Saturday, September 12, 2009

Weight Lifting in Women w/Breast-Cancer-Related Lymphedema

I recently read a very interesting article that challenged previously held beliefs in the health care industry. I like challenging the norms, especially when it can get the patient better outcomes. The study pubished in the Aug 13 issue of the New England Journal of Medicine found that
In breast-cancer survivors with lymphedema, slowly progressive weight lifting had no significant effect on limb swelling and resulted in a decreased incidence of exacerbations of lymphedema, reduced symptoms, and increased strength.

The study was made more significant by being longer (1 year follow-up) and being the largest randomized controlled trial to date (sample of 141 patients). Furthermore it was made more generalizable by including nonwhite women and women with a broad range of occupational and educational levels.

An argument is made in the editorial regarding this article that there are potential cost savings, not only by reducing direct health care costs but also by potentially reducing the risk of disability and allowing women to return to work at full capacity.

Exacerbations of the lymphedema was one of the main outcomes and they found that of the 70 patients in the control group there were 195 visits secondary to a flare-up while the weight lifting group that had 71 patients only had 77 visits.

While recently this population had been cautioned against making repetitive arm movements and lifting more than 10-15 poinds, in this study the weight lifting exercises included seated row, chest press, lateral or front raises, bicep curls, and tricep pushdowns as well as a number of lower-body exercises. To bust through the 10-15 pound limit there was no upper limit placed on the weight to which women could progress in any exercise (although they do not specify in the study how high they actually went).

Another element of the study I enjoyed is that the women were not just told to go exercise but given clear instructions with proper biomechanical focus from professionals trained in Lymphedema management at a local YMCA which is very accessible to most individuals in most cities, so this could be a program that would be much more realistic to implement. They also were nice enough to offer a free year of this program to the control group after the study was over.

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