Weight Lifting in Patients With Lower-Extremity Lymphedema Secondary to Cancer: A Pilot and Feasibility Study

Abstract

Objective To assess the feasibility of recruiting and retaining cancer survivors with lower limb lymphedema into an exercise intervention study. To develop preliminary estimates regarding the safety and efficacy of this intervention. We hypothesized that progressive weight training would not exacerbate leg swelling and that the intervention would improve functional mobility and quality of life. Design Before-after pilot study of 5 months duration. Setting University of Pennsylvania Participants Cancer survivors with a known diagnosis of lower limb lymphedema (N=10) were directly referred by University of Pennsylvania clinicians. All 10 participants completed the study. Intervention Twice weekly slowly progressive weight-lifting, supervised for 2 months, unsupervised for 3 months. Main Outcome Measures The primary outcome was interlimb volume differences as measured by optoelectronic perometry. Additional outcome measures included safety (adverse events), muscle strength, objective physical function, and quality of life. Results Interlimb volume differences were 44.4 and 45.3% at baseline and 5 months, respectively (pre-post comparison, p = 0.70). There were 2 unexpected incident cases of cellulitus within the first two months. Both resolved with oral antibiotics and complete decongestive therapy by 5 months. Bench and leg press strength increased by 47% and 27% over 5 months (p = 0.001 and p = 0.07, respectively). Distance walked in 6 minutes increased by 7% in 5 months (p = 0.01). No improvement was noted in self-reported quality of life. Conclusions Recruitment of patients with lower limb lymphedema into an exercise program is feasible. Despite some indications that the intervention may be safe (e.g., a lack of clinically significant interlimb volume increases over 5 months), the unexpected finding of two cellulitic infections among the 10 participants suggests additional study is required before concluding lower extremity lymphedema patients can safely perform weight-lifting.

Systematic Review of Quality of Life and Patient Reported Outcomes in Patients with Oncologic Related Lower Extremity Lymphedema

“…13 The exercise study found that weight lifting did not improve HRQOL with no significant changes in any of the domains measured by the SF-36. 2 Usage of compression bandaging significantly improved HRQOL but this was greater in patients with lymphedema secondary to ulcers when compared to those whose lymphedema was secondary to cancer. Improvements were significant in the physical functioning, role physical, bodily pain, social functioning, role emotional and mental health domains of the SF-36.…”

“…Complete Decongestive Physiotherapy (CDP) was used twice, 1 level II study 13 and 1 level IV study. 16 One study used exercise (level II) 2 and one used treatment with compression bandaging (level III). 15 In both studies using CDP, patients had significant improvement in HRQOL and specifically, patients reporting a more active lifestyle were found to have higher QOL in all domains measured in the IDI-ILA part II, specifying less pain, fatigue, and anxiety.…”

“…[2][3][4][5][6][7][8] Therefore, the goal of the current study was to perform a systematic review of health-related quality of life (HRQOL) studies in patients with lower extremity lymphedema in order to summarize the known literature on the effects of lymphedema. In addition, we aimed to use validated standards including the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) 9 and check lists such the Efficace criteria 10 (Table 1) to assess the validity of these studies, identify potential biases, and define high quality measures.…”

“…The SF-36 was used in 3 studies. 2,13,15 The oncology-specific measures included the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core questionnaire version 3.0 (EORTC-QLQ-30) used in 2 studies, 14,17 and the Instituto Dermopatico Dell'Immacolata-Italian Lymphedema Association part II (IDI-ILA part II) used in 1 study. 16 Only 2 of the 6 studies (33%) used psychometric analysis.…”

“…In addition, the treatment of lower extremity lymphedema is arguably even more complicated than breast cancer-related lymphedema due to the dependent position of the leg, the larger volume of the lower extremity, and the effects of ambulation. Yet, despite the fact that lower extremity lymphedema is common and seemingly more morbid than upper extremity lymphedema, there are only a few studies that have analyzed 1 The Division of Plastic and Reconstructive Surgery, Department of Surgery, and 2 Memorial Sloan-Kettering Cancer Center Library, Memorial Sloan-Kettering Cancer Center, New York, New York.…”