strengthening Archives - Lymphedema Therapy Source

(Part 3)

In this final post on arm use after breast cancer, we’ll take a look at research-backed strengthening. But first, an announcement.

Announcement

from the Lymphedema Treatment Act website

The Lymphedema Treatment Act (LTA) passed Congress³ just before Christmas (passing the House of Representatives – Bill H.R. 3630 on 11/17/22¹ & Senate – Bill S.1315 on 12/23/22²). This means compression garments will be covered by Medicare. Say thank you to your congressmen & women by sending an email here.

Research Says

According to research, how should you safely, progressively strengthen your arm to avoid causing or exacerbating lymphedema? (Disclaimer: This is my general conclusion of the articles I reviewed. Be sure to ask your certified lymphedema therapist what the best protocol is for your situation before engaging in any exercise. Proper form is important, and you should not experience pain with exercise. Stretching & strengthening should be done slowly and with control.)

Step One – Warm Up and Stretch

According to the Pal study,¹ participants started with 10 minutes of cardiovascular warm-up followed by brief stretching of the muscles to be strengthened.

Step Two – Focus on the Core

Participants then did 5-15 minutes of core strengthening (spine stabilizing and abdominal exercises) to prevent injury during arm strengthening.

There are 29 pairs of muscles that make up the core.⁴ The study doesn’t specify which core muscles were targeted. But I anticipate these would include the glutes and paraspinal muscles,² transverse abdominus, quadratus lumborum and obliques.

According to a Sports Medicine article,⁴ proper core strengthening might start with:

Cat camel (or cat cow) stretch. This is a common Yoga stretch done in a quadruped position on the hands and knees.
Abdominal bracing variations (it’s important to properly engage the abs through abdominal bracing exercises before advancing core exercise).
Bird dog pose (alternating arm and leg lifts in quadruped) or planks to engage paraspinal muscles. Modified versions of side planks (such as standing side trunk flexion) might be added to engage quadratus lumborum and obliques before doing floor side planks. (For a more robust and difficult core-strengthening program, visit here.³But know that many people will need to start with easier, modified versions.)

The number of repetitions will vary according to a person’s fitness and status. Anywhere from 5-10 reps of each is a good place to start and working up to 15 reps.

Step Three – Strengthening

Start with no weight or 1 lb. (You can also use a low-resistance Theraband.) If there are no changes in symptoms or lymphedema-onset by the next week, increase weight by 0.5 or 1 lb.

^{(Two 2 Kg. weights image licensed under Creative Commons Zero by Pixabay/Pexels)}

The goal is to reach 3 sets per exercise* in the first 3-4 weeks. As a general rule, increase weight after 4 consecutive sessions lifting the same weight for 10, 10, and 12 reps for sets 1, 2, and 3, respectively.¹

Tips:
1. If there are changes in symptoms, the exercise thought to be causing the problem should be skipped or a lighter weight should be used until symptoms clear up.
2. If 2 sessions are missed, deconditioning may result. Resistance should be reduced and gradually increased as outlined above.
3. Monitor symptoms weekly for changes indicating decline (i.e. swelling, tightness, discomfort, etc.) and measure monthly¹ (or more often if you want to be more vigilant).

*Exercises might include: Chest press, lat pull-down, bicep curl, triceps extension, lateral arm raise, wrist curl ⁵among others.

Step Four – Repeat Step One with Cool Down Stretching (hold positions for 30 seconds)

References (blog)
1 Schmitz KH, Troxel AB, Cheville A, et al. Physical Activity and Lymphedema (the PAL trial): assessing the safety of progressive strength training in breast cancer survivors. Contemp Clin Trials. 2009;30(3):233-245. doi:10.1016/j.cct.2009.01.001
2 https://www.healthline.com/health/paraspinal-muscles#takeaway
3 https://www.mayoclinic.org/healthy-lifestyle/fitness/multimedia/core-strength/sls-20076575
4 https://journals.lww.com/acsm-csmr/Fulltext/2008/01000/Core_Stability_Exercise_Principles.14.aspx
5 Cormie P, Singh B, Hayes S, et al. Acute Inflammatory Response to Low-, Moderate-, and High-Load Resistance Exercise in Women With Breast Cancer-Related Lymphedema. Integr Cancer Ther. 2016;15(3):308-317. doi:10.1177/1534735415617283

