Resistance exercise and breast cancer–related lymphedema—a systematic review update and meta-analysis

Abstract

Background The purpose of this systematic review update and meta-analysis was to analyze resistance exercise (RE) intervention trials in breast cancer survivors (BCS) regarding their effect on breast cancer-related lymphedema (BCRL) status and upper and lower extremity strength. Methods Systematic literature search was conducted utilizing PubMed, MEDLINE, and Embase databases. Any exercise intervention studies—both randomized controlled and uncontrolled—which assessed the effects of RE on BCRL in BCS in at least one intervention group published between 1966 and 31st January 2020 were included. Included articles were analyzed regarding their level of evidence and their methodological quality using respective tools for randomized and nonrandomized trials of the Cochrane collaboration. Meta-analysis for bioimpedance spectroscopy (BIS) values as well as upper and lower extremity strength was conducted. Results Altogether, 29 studies were included in the systematic review. Results of six studies with altogether twelve RE intervention groups could be pooled for meta-analysis of the BCRL. A significant reduction of BCRL after RE was seen in BIS values (95% CI − 1.10 [− 2.19, − 0.01] L-Dex score). Furthermore, strength results of six studies could be pooled and meta-analysis showed significant improvements of muscular strength in the upper and lower extremities (95% CI 8.96 [3.42, 14.51] kg and 95% CI 23.42 [11.95, 34.88] kg, respectively). Conclusion RE does not have a systematic negative effect on BCRL and, on the contrary, potentially decreases it.

Effects of a structured exercise program on physical performance and function, quality of life and work ability of physically active breast cancer survivors

“…This meta-analysis showed a significant beneficial effect of the resistance exercise (RE) on the BCRL when measured with bioimpedance spectroscopy. These findings mark an interim endpoint regarding the question if RE might be detrimental for BCRL [5]; however, bioimpedance spectroscopy is an unreliable method to differentiate between lymphedema volume and muscle mass in BCRL. This is of particular relevance as larger muscle growth rates have been shown in the affected arm of BCS performing a progressive resistance exercise protocol [22].…”

“…The shift of paradigm regarding exercise with BCS started with Harris and Niesen-Vertommen (2000) [2]. Due to the lack of a gold standard in terms of the assessment of BCRL, it took 20 years until enough homogeneous data collected with the same assessment method were available for the realization of a thorough meta-analysis regarding the development of the BCRL [5]. This meta-analysis showed a significant beneficial effect of the resistance exercise (RE) on the BCRL when measured with bioimpedance spectroscopy.…”

“…Back then, it was feared that vigorous and repetitive loading of the upper extremities could negatively affect the status of an existing breast cancer related lymphedema (BCRL) or could provoke the development of a BCRL in the affected arm [2]. Today it is known that this fear was unsubstantiated and strengthening physical activity is not just not harmful but is beneficial in the management of BCRL in BCS [3][4][5]. Although various exercise stimuli have been investigated regarding feasibility and effects on BCS or BCRL, the historical connection between BCS and the dragon boat sport is still strong today.…”

Relevance of tumor boards for cancer rehabilitation

“…In this tumor board, very challenging and complex cases are discussed to plan their rehabilitation. Their most important issues are decreased physical performance and fatigue, metastatic or lytic bone lesions, brain lesions, chemotherapyinduced peripheral neuropathy, and also cardiovascular and pulmonary disease and/or side effects of necessary (cancer) treatment, metabolic dysregulation, and lymphedema [5][6][7][8][9]. Referring to specialists from different medical specialties such as oncology, physical and rehabilitation medicine, radiology, radiation oncology, surgery, cardiology, and orthopedics (and traumatology) attend the board.…”

“…Furthermore, nutritionists, sports scientists, physiotherapists, massage therapists, and psychologists complete this interdisciplinary and multiprofessional tumor board [3,4]. All of these tumor board members are involved in the rehabilitation process, and therefore, their decision helps to define individual rehabilitation concepts for challenging cancer patients with their individual functional deficits and medical conditions [5][6][7][8][9]. After the tumor board meeting, there results a decision with (1) a contraindication for the start of rehabilitation due to different dangerous clinical issues, but in most cases, there is (2) an individual rehabilitation concept with prescriptions concerning exercise and physiotherapy, and further treatment modalities such as extracorporeal shockwave therapy, other physical modalities, and additional prescriptions for pharmacological treatment (of pain), nutrition, and psychological interventions (psycho-oncology) [1,3,4,9].…”