IMPORTANCE To our knowledge, no randomized clinical trials have assessed the effects of the combination of weight loss and home-based exercise programs on lymphedema outcomes. OBJECTIVE To assess weight loss, home-based exercise, and the combination of weight loss and home-based exercise with clinical lymphedema outcomes among overweight breast cancer survivors. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial (Women in Steady Exercise Research [WISER] Survivor clinical trial ) of 351 overweight breast cancer survivors with breast cancer-related lymphedema (BCRL) was conducted in conference rooms at academic and community hospitals and in the homes of participants from March 12, 2012, to May 28, 2016; follow-up was conducted for 1 year from the start of the intervention. Statistical analysis by intention to treat was performed from September 26, 2018, to October 28, 2018. INTERVENTIONS A 52-week, home-based exercise program of strength/resistance training twice per week and 180 minutes of walking per week, a weight loss program of 20 weeks of meal replacements and 52 weeks of lifestyle modification counseling, and a combination of the home-based exercise and weight loss programs. MAIN OUTCOMES AND MEASURES The 12-month change in the percentage of interlimb volume difference.RESULTS Of 351 participants, 90 were randomized to the control group (facility-based lymphedema care with no home-based exercise or weight loss intervention), 87 to the exercise intervention group, 87 to the weight loss intervention group, and 87 to the combined exercise and weight loss intervention group; 218 (62.1%) were white, 122 (34.8%) were black, and 11 (3.1%) were of other races or ethnicities. Median time since breast cancer diagnosis was 6 years (range, 1-29 years). Mean (SD) total upper extremity score changes from the objective clinical evaluation were −1.40 (11.10) in the control group, −2.54 (13.20) in the exercise group, −3.54 (12.88) in the weight loss group, and −3.84 (10.09) in the combined group. Mean (SD) overall upper extremity score changes from the self-report survey were −0.39 (2.33) in the control group, −0.12 (2.14) in the exercise group, −0.57 (2.47) in the weight loss group, and −0.62 (2.38) in the combined group. Weight loss from baseline was −0.55% (95% CI, −2.22% to 1.11%) in the control group, −8.06% (95% CI, −9.82% to 6.29%) in the combined group, −7.37% (95% CI, −8.90% to −5.84%) in the weight loss group, and −0.44% (95% CI, −1.81% to 0.93%) in the exercise group. CONCLUSIONS AND RELEVANCE Study results indicate that weight loss, home-based exercise, and combined interventions did not improve BCRL outcomes; a supervised facility-based program of exercise may be more beneficial than a home-based program for improving lymphedema outcomes. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01515124

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Background:Collegiate football is a high-demand sport in which shoulder injuries are common. Research has described the incidence of these injuries, with little focus on causative factors or injury prevention.Hypothesis:Football athletes who score lower on preseason strength and functional testing are more likely to sustain an in-season shoulder injury.Study Design:Prospective, cohort study.Level of Evidence:Level 2.Methods:Twenty-six collegiate football players underwent preseason testing with a rotational profile for shoulder range of motion, isometric strength of the rotator cuff at 90° elevation and external rotation in the 90/90 position, fatigue testing (prone-Y, scaption, and standing cable press), and the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST). Data collected postseason included the type of shoulder injury and the side injured. Logistic regression was used to determine if the testing measures predicted injury, and a receiver operating characteristic curve was constructed to examine the relationship of CKCUEST to injury.Results:Six athletes sustained shoulder injuries during the season. Predictor variables could significantly predict whether that player would sustain an injury during the season for both the right and left shoulders (P < 0.05). The variables that were significantly correlated with injury of the right side were forward elevation strength, prone-Y to fatigue, and the CKCUEST (P < 0.05); on the left, only the CKCUEST was significant (P < 0.05). The area under the receiver operating characteristic curve for the CKCUEST was 0.86 (ϵ = 0.87, P = 0.01). Using a score of 21 touches, the CKCUEST had a sensitivity of 0.83, a specificity of 0.79, and an odds ratio of 18.75 in determining whether a player sustained a shoulder injury.Conclusion:For this sample, the combination of preseason strength, fatigue, and functional testing was able to identify football players who would sustain a shoulder injury during the season.Clinical Relevance:Using a battery of strength, fatigue, and functional testing may be helpful in identifying football players during preseason who are at a higher risk for sustaining a shoulder injury. This information can be used to optimize preseason testing and implementation of injury prevention programs.

Background: Survivors of breast cancer (SBC) with breast cancer–related lymphedema (BCRL) have demonstrated neuromusculoskeletal restrictions, sensorimotor impairments, postural instability, and balance deficits. To date, there have been no studies that investigate outcome measures (OMs) used by certified lymphedema therapists (CLTs) with SBC with BCRL. Objective: The purposes of this study were to (1) determine types of OMs used and their frequency of use by CLTs with SBC with BCRL and their differences between therapy professions, and (2) identify unique characteristic predictors for use of OMs. Methods: Cross-sectional online survey research design. Electronic surveys were distributed to CLTs from various institutions. Data from 70 physical therapists (PTs) and 41 occupational therapists were analyzed from 130 completed surveys. Results: Sixteen OMs used most often assessed joint function, flexibility, strength, pain, volume, sensation, tissue consistency, body composition, health-related quality of life, and upper quadrant function. There were differences between PTs and occupational therapists in use of OMs. Lymphology Association of North America certification, practice setting, and profession (physical therapy and occupational therapy) predicted the use of some OMs. Conclusions: This study identified individual OMs used on SBC with BCRL in clinical practice among interdisciplinary CLTs. The number of OMs used to assess body functions and structures exceed those OMs for activities and participation, which may be influenced by CLT profession, Lymphology Association of North America certification, and level of highest degree.

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Purpose: Lymphedema is a common debilitating late effect among patients post-head and neck cancer (HNC) treatment. Head and neck lymphedema was associated with symptom burden, functional impairment, and decreased quality of life. The objective of this study was to determine the feasibility and potential efficacy of the use of photobiomodulation (PBM) therapy for head and neck lymphedema, symptom burden, and neck range of motion among HNC survivors. Methods: This was a single-arm, pre- and post-design clinical trial. Eligible patients included those with lymphedema after completion of complete decongestive therapy (CDT) and 3 to 18 months after completion of cancer therapy. The intervention included PBM therapy 2 times a week for 6 weeks for a total of 12 treatments. Lymphedema, symptom burden, and neck range of motion were measured at baseline, end-of-intervention, and 4-week post-intervention. Results: Of the 12 patients enrolled in the study, 91.7% (n = 11) completed the study intervention and assessment visits, and no adverse events were reported. When comparing the baseline to 4-week post-intervention, we found statistically significant improvements in the severity of external lymphedema, symptom burden, and neck range of motion (all P < .05). Conclusion: PBM therapy was feasible and potentially effective for the treatment of head and neck lymphedema. Future randomized controlled trials are warranted to examine the efficacy of PBM therapy for HNC-related lymphedema. Trial Registration Number and Date of Registration: ClinicalTrials.gov Identifier: NCT03738332; date of registration: November 13, 2018.

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