Physical Activity and Lower Limb Lymphedema among Uterine Cancer Survivors

Abstract

Purpose Physical activity (PA) is known to provide physical and mental health benefits to uterine cancer survivors. However, it is unknown if PA associates with lower limb lymphedema (LLL), an accumulation of protein-rich fluid in the lower limbs. Therefore, we sought to examine the association between PA and LLL in uterine cancer survivors, with a focus on walking. Methods We conducted a cross-sectional study using mailed surveys among uterine cancer survivors who received care at a university-based cancer center. We asked about PA, walking, and LLL symptoms using validated self-report questionnaires. PA was calculated using metabolic equivalent hours per week (MET-hrs∙wk−1), and walking was calculated using blocks per day (blocks∙d−1). Results The response rate to our survey was 43%. Among the 213 uterine cancer survivors in our survey, 36% were classified as having LLL. Compared with participants who reported <3 MET-hrs∙wk−1 of PA, participants who reported ≥18.0 MET-hrs∙wk−1 of PA had an odds ratio of LLL of 0.32 (95% CI: 0.15–0.69; Ptrend = .003). Stratified analyses suggested the association of PA and LLL existed only among women with a body mass index (BMI) <30 kg/m2 (Ptrend = .007), compared to women with a BMI ≥30 kg/m2 (Ptrend = .47). Compared with participants who reported <4.0 blocks∙d−1 of walking, participants who reported ≥12 blocks∙d−1 of walking had an odds ratio of LLL of 0.19 (95% CI: 0.09–0.43; Ptrend < .0001). Stratified analyses suggested the association of walking and LLL was similar among women with a BMI <30 kg/m2 (Ptrend = .007) and women with a BMI ≥30 kg/m2 (Ptrend = .03). Conclusion Participation in higher levels of PA or walking is associated with reduced proportions of LLL in dose-response fashion. These findings should be interpreted as preliminary, and investigated in future studies.

Physical activity, daily walking, and lower limb lymphedema associate with physical function among uterine cancer survivors

“…Women who self-reported higher levels of daily walking were marginally more likely to be retired ( P =0.07), and have lower BMI ( P =0.06; data not shown). Demographic and clinical characteristics associated with LLL have been reported previously [5]. …”

“…For each participant, an aggregate measure of MET-hrs·wk −1 was created by summing the MET-hrs·wk −1 for each activity described by the participant. We created categories of MET-hrs·wk −1 , defined as <3.0, 3.0–8.9, 9.0–17.9, and ≥18.0 that correspond to <1.0, 1.0–2.9, 3.0–5.9, and ≥6.0 hours per week of moderate-intensity PA, consistent with prior analyses among uterine cancer survivors [5]. Participants were asked to report how many blocks they walked on an average day during the past year.…”

“…The PPAQ is correlated with maximal oxygen consumption among women ( r =0.53; P <0.01) [24], and has been used previously among uterine cancer survivors [5]. Participants were asked to list any PA that they participated in during the past year, and the frequency and duration of each PA. Research staff converted the PA to metabolic equivalents (MET), using the compendium of PA [25].…”

“…Participants were asked to report how many blocks they walked on an average day during the past year. We created categories of blocks per day (blocks·d −1 ) of walking, defined as <4.0, 4.0–11.9, and ≥12 blocks·d −1 , which correspond to <¼, ¼ to <1, and ≥1 mile of walking per day, consistent with prior analyses among older adults [26], and uterine cancer survivors [5]. …”

Functional Impairment and Physical Activity Adherence Among Gynecologic Cancer Survivors

“…Participation in higher levels of physical activity or in walking was associated with reduced lymphedema. 35 Another qualitative study that was conducted among GCSs who were involved in a home-based physical activity efficacy trial 36 found that participants experienced several benefits, including psychological well-being, physical fitness, and improved functioning. Our findings also are consistent with a previous report that positively associated the availability of emotional support with physical activity.…”