Just as doctors now know heart attack and back pain patients can benefit from physical activity during recovery, a study published in Wednesday's Journal of the American Medical Association (JAMA) finds breast cancer survivors may benefit from pumping iron after surgery.
The study, performed by researchers at the University of Pennsylvania, shows that breast cancer survivors who participated in a supervised, slowly progressive weight training program after undergoing surgery did not develop the painful, arm-swelling condition known as lymphedema -- and in fact, may have even reduced or prevented the complication.
The researchers placed 154 women who had been diagnosed with breast cancer in the previous five years, and who had had at least two lymph nodes removed but did not have lymphedema, into two randomly assigned groups. The first group was supervised by a personal trainer who led them through a 13-week weight lifting program, which they continued for another nine months at home. The second group didn't exercise.
By the end of the one year study, the weight lifters had cut their risk of developing the condition by 35 percent. Only 11 percent of the group developed lymphedema, compared to 17 percent of those in the non-exercising group. Among women who had the most aggressive surgery, with five or more lymph nodes removed, the impact of the weightlifting intervention was even greater -- a nearly 70 percent risk reduction. Twenty-two percent of inactive participants developed lymphedema, compared to just 7 percent in the exercising group.
"Women have been told for decades that they should not do anything with the affected limb," said the study's lead author, Dr. Kathryn Schmitz, an associate professor of epidemiology and biostatistics and a member of Penn's Abramson Cancer Center. "Our work is showing that women who have had lymph nodes removed and have not developed cancer are less likely to develop arm swelling over time if they slowly and progressively increase the capacity of their damaged limb to withstand the stresses of real life like lifting their purse, moving heavy boxes or carrying a child."
Currently half of all breast cancer survivors have some sort of arm and shoulder problems, but their doctors have been cautious about recommending exercise for fear it would harm the affected areas and cause further problems. Schmitz said she hopes her work will put these fears to rest for both doctors and patients.
She said she believes her findings may be the greatest help to African American women who, studies show, are typically diagnosed with later stage cancer, have more lymph nodes removed in surgery and are more apt to return manual labor jobs after medical care.
"These women are prime candidates for developing lymphedema and all the complications that go with it. Without an evaluation and proper rehabilitation they often find themselves out of work because they can no longer lift things," she said.
This latest study builds on the team's previous work, which showed that slow and careful strength training with an assessment beforehand by a qualified therapist is not only safe for women but also decreases the likelihood that lymphedema would flare up.
"It should be a wakeup call for women to be given a prescription for rehabilitation as a standard of care. If their doctor doesn't automatically make a referral, women need to become squeaky wheels and demand it," Schmitz said.
However, Schmitz cautions that women who have been through breast cancer surgery should not rush out to buy a gym membership and start exercising on their own. Instead, they should work with a qualified professional who can guide them carefully through a customized program. She also recommends they review the exercise guidelines for cancer patients published earlier this year by the American College of Sports Medicine. Her team has a website that will release weight training protocols to licensed physical therapists but not to the survivors themselves. This is necessary, she says, to ensure proper treatment and keep patients out of harm's way.