Nelson, N.L. (2016). Breast cancer-related lymphedema and resistance exercise: A systematic review. Journal of Strength and Conditioning Research. Advance online publication.

DOI Link

Purpose

STUDY PURPOSE: To review and study resistance exercise training (RET) effects on breast cancer–related lymphedema (BCRL) based on existing studies, and to find out if RET increases muscle strength without worsening or causing lymphedema
 
TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: PubMed, Medline, SPORTDiscus, and Science Direct
 
INCLUSION CRITERIA: Patients with breast cancer, at any age or of any nationality, who had BCRL or were at risk for BCRL. RET was part of or the only intervention in the accepted and reviewed studies.
 
EXCLUSION CRITERIA: Studies with results not in English, studies in which outcomes of muscle strength or endurance were not reported, studies without reported lymphedema measures

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 669 returned, 267 screened
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: The quality of all studies was evaluated using the PEDro scale for reliability and validity. The strength of all studies was evaluated with a grading system by van Tulder et al.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 6
  • TOTAL PATIENTS INCLUDED IN REVIEW = 805
  • SAMPLE RANGE ACROSS STUDIES: n = 19 up to n = 79 across the six studies 
  • KEY SAMPLE CHARACTERISTICS: Breast cancer survivors with, or at risk for, BCRL; RET was part of the intervention or the only intervention; no restrictions on age, nationality, or ethnicity but presumed all patients were female in these six studies; control group in each study; studies not written in English excluded

Phase of Care and Clinical Applications

PHASE OF CARE: Late effects and survivorship

Results

  • No adverse effects were reported.
  • Blinding was either not conducted or was less than acceptable across all six studies.
  • Five of the six studies were high quality per evaluation results.
  • BCRL was not increased and triggered by RET.
  • Moderate to high intensity RET was superior to moderate intensity aerobic exercise in relation to building strength safely in BCRL at-risk patients.

Conclusions

Performing structured RET is safe and effective in increasing muscle strength in patients with breast cancer.

Limitations

  • Limited search
  • Limited number of studies included
  • Gender of study participants not clarified (women only?)

Nursing Implications

  • Nurses can—and should—encourage and reassure patients with breast cancer that moderate-intensity RET is an effective means of increasing strength and regaining physical health, without risk for BCRL or any increase of existing BCRL. 
  • More research is needed to focus on and to isolate the multiple variables within the different exercise options and their effects on BCRL to further compare benefits and risks in this population.

Legacy ID

6129