This probably doesn't apply to most of you, but the New York Times today published an article that applies to Lymphodema in general. It runs counter to what many of us are told (but wisely suggests that anything like this be done under the care of a doctor). Also if you look up the reference to the study in
www.uphs.upenn.edu/news indicates that personal trainers, constant monitoring, and compression sleeves were used.
Melanie
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Weight Lifting May Help to Avert Lymph Problem
By TARA PARKER-POPE
Published: August 17, 2009
After a woman has surgery for breast cancer, she is typically given a long list of don’ts. Don’t lift anything heavier than 15 pounds, including your child. Don’t carry a heavy purse or grocery bags. Don’t scrub, push, pull or hammer.
The goal is to prevent lymphedema, a painful and unsightly swelling of an arm or leg that can occur near the site where lymph nodes have been removed or damaged by radiation. But new research suggests that much of that advice may be too restrictive. To prevent lymphedema after breast cancer, the best strategy may be more exercise, not less.
Last week, The New England Journal of Medicine reported on a study of 141 breast cancer patients who had lymphedema. Half adhered to the traditional restrictions, while the other half embarked on a slow, progressive program of weight lifting. To the researchers’ surprise, the weight lifters actually had significantly fewer flare-ups than the women who restricted their activity.
“Lymphedema is a very feared complication, and many women have made major alterations to their lifestyle in an effort to avoid it,” said Dr. Monica Morrow, chief of breast surgery at Memorial Sloan-Kettering Cancer Center in Manhattan.
“This is a very welcome study that very clearly shows controlled weight lifting does not make it worse and, in fact, improves symptoms. That should be a reason to re-evaluate a whole lot of things we tell people about lymphedema.”
The findings don’t mean that patients should disregard everything their doctors tell them about lymphedema, which can also occur with other cancers. Once lymph nodes have been damaged or removed, the lymphatic system is less able to cope with trauma or infection, and the painful swelling, tightness and heaviness of lymphedema can result. While physical therapy can ease the symptoms, some patients never fully recover.
Doctors say some of the standard guidelines are reasonable. Intravenous lines, for example, pose a risk of infection, and they should not be used on an arm affected by lymphedema. But other restrictions, like not carrying children or using a blood pressure cuff on the affected arm, may be too extreme.
An editorial accompanying the weight-lifting study in The New England Journal notes that the current “policy of avoidance” should be replaced by recommendations for rehabilitation, particularly because many women have to ignore the restrictions anyway — they are caring for young children, or their jobs require manual labor.
“Rather than saying, ‘Don’t ever lift more than 15 pounds, don’t carry a suitcase,’ instead we should empower women,” said Wendy Demark-Wahnefried, a professor of behavioral science at the University of Texas M. D. Anderson Cancer Center, who wrote the editorial. “Give them the rehab and the exercise training they need after their treatment.”
Kathryn H. Schmitz, an associate professor at the University of Pennsylvania School of Medicine and the study’s lead author, notes that in the past, patients were wrongly advised to avoid activity after a heart attack or a back injury.
“It’s the same principle as back rehab and cardiac rehab,” she said. “You’re slowly and progressively increasing the stress that your system can handle. We’re applying that to lymphedema.”
Corrie Roberts of Philadelphia developed lymphedema in her left arm in June 2004, about 18 months after a mastectomy. She had taken the usual precautions, but during back surgery the anesthesiologist mistakenly used her left arm to insert the intravenous line.
After taking part in the weight-lifting study, she said the swelling and discomfort were finally under control. She uses an exercise room in her apartment building and lifts weights three to five days a week.
“It sure was an improvement,” said Ms. Roberts, 75. “As long as I keep the weight lifting up, I don’t have swelling in my arm.”
Dr. Schmitz is conducting a separate study to determine whether weight lifting can prevent symptoms in women who have never had lymphedema. Another study will focus on exercise programs for people with lower-limb lymphedema.
Experts warn that women should not embark on an exercise program on their own, but should ask their doctor about finding a rehabilitation center or exercise program for patients at risk for lymphedema. The women in the study began with very light weights and were regularly monitored for swelling or pain. Dr. Schmitz noted that not every woman is a candidate, and that a few women in the study developed swelling almost immediately after exerting the arm.
Centers that offer the weight-lifting program used in the New England Journal study can be found at
www.uphs.upenn.edu/news. Patients can look for a personal trainer who has a cancer exercise certification from the American College of Sports Medicine. In addition, many Y’s now have exercise programs for cancer patients through a partnership with the Lance Armstrong Foundation.
Women can also order the DVD “Strength and Courage: Exercises for Breast Cancer Survivors,” which was developed by Dr. Sharon Cowden, a Pittsburgh pediatrician and golfer who had breast cancer, and Janette Poppenberg, a health fitness specialist certified by the American College of Sports Medicine.
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