For as many as two-thirds of breast-cancer survivors, their lifesaving cancer treatment can lead to an incurable and painful condition known as lymphedema. The condition commonly affects patients whose lymph nodes were removed during surgery, causing often debilitating swelling in the hands and arms because of lymph fluid buildup.
Doctors typically tell patients who have the chronic condition to avoid heavy lifting, since lymphedema can flare up and cause infection easily. Many women are advised to not pick up their children, to not use heavy handbags or lift more than 10-15 lb. at a time and to limit exercise to milder forms such as walking, swimming and light aerobics.
Those rules can complicate everyday life, as Ethel Jefferson, 68, a breast-cancer patient in Philadelphia, learned firsthand. When her condition was diagnosed several months after her lumpectomy and radiation treatment, her doctor warned her against lifting more than 2 lb. with the affected arm. "Can you imagine going grocery-shopping?" she says. "I would ask someone at the store to lift my bags and then make sure someone would be home to help. You learn to compensate, but it was a challenge."
But a new study suggests that doctors may be overlooking some significant benefits of heavy-lifting activity for thousands of patients like Jefferson. Published in the Aug. 13 issue of the New England Journal of Medicine, the study is the largest and longest of its kind to date. University of Pennsylvania researchers recruited 141 breast-cancer patients with a diagnosis of stable lymphedema. Half of them participated in a biweekly 90-min. weight-lifting program, which involved the slow, progressive addition of weight machines and free weights, up to as much weight as patients could comfortably lift; the other half of the patients did not lift weights at all.
By the end of the yearlong study, the women who worked out were stronger than the nonweight lifters some could bench-press as much as 85 lb., while the majority were able to press dumbbells weighing more than 15 lb. and did not experience any more swelling than the nonlifting group. Indeed, the exercisers were more likely to report that their symptoms had improved, with half as many (14%) reporting flare-ups as their counterparts (29%). Fewer flare-ups, doctors say, means less physical therapy to treat them which means considerable savings in patients' time, money and discomfort.
Although some previous research had hinted at similar benefits of weight training, the overall lack of rigorous evidence to support it led doctors to take a conservative approach in recommending excess activity. "Because we didn't have strong data one way or another, there was this dictum that translated to, Don't lift anything, or only minimally use your arm," explains Dr. Brian Lawenda, a breast-cancer-radiation specialist at Naval Medical Center San Diego, who was not involved in the new study.
The study's lead author, Kathryn Schmitz, an exercise physiologist, is betting that her research will change doctors' approach. "Hopefully this will be the last nail in the coffin for that kind of misguided advice," she says.
The merit of the weight-lifting program beyond its health benefits is that it could be affordable and accessible for breast-cancer survivors, says Schmitz. The classes used in her study were designed to be easily replicated; they were offered at community locations like YMCA centers and taught by fitness coaches who underwent a short training period to learn to spot problematic symptoms.
Experts also foresee significant potential health-care savings, based on the alleviation of symptoms among the study's weight-training patients. Treatment of an exacerbated case of lymphedema requires specialized attention from physical therapists including massage and compression bandaging expenses that many but not all insurance companies cover. For a patient with early-stage lymphedema, an eight-day course of therapy sessions can cost an average of $2,000, not including supplies and time spent by patients in daily sessions, according to the National Lymphedema Network. But if the new study leads to a shift in physicians' recommendations, perhaps for some patients, that money can be spent pursuing activities instead of shying away from them.