Abstract of a study conducted by Andrea Damato

BACKGROUND:

Lymphoedema can be described as a chronic lymphatic disease that results in an abnormal accumulation of protein-rich fluid in the interstitial space in one or more parts of the body that have damaged nearby lymph nodes or vessels (Lyons and Modarai, 2019). The most common cause of lymphoedema in the upper limbs (UL) is a side effect of breast cancer and its treatment and affects up to 49% of this population (Gillespie et al., 2018; Liu, Y.-f. et al., 2021). Breast Cancer Related Lymphoedema (BCRL) can cause pain, discomfort, heaviness, tightness, distortion and reduced mobility and function of the affected limb (Hormes et al., 2010), and these symptoms heavily impact self-image, while also increasing anxiety, possible depression and frustration (Fu, Mei R. and Kang, 2013) affecting the psychosocial function and the QoL of patients (Vassard et al., 2010). The consensus is to advise patients to maintain an active lifestyle however there are limited guidelines on what types of activities may be beneficial or not (Lane, Worsley and McKenzie, 2005).

PURPOSE

The study was conducted to investigate whether resisted exercise programs are safe and beneficial to BCRL patients, and how this affects their function and QoL.

METHODS

 The study investigated the safety and effectiveness of adding a moderate/high intensity resisted exercise (RE) program for 6 weeks on arm circumference, muscular strength, and quality of life (QoL) measure including function, appearance, symptoms, and mood in patients with BCRL. This study included thirty-five patients with a history of breast cancer who were in phase two of their lymphoedema rehabilitation. They were assigned to either the intervention (n=18) or control (n=17) groups. The intervention consisted of resistance band exercises 4 times a week for 6 weeks. These were performed independently and unsupervised during the study period using pre-recorded exercise programs. Limb circumference measurements, muscular strength, Disabilities of Arm, Shoulder, and Hand (DASH), Lower Extremity Functional Scale (LEFS) and Lymphoedema Quality of Life (LYMQOL) questionnaires were administered at baseline and at 6 weeks.

RESULTS

After 6 weeks, the intervention group demonstrated statistically significant improvements (p<0.01) in the DASH and LYMQOL scores. There was a significant change in UL and LL strength between both groups (p<0.05). Unexpectedly, there was a significant decrease in UL measurements in the hand, forearm, elbow, and proximal arm in the intervention group (p<0.05).

CONCLUSIONS

The results indicate that RE demonstrates a positive effect on arm function, symptoms and QoL without increasing arm volume in breast cancer-related lymphedema. Future work should assess longer term effects of such exercise. It could also assess whether RE can be performed without compression garments or whether RE can decrease the reliance of compression garments following lymphoedema diagnosis.

IMPLICATIONS

This study offers a safe and structured exercise program for specialists, physiotherapists, and lymphologists to be recommended to women with lymphoedema. It gives reassurance that after a stable lymphoedema status, patients with BCRL can engage in resisted exercise without risk of increased lymphoedema in the affected arm.

KEYWORDS:

#lymphoedema #resistedexercise #qualityoflife

FUNDING

This study was not funded by any organisation.

ETHICAL APPROVAL

The study was approved by REACH (EP 20/21 103) within the University of Bath, UK and by the Russian Lymphology Association where the study was conducted.

INFORMATION ABOUT THE WORK

The study was in part fulfillment for a Masters Degree at the University of Bath, in Sports Physiotherapy.