References (Lymphedema Treatment Act)
¹ https://www.congress.gov/bill/117th-congress/house-bill/3630
² https://www.congress.gov/bill/117th-congress/senate-bill/1315/text
³ https://buddycarter.house.gov/news/documentsingle.aspx?DocumentID=10733

(Part 2)

Last month, we looked at one common fear among women who have had breast cancer – developing lymphedema. I told the story of a woman who came into the outpatient department where I worked at the time with a new onset of arm swelling after lifting heavy pots and pans while cooking for family during the holidays. This was an activity she didn’t regularly do. And that was the problem.

Another True Story

I opened a temporary Facebook group this past year to answer questions people had about lymphedema. The very first virtual meetup, a woman said she had been told not to fly. So, she hadn’t been to see her family a few states away in years! How sad! I couldn’t believe the misinformation and the radical impact on this woman’s life.

Flying

First of all, if you’ve had breast cancer, should you avoid flying to prevent or control lymphedema? No. My goodness, no!¹ You might consider getting baseline measurements with a certified lymphedema therapist and a compression sleeve (and glove, if warranted) as a preventative for the potential risk flying can impose.

But there’s no reason to avoid flying. What else can be done in everyday life to reduce your risk of lymphedema – according to research?

How to Safely Use Your Arm

Several years ago, I attended a continuing education course on breast cancer-related lymphedema presented by Jodi Winicour of Klose Training.² She mentioned a recent study reviewing strength training. I believe that was the PAL study from 2009.³ In that study, the safety of progressive strength training in breast cancer survivors was investigated. The study found slow, progressive weightlifting did not result in an increased incidence of lymphedema. But there are more recent studies that reinforce this principle.

Research

In 2016, the Integrative Cancer Therapies journal looked at the acute inflammation response in women with breast cancer-related lymphedema undertaking upper-body resistance exercise. Groups were divided into those participating in low, moderate and high-resistance loads. The findings were that lymphedema status and severity were not affected by the load lifted.⁴

In 2018, the International Journal of Nursing Sciences published an article summarizing the current literature on the effects of strength-training in breast cancer-related lymphedema.⁵ The article found that “supervised resistance exercise may be safe, feasible, and beneficial in patients with breast cancer-related lymphedema or [those] at risk for breast cancer-related lymphedema.”

And in 2019, the Danish Cancer Society Research Center noted in their study that “patients [previously] were encouraged to avoid strenuous activity of the affected arm because it was believed to stress the already compromised lymphatic transport system.” However, evidence suggests “that progressive resistance training is safe in terms of lymphedema onset and exacerbation.”

Final question

We’ve determined it is okay to use an arm affected by breast cancer as it relates to lymphedema (whether lymphedema is present or not). That leaves us with one question: How do you safely, progressively strengthen an arm to avoid causing or exacerbating lymphedema? You’ll have to wait for the next post … while I safely and progressively strengthen my fingers to type out the potential protocols.

References
1 https://lymphnet.org/position-papers (Air Travel)
2 https://klosetraining.com/about-us/faculty/
3 Schmitz KH, Troxel AB, Cheville A, et al. Physical Activity and Lymphedema (the PAL trial): assessing the safety of progressive strength training in breast cancer survivors. Contemp Clin Trials. 2009;30(3):233-245. doi:10.1016/j.cct.2009.01.001
4 Cormie P, Singh B, Hayes S, et al. Acute Inflammatory Response to Low-, Moderate-, and High-Load Resistance Exercise in Women With Breast Cancer-Related Lymphedema. Integr Cancer Ther. 2016;15(3):308-317. doi:10.1177/1534735415617283
5 Wanchai A, Armer JM. Effects of weight-lifting or resistance exercise on breast cancer-related lymphedema: A systematic review. Int J Nurs Sci. 2018;6(1):92-98. Published 2018 Dec 24. doi:10.1016/j.ijnss.2018.12.006
6 Ammitzbøll G, Johansen C, Lanng C, et al. Progressive resistance training to prevent arm lymphedema in the first year after breast cancer surgery: Results of a randomized controlled trial. Cancer. 2019;125(10):1683-1692. doi:10.1002/cncr.31962

Avoid using Your Arm – Really?