Kim do, S., Sim, Y.J., Jeong, H.J., & Kim, G.C. (2010). Effect of active resistive exercise on breast cancer-related lymphedema: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 91(12), 1844–1848.doi: 10.1016/j.apmr.2010.09.008
To investigate the effects of complex decongestive physiotherapy with and without active resistive exercise on volume reduction of the upper limb and improvement of quality of life (QOL) in patients with breast cancer-related lymphedema
Patients were randomly assigned to the active resistive exercise (ARE) group or the the nonactive resistive exercise group. Both groups received complete decongestive physiotherapy (CDPT) led by a physical therapist once a day, five days a week, for two weeks. The nonactive resistive exercise group then continued self-administered CDPT for another six weeks. The ARE group performed shoulder stretching exercises followed by using dumbbells for 15 minutes while wearing a compression stocking or multilayer bandage.
The study took place in an outpatient setting at Kosin University Gospel Hospital in Korea.
The study has clinical applicability for late effects and survivorship.
The study used a randomized controlled trial design.
Both groups showed significantly reduced volumes after treatment, but the difference between the reduced volume in the distal arm and that of the total arm was not significant. The ARE group showed a significantly reduced volume in the proximal arm. Although CDPT is described as manual lymphatic drainage, compression therapy, and remedial exercise, description of the remedial exercises does not identify whether or not a compression garment or multilayer bandages were worn. Patients in the ARE group wore a compression stocking or a multilayer bandage to avoid aggravation of the lymphedema in the shoulder and arm while doing exercises.
Both groups had reduced QOL demonstrated by baseline values on the SF-36v2. After treatment, patients in the ARE group showed significant improvements in the SF-36v2 categories of physical functioning, role-physical, body pain-general and mental health. The nonactive resistive exercise group experienced improvements in physical functioning, role-physical, body pain, and mental health. By comparison, the ARE group showed significant improvements in role-physical and general health as compared with the nonactive resistive exercise group.
ARE demonstrated volume reduction in the proximal arm, with no statistically significant reduction in the distal or overall measurement. More robust research focusing on the relationship between resistive exercise and lymphedema is needed.
Exercise, including ARE, appear to be beneficial for patients with BCRL. It is important to note that all participants in this small study received CDPT, with self-administration techniques included. Nurses should encourage patients to speak with a therapist experienced in CDPT prior to initiating an exercise program.