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Exercise and Arm lymphedema

Exercise and Arm lymphedema. Karin Johansson RPT, LT, Lymphedema Unit, Lund University Hospital Dr Med Sci, Dep. of Health Science, Lund University Sweden. Myths and realities. Rockson S. Precipitating factors in lymphedema. Cancer (Suppl) 1998; 83: 2814-16. Exercise?. Physical activity.

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Exercise and Arm lymphedema

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  1. Exercise and Arm lymphedema Karin Johansson RPT, LT, Lymphedema Unit, Lund University Hospital Dr Med Sci, Dep. of Health Science, Lund University Sweden

  2. Myths and realities Rockson S. Precipitating factors in lymphedema. Cancer (Suppl) 1998; 83: 2814-16

  3. Exercise?

  4. Physical activity • Can be associated with reduced risk for breast cancer (McTiernan et al. 2003) • Can reduce risk of dying of breast cancer (Holmes et al. 2005) 3-5 hours walking per week

  5. Shoulder muscle strength (kp) Preop. 6 months n=61 n=61 • Flexors 8.3±1.5 8.0±1.5 (p<0.05) • Adductors 6.2±1.5 5.8±1.3 (p<0.01) • Inward rot. 13.2±3.5 12.4±2.9 (p<0.05) Johansson K. et al. Arm lymphoedema, shoulder mobility and muscle strength after breast cancer treatment. A prospective 2-year study. Advances in Physiotherapy 2001; 3: 55-66.

  6. Shoulder Range of Motion and Arm lymphedema n=61 (all axillary dissection) No radiotherapy (n=26) Breast radiotherapy (n=16) Breast and axilla radiotherapy (n=19) AbductionVolume difference degrees ml preop 2 years preop 2 years

  7. Matched case-control studyResults - Occupational work-load • Blind assessment (0-3 scale) controls/lymphedema n=38 • heavy lifting n.s. • repetitive/static work n.s. • awkward working posture n.s. neck/shoulder • heavy work hand/forearm n.s.

  8. Life-style related factors Before and after surgery controls lymphedema n=71 Part of housework (%) p<0.001  p>0.001 Sports activities (number) n.s.  p>0.001 Hobby activities (number) n.s.  p>0.001

  9. Risk factor – overweight Weight Activity

  10. Exercise and Arm lymphedema What can the physiotherapist do?

  11. Breast Cancer Physical Therapy Center Philadelphia Linda Miller, PT and LT

  12. No development of arm lymphedema after Dragoon Boat racing 20 women with axillary dissection Arm muscle strength training for 2 months 7-8 months competition season Harris SR, Niesen-Vertommen SL .Challenging the myth of exercise-induced lymphedema following breast cancer: A series of case reports. J Surg Oncol 2000; 74: 95-99

  13. No deterioration of arm lymphedema after exercise program 7+7 women with arm lymphoedema 8-week program Resistance and Aerobic training McKenzie C, Kalda A. Effect of upper extremity exercise on secondary lymphedema in breast cancer patients: A pilot study. J Clin Oncol 2003; 21: 463-466

  14. Mixed groupNo increased risk for or exacerbation of arm lymphedema 45 women with axillary dissection 13 with arm lymphedema Weight training twice-a-week for 6 months Ahmed RL et al. Randomized controlled trail of weight training and lymphedema in breast cancer survivors. J Clin Oncl 2006;24:2765-72

  15. What have we done in Sweden?

  16. Pool exercise – 1 hourResults volume change % Temperature Arm lymphedema p-value 28 C 20±31 p=0.06 34 C n = 7

  17. Exercises Elbow flexion 10 repetitions each Shoulder abduction Elbow extention Shoulder flexion Shoulder horizontal adduction

  18. Weight bearing exerciseResults volume Arm lymphedema • Light dumbbells* after 24 hours (n=31) • Heavy dumbbells** after 24 hours (p=0.1) (n=18) • Prospective after 12 week (p=0.03) (n=20) *Johansson K, Tibe K, Weibull A, Newton R. Low intensity resistance exercise for breast cancer patients with arm lymphoedema with or without compression sleeve. Lymphology 2005; 38: 167-180. **Johansson K, Piller N. Weight-bearing exercise and its impact on arm lymphoedema. J Lymphoedema 2007; 2: 15-22.

  19. Recommendation When starting heavy exercisedo regular follow-up1-2 months

  20. Pole walking n=26 Purpose To investigate the influence of pole walking on arm lymphedema . Lotta Jönsson, PT, Lymphedema Unit, Lund University Hospital, Sweden

  21. Pole walking - Results volume Arm volume • One occasion (n=26)after 24 hours • Prospective (n=14) after 8 weeks Jönsson L, Johansson K. Does pole walking affect arm lymphedema in breast cancer treated women? Submitted to Physiotherapy Theory and Practice 2007.

  22. Perceived exertion • 7 = Very, very light • 11 = Fairly light • 15 = Hard • 19 = Very, very hard Borg scale: The patients’ perceived exertion after physical exercise was rated on a scale ranging from 6 (minimum) to 20 (maximum) where every other step is provided with a verbal statement (Borg 1982).

  23. n=6 healthy females Lymphoscintigraphy Handgrip contractions 12 X 2.5 min 75 contractions with 50% of max. Arm crank ergometer 6 X 5 min 0.6 Watts.kg (p≤0.001) Lane K, Worsley D, McKenzie D. Lymphscintigraphy to evaluate the effect of upper body dynamic exercise and handgrip exercise on radiopharmaceutical clearance from hands of healthy females. Lymphat Res Biol 2005;3:16-24. Pumping exercise?

  24. Compression sleeve ? Pole-walking (n=26) healthy arm after ex after 24 hours Light dumbbells (n=31)LE arm with sleeve on after 24 hours Heavy dumbbells (n=18) after 24 hours

  25. Long time effect of compression sleeve Age Edema Edema duration volume (years) (months) (%) Sleeve from start of lymphedema (Sweden) Pole walking light (n=26) 58±6 76±77 15.0 Weight lifting light (n=31) 55±7 67±52 17.2 No sleeve ever (Australia) Weight lifting heavy (n=18) 58±11 54±49 25.6

  26. ConclusionHeavy exercises can be performed • Individually adjusted • Controlled

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