Strength Training Can Improve Lymphedema in Breast Cancer

Medscape

24-06-2025

TOPLINE:
A recent study found that 3 months of resistance training did not worsen lymphedema in breast cancer survivors and instead significantly improved fluid balance and increased upper extremity muscle mass. The edema index also improved, suggesting potential therapeutic benefits of intense resistance training for managing lymphedema.
METHODOLOGY:
Lymphedema is a common adverse effect of breast cancer treatment that can limit mobility. Although strength training can have multiple benefits for breast cancer survivors, such as increased bone density and metabolism, data on whether more intense resistance training exacerbates lymphedema in this population are limited. Worries that more intense training will lead to or worsen lymphedema have typically led to cautious recommendations.
Researchers conducted a cohort study involving 115 women with breast cancer (median age, 54 years; 96% White; 4% Black) between September 2022 and March 2024. Most (83%) underwent sentinel lymph node biopsy (SLNB), while 12% had axillary lymph node dissection (ALND). At baseline, 13% had clinical lymphedema, including 37% in the ALND group and 8% in the SLNB group.
Participants attended resistance training sessions three times a week, with intensity escalation over 3 months. Exercises involved hand weights, resistance bands, and body weight (eg, pushups) to promote strength, mobility, and muscle hypertrophy.
Bioimpedance analysis measured intracellular water, extracellular water, and total body water before and after exercise. Lymphedema was defined as more than a 3% increase in arm circumference discrepancy relative to preoperative ipsilateral arm measurements, along with an elevated edema index (extracellular water to total body water ratio).
TAKEAWAY:
No participants experienced subjective or clinical worsening of lymphedema after completing the resistance training regimen.
Lean mass in the affected arm increased from a median of 5.45 lb to 5.64 lb (P < .001), while lean mass in the unaffected arm rose from 5.51 lb to 5.53 lb (P < .001) after the resistance training.
Overall, participants' fluid balance improved. The edema index in both arms showed a significant reduction at training completion (mean, 0.383) vs baseline (mean, 0.385), indicating reduced lymphedema. Subgroup analysis of women who underwent SLNB showed similar improvements in the edema index.
IN PRACTICE:
'These findings highlight the safety of strength and resistance training in a large group of patients with breast cancer during and after treatment,' the authors wrote. Beyond that, the authors noted, the results point to a potential role for resistance training in reducing lymphedema.
SOURCE:
This study, led by Parisa Shamsesfandabadi, MD, Allegheny Health Network, Pittsburgh, was published online in JAMA Network Open.
LIMITATIONS:
A major limitation was the absence of a control group, which prevented a direct comparison between the effects of exercise and the natural progression of lymphedema. The 3-month intervention provided limited insight into the long-term sustainability of benefits. Patient-reported outcomes were not included. Additionally, potential confounding variables such as diet, medication use, and baseline physical activity levels were not controlled for in the analysis.
DISCLOSURES:
The authors did not disclose any funding information. Several authors reported having ties with various sources. Additional disclosures are noted in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.