Jonsson, C., & Johansson, K. (2013). The effects of pole walking on arm lymphedema and cardiovascular fitness in women treated for breast cancer: A pilot and feasibility study. Physiotherapy Theory and Practice, 30, 236–242.

DOI Link

Study Purpose

To investigate the effects on intensive pole walking on cardiovascular fitness, subjective assessment, and arm lymphedema in women who were treated for breast cancer

Intervention Characteristics/Basic Study Process

Eight-week exercise period preceded by a two-week control period where subjects were asked not to change anything in daily living. Exercise was self directed 3–5 times/week for 30–60 minutes. Subject pace had to correspond to 70%–80% of estimated maximum heart rate (220-age). Warm up period of 10 minutes included pole walking and light arm exercises. Subjects wore compression garments during exercise and various measurements prestudy, at various intervals, and at the conclusion of the study.

Sample Characteristics

N = 23  
MEAN AGE = 60 years
MALES: 0, FEMALES: 100%
KEY DISEASE CHARACTERISTICS: Patients with breast cancer with mean onset of lymphedema at 15 months post-op

Setting

SITE:  Multi-site  

SETTING TYPE:  Outpatient  

LOCATION: Lymphedema unit at Skane University Hospital in Lund and Malmo, Sweden

Phase of Care and Clinical Applications

PHASE OF CARE: Late effects and survivorship
APPLICATIONS: Elder care, palliative care

Study Design

Quasiexperimental

Measurement Instruments/Methods

  • Pre-post design: 8 week exercise period preceded by a 2 week control period.
  • Arm volume bilateral measurements using the water displacement method and using unaffected arm as a control, cardiovascular fitness was assessed using sub-maximal bicycle ergometer test, which included heart rate monitoring. 
  • DASH questionnaire for symptom assessment 
  • Visual analogue scale for heainess and tightness in the affected arm
  • Two general well-being questions

Results

Statistically significant reduction in total arm volume (p = 0.001), lymphedema absolute volume (p = 0.014), and lymphedema relative volume (p = 0.015), as well as decreased heart rate and rating of tightness in the arms. Both positive and negative influences on well-being were reported.

Conclusions

Moderately intense exercise, such as pole walking, is feasible for patients with breast cancer with lymphedema. Standard precautions and use of compression garments during exercise is advisable. The effects of exercise on cardiovascular health and well-being are consistent with general public. Reduction in arm volume measurements post intervention should be further studied.

Limitations

  • Small sample (< 30)
  • Measurement/methods not well described
  • Measurement validity/reliability questionable
  • Other limitations/explanation: Self reported adherence to intervention; measurement of well being and heaviness/tightness in affected arm—subjective assessment—reliability and validity of tools not addressed. Small n value. Further studies are needed.

Nursing Implications

Patient education