title: Weight lifting for women at risk for breast cancer-related lymphedema: a randomized trial.
abstract: BACKGROUND
  Clinical guidelines for breast cancer survivors without lymphedema advise against upper body exercise, preventing them from obtaining established health benefits of weight lifting.
  
  
  OBJECTIVE
  To evaluate lymphedema onset after a 1-year weight lifting intervention vs no exercise (control) among survivors at risk for breast cancer-related lymphedema (BCRL).
  
  
  METHODS
  A randomized controlled equivalence trial (Physical Activity and Lymphedema trial) in the Philadelphia metropolitan area of 154 breast cancer survivors 1 to 5 years postunilateral breast cancer, with at least 2 lymph nodes removed and without clinical signs of BCRL at study entry. Participants were recruited between October 1, 2005, and February 2007, with data collection ending in August 2008.
  
  
  METHODS
  Weight lifting intervention included a gym membership and 13 weeks of supervised instruction, with the remaining 9 months unsupervised, vs no exercise.
  
  
  METHODS
  Incident BCRL determined by increased arm swelling during 12 months (≥5% increase in interlimb difference). Clinician-defined BCRL onset was also evaluated. Equivalence margin was defined as doubling of lymphedema incidence.
  
  
  RESULTS
  A total of 134 participants completed follow-up measures at 1 year. The proportion of women who experienced incident BCRL onset was 11% (8 of 72) in the weight lifting intervention group and 17% (13 of 75) in the control group (cumulative incidence difference [CID], -6.0%; 95% confidence interval [CI], -17.2% to 5.2%; P for equivalence = .04). Among women with 5 or more lymph nodes removed, the proportion who experienced incident BCRL onset was 7% (3 of 45) in the weight lifting intervention group and 22% (11 of 49) in the control group (CID, -15.0%; 95% CI, -18.6% to -11.4%; P for equivalence = .003). Clinician-defined BCRL onset occurred in 1 woman in the weight lifting intervention group and 3 women in the control group (1.5% vs 4.4%, P for equivalence = .12).
  
  
  CONCLUSIONS
  In breast cancer survivors at risk for lymphedema, a program of slowly progressive weight lifting compared with no exercise did not result in increased incidence of lymphedema.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00194363.
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine and Abramson Cancer Center, Philadelphia, PA 19104-6021, USA. schmitz@mail.med.upenn.edu
authors.forename: Kathryn H
authors.initials: KH
authors.lastname: Schmitz
authors.forename: Rehana L
authors.initials: RL
authors.lastname: Ahmed
authors.forename: Andrea B
authors.initials: AB
authors.lastname: Troxel
authors.forename: Andrea
authors.initials: A
authors.lastname: Cheville
authors.forename: Lorita
authors.initials: L
authors.lastname: Lewis-Grant
authors.forename: Rebecca
authors.initials: R
authors.lastname: Smith
authors.forename: Cathy J
authors.initials: CJ
authors.lastname: Bryan
authors.forename: Catherine T
authors.initials: CT
authors.lastname: Williams-Smith
authors.forename: Jesse
authors.initials: J
authors.lastname: Chittams
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008209:Lymphedema / Q000209:etiology* / Q000517:prevention & control*; D008875:Middle Aged; D012306:Risk; D017741:Survivors; D016896:Treatment Outcome; D014891:Weight Lifting