Weightlifting with Lymphedema

If you’ve heard that women shouldn’t lift weights or pick up their children after breast cancer surgery, a recent study suggests that for some women, doing so may be safe. The study, published in the New England Journal of Medicine in August, found that weight lifting does not necessarily increase the risk of painful flare-ups for some women suffering lymphedema, a swelling in the upper limbs that can occur after surgery to remove breast cancer tumors. The finding contradicts the widely held belief that weight lifting exacerbates lymphedema’s symptoms.

During breast cancer surgery, lymph nodes, belonging to the immune system, in the armpit area may be damaged or removed, leading to a build-up of lymph fluid in the arm that can cause painful swelling and lead to infection. An estimated 20 to 40 percent of breast cancer survivors suffer from lymphedema after surgery, and the condition does not have a cure. Lifting heavy things has generally been discouraged among women with lymphedema, due to fears that such activities may further injure the already damaged tissue.

“Our data indicate that careful, controlled weight lifting can be safe for survivors,” said Rehana Ahmed, a dermatologist and cancer epidemiologist at the University of Minnesota Medical School, and one of the study’s authors.

The study followed 141 breast cancer survivors with stable lymphedema in one arm over the course of a year. Half the participants took part in a twice-weekly, supervised strength-training program at a community fitness center, and half did not lift weights. The women who worked out performed upper body exercises such as bench press, biceps curls, and triceps pushdowns, and lower body exercises such as leg press and leg extension. Resistance was increased after two consecutive sessions at a given weight if no lymphedema symptoms arose. Participants wore well-fitted compression sleeves throughout the exercises.

The study found that women in the weight lifting group showed no significant difference in limb swelling compared to women in the non-lifting group, and while 29 percent of women who didn’t lift weights saw their lymphedema symptoms worsen at some point during the study, only 14 percent of those who lifted weights did. Lymphedema symptoms include limb swelling, but also pain, tightness and even skin infections.

Exercise and greater muscle strength increase lymph flow, which may reduce the effects of stress on the affected limb. This could help explain the study’s results, according to the researchers.

“This paper has stirred a lot of great discussion in both the medical and patient communities,” says Mei Fu, a doctor of nursing at New York University. Fu, who was not involved in the study, is cautious to generalize from the study group that all women with breast-cancer-related lymphedema could take up weight lifting with similar results. She points to the large group of eligible patients, more than 3,200 women, from which the authors chose a small number of participants. The study group was selected on a very strict basis. For instance, participants needed to have had cancer in just one breast, could not currently have cancer and could not have been diagnosed with lymphedema within the past year.

There were also fewer women with severe lymphedema in the weight lifting group than in the non-weight-lifting group. Participants with severe lymphedema are more likely to experience symptoms than women with mild or moderate lymphedema, regardless of whether or not they lift weights, according to Fu.

When the study was first released in August, some media outlets touted weight lifting as a way to manage or even cure the disease. It is not a cure and should not be viewed as a way to manage or prevent lymphedema, according to Fu, but as a way to increase overall health and muscle strength. Ahmed, the study co-author, emphasizes the importance of wearing a well-fitted compression garment during exercise, starting slowly and lifting under the supervision of a physical trainer — preferably one who has experience working with cancer survivors to prevent injury.

“What we can infer from this study,” says Fu, “is that with close supervision and a well-fitted compression garment, patients who meet similar criteria as described in the study are safe to perform weight lifting.”