor of epidemiology and biostatistics, University of Pennsylvania School of Medicine, Philadelphia.Lee W. Jones, PhD, scientific director, Duke Center for Cancer Survivorship, Duke Comprehensive Cancer Center, Durham, N.C.Alphonse Taghian, MD, PhD, chief of breast radiation oncology, Massachusetts General Hospital, Boston.Schmitz, K. Journal of the American Medical Association, published online Dec. 8, 2010.

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