The Effects of Resistance Exercises on Secondary Lymphedema Due to Treatment of Breast Cancer: A Review of Current Literature

Shi

Journal of Clinical Nursing

et al. 2022

Aims and Objectives Breast cancer‐related lymphoedema (BCRL) is a side effect of cancer treatment and can be alleviated by resistance exercise. This systematic, evidence‐based review examined the existing best evidence on resistance exercise for BCRL to accurately describe the current status of the field and offer recommendations for clinicians. Methods This review adheres to the PRISMA guidelines. Clinical practice guidelines, consensus documents, systematic reviews and other related evidence‐based resources about resistance exercise for BCRL were retrieved through the English databases and guideline websites. The publication data limit was set to December 2020. The following search terms were used: ‘breast cancer/breast neoplasm/breast carcinoma/breast tumor/breast malignancy, lymphedema/swelling/edema/lymphoedema, resistance/weight/strength training, best practice/clinical practice/guideline/consensus documents’. The quality of the included studies was evaluated by two authors independently using AGREE II and AMSTAR II tools. Evidence‐based recommendations on resistance exercise relevant for BCRL were synthesised and categorised. Results Twenty two articles (seven guidelines, four consensus documents and eleven systematic reviews) were included. The overall quality of the eleven eligible guidelines and consensus documents was moderate to high according to the AGREE II criteria. The quality of the eleven systematic reviews was critically low to high according to the AMSTAR criteria. Six clinical topics involving 43 recommendations were identified. Recommendations were categorised by safety of resistance training, effectiveness of resistance training, evaluation prior to resistance exercise, resistance exercise prescription, resistance training outcome index and points for attention. Conclusions This study summarises 43 recommendations for resistance training for BCRL and provides guidance for clinicians. Based on randomised trials and systematic reviews published in recent years, there is an urgent need to update the guidelines and consensus documents in terms of topics, for example effectiveness of resistance training and resistance training outcome index.

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Breast cancer‐related lymphoedema and resistance exercise: An evidence‐based review of guidelines, consensus statements and systematic reviews

Shi

Journal of Clinical Nursing

et al. 2022

“…Physical therapy treatment (PTT)12 focused on BCRL includes a wide range of interventions, such as complete decongestive therapy, manual lymphatic drainage, low-level laser therapy, shock waves, pneumatic pumps, Kinesio-taping, and endurance training/aerobic exercise, multimodal training, water training, yoga and Pilates. Currently, there are several systematic reviews that evaluate the efficacy of these different PTTs in reducing BCRL 13–47…”

Section: Introductionmentioning

confidence: 99%

Which physical therapy intervention is most effective in reducing secondary lymphoedema associated with breast cancer? Protocol for a systematic review and network meta-analysis

et al. 2022

IntroductionLymphoedema associated with breast cancer is caused by an interruption of the lymphatic system, together with factors such as total mastectomy, axillary dissection, positive lymph nodes, radiotherapy, use of taxanes and obesity. Physiotherapy treatment consists of complex decongestive therapy, manual lymphatic drainage and exercises, among other interventions. Currently, there are several systematic review and randomised controlled trials that evaluate the efficacy of these interventions. However, at present, there are no studies that compare the effectiveness of all these physical therapy interventions. The purpose of this study is to determine which physical therapy treatment is most effective in reducing breast cancer-related lymphoedema, improving quality of life and reducing pain.Methods and analysisMEDLINE, PEDro, CINAHL, EMBASE, LILACS and Cochrane Central Register of Controlled Trials will be searched for reports of randomised controlled trials published from database inception to June 2022. We will only include studies that are written in English, Spanish and Portuguese. We will also search grey literature, preprint servers and clinical trial registries. The primary outcomes are reduction of secondary lymphoedema associated with breast cancer, improvements in quality of life and pain reduction. The risk of bias of individual studies will be evaluated using the Cochrane Risk of Bias 2.0 Tool. A network meta-analysis will be performed using a random-effects model. First, pairs will be directly meta-analysed and indirect comparisons will be made between the different physical therapy treatments. The GRADE system will be used to assess the overall quality of the body of evidence associated with the main results.Ethics and disseminationThis protocol does not require approval from an ethics committee. The results will be disseminated via peer-reviewed publications.PROSPERO registration numberCDR42022323541.

Journal of Acute Care Physical Therapy

“…This was theoretically founded in the notion that exercise promotes increased lymph production, and hence, the potential to overwhelm a potentially compromised system. However, numerous recent systematic reviews and meta-analyses have challenged this traditional viewpoint and shown that exercise is not associated with lymphedema among breast cancer survivors 57–62. The Physical Activity and Lymphedema (PAL) trials were large, well-powered randomized clinical trials, which showed that gradual, carefully monitored weight training does not increase interlimb volume in those with or at risk for BCRL 63,64.…”

mentioning

confidence: 99%

Utilization of Forearm Crutches to Avoid Lymphedema After Breast Cancer Lymph Node Surgery: A Case Report

Curfman¹,

Austin²,

Radack³

2021

Background: Despite many patients with breast cancer being advised to limit upper extremity (UE) use, there is growing evidence that UE use is not associated with lymphedema. Subsequently, clinicians may be unsure of how to advise patients with a history of breast cancer who need assistive devices to ambulate. Study Design/Case Description: A 51-year-old woman who had recently undergone treatment for breast cancer sustained a knee injury requiring the use of crutches. Forearm crutches were used instead of axillary crutches to minimize the potential for irritation to the axillary lymphatic vessels and thus reduce the risk for lymphedema. L-Dex measures were used to monitor for lymphedema. Outcomes: L-Dex scores did not exceed the change of more than +7.1 to indicate the presence of lymphedema. Furthermore, there were no clinical signs or symptoms of lymphedema while using crutches and in the 7 months following. Discussion: Prolonged rigorous UE use by ambulating non-weight-bearing with forearm crutches within 1 to 2 months of treatment for breast cancer did not result in UE lymphedema. This case report reinforces the growing body of evidence that avoiding aggressive UE activity may not be necessary in those at low risk of lymphedema and informs assistive device prescription for patients with breast cancer.