Exercise and Arm lymphedema Karin Johansson RPT, LT

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Exercise and Arm lymphedema

• Karin Johansson
• RPT, LT, Lymphedema Unit, Lund University
  Hospital
• Dr Med Sci, Dep. of Health Science, Lund
  University
• Sweden

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Myths and realities

• Rockson S. Precipitating factors in lymphedema.
  Cancer (Suppl) 1998 83 2814-16

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Exercise?
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Physical activity

• Can be associated with reduced risk for breast
  cancer (McTiernan et al. 2003)
• Can reduce risk of dying of breast cancer
• (Holmes et al. 2005)
• 3-5 hours walking per week

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Shoulder muscle strength (kp)

• Preop. 6 months
• n61 n61
• Flexors 8.31.5 8.01.5 (plt0.05)
• Adductors 6.21.5 5.81.3 (plt0.01)
• Inward rot. 13.23.5 12.42.9 (plt0.05)
• Johansson K. et al. Arm lymphoedema, shoulder
  mobility and muscle strength after breast
• cancer treatment. A prospective 2-year study.
  Advances in Physiotherapy 2001 3 55-66.

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Shoulder Range of Motion and Arm lymphedema
n61 (all axillary dissection)
No radiotherapy (n26) Breast radiotherapy
(n16) Breast and axilla radiotherapy (n19)
Abduction Volume
difference degrees ml
preop 2 years
preop 2 years
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Matched case-control studyResults - Occupational
work-load

• Blind assessment (0-3 scale)
  
  
  controls/lymphedema
  
  n38
• heavy lifting n.s.
• repetitive/static work n.s.
• awkward working posture n.s.
  neck/shoulder
• heavy work hand/forearm n.s.

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Life-style related factors

• Before and after surgery
• controls lymphedema
• n71
• Part of housework () ? plt0.001 ?
  pgt0.001
• Sports activities (number) n.s. ?
  pgt0.001
• Hobby activities (number) n.s. ?
  pgt0.001

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Risk factor overweight

• Weight
• Activity

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Exercise and Arm lymphedema What can the
physiotherapist do?
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Breast Cancer Physical Therapy Center
Philadelphia
Linda Miller, PT and LT
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No development of arm lymphedema after Dragoon
Boat racing

• 20 women with axillary dissection
• Arm muscle strength training for 2 months
• 7-8 months competition season
• Harris SR, Niesen-Vertommen SL .Challenging the
  myth of exercise-induced lymphedema
• following breast cancer A series of case
  reports. J Surg Oncol 2000 74 95-99

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No deterioration of arm lymphedema after exercise
program

• 77 women with arm lymphoedema
• 8-week program
• Resistance and Aerobic training
• McKenzie C, Kalda A. Effect of upper extremity
  exercise on secondary lymphedema in breast cancer
  patients A pilot study. J Clin Oncol 2003 21
  463-466

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Mixed groupNo increased risk for or exacerbation
of arm lymphedema

• 45 women with axillary dissection
• 13 with arm lymphedema
• Weight training twice-a-week
• for 6 months
• Ahmed RL et al. Randomized controlled trail of
  weight training and lymphedema in breast cancer
  survivors. J Clin Oncl 2006242765-72

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What have we done in Sweden?
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Pool exercise 1 hour Results volume change

• 
  
  
• Temperature Arm lymphedema
  p-value
• 28 C 2031 p0.06
• 34 C

n 7
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Exercises
Elbow flexion
Shoulder abduction
10 repetitions each
Elbow extention
Shoulder flexion
Shoulder horizontal adduction

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Weight bearing exerciseResults volume

• Arm lymphedema
• Light dumbbells after 24 hours
• (n31)
• Heavy dumbbells after 24 hours
  (p0.1)
• (n18)
• Prospective after 12 week (p0.03)
• (n20)
• Johansson K, Tibe K, Weibull A, Newton R. Low
  intensity resistance exercise for breast cancer
  patients with arm lymphoedema with or without
  compression sleeve. Lymphology 2005 38 167-180.
  
• Johansson K, Piller N. Weight-bearing exercise
  and its impact on arm lymphoedema. J Lymphoedema
  2007 2 15-22.

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Recommendation
When starting heavy exercisedo regular
follow-up1-2 months
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Pole walking n26
Purpose To investigate the influence of pole
walking on arm lymphedema .
Lotta Jönsson, PT, Lymphedema Unit, Lund
University Hospital, Sweden
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Pole walking - Results volume

• Arm volume
• One occasion (n26) after 24 hours
• Prospective (n14)
  after 8 weeks
• Jönsson L, Johansson K. Does pole walking affect
  arm lymphedema in breast cancer treated women?
  Submitted to Physiotherapy Theory and Practice
  2007.

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Perceived exertion

• Borg scale
• The patients perceived exertion after physical
  exercise
• was rated on a scale ranging from 6 (minimum) to
  20 (maximum)
• where every other step is provided with a verbal
  statement (Borg 1982).

• 7 Very, very light
• 11 Fairly light
• 15 Hard
• 19 Very, very hard

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Pumping exercise?

• n6 healthy females
  Lymphoscintigraphy
• Handgrip contractions
• 12 X 2.5 min
• 75 contractions with 50 of max.
• Arm crank ergometer
• 6 X 5 min
• 0.6 Watts.kg (p0.001)
• Lane K, Worsley D, McKenzie D. Lymphscintigraphy
  to evaluate the effect of upper body dynamic
  exercise and handgrip exercise on
  radiopharmaceutical clearance from hands of
  healthy females. Lymphat Res Biol 2005316-24.

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Compression sleeve ?

• Pole-walking (n26) healthy arm after ex
• after 24 hours
• Light dumbbells (n31) LE arm with
  sleeve on
• after 24 hours
• Heavy dumbbells (n18) after 24 hours

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Long time effect of compression sleeve

• Age Edema Edema
• duration volume (years) (months)
  ()
• Sleeve from start of lymphedema (Sweden)
• Pole walking light (n26) 586 7677 15.0
• Weight lifting light (n31) 557 6752 17.2
• No sleeve ever (Australia)
• Weight lifting heavy (n18) 5811 5449 25.6

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ConclusionHeavy exercises can be performed

• Individually adjusted
• Controlled