by Kathy Steligo
Don’t carry your kids.
Don't lift heavy bags of groceries.
Don't scrub the shower.
If you’ve been diagnosed with lymphedema, you’re all too familiar with these cautions and the long list of don’ts traditionally advised by doctors: carefully protect your affected arm, avoid lifting anything too heavy, have blood pressure taken and blood drawn from the opposite arm, and even avoid a sunburn. Lymphedema is a chronic, incurable condition that sometimes occurs when lymph nodes are damaged by radiation or removed during breast cancer surgery. The nodes are part of the lymphatic system, the body’s elaborate mechanism that filters pathogens, cancer cells and other toxins so lymph fluid can be safely returned to the circulatory system. You’ve probably noticed swollen glands in your neck when you have a cold or strep throat—that’s your lymph system at work. When nodes are removed or damaged, they may not be up to the task, especially when infection occurs. Fluid subsequently accumulates in the tissues, causing the arm and hand to swell.
Symptoms of lymphedema range from mild swelling to debilitating pain and even loss of mobility in the arm or fingers. Physical therapy and lymphatic massage may help, but don’t consistently eliminate symptoms for all women. Aside from the annoyance, inconvenience and pain, lymphedema disrupts everyday life, making many routine tasks impossible. Many women are forced to perform functions one-handed, which can be challenging when taking care of small children or working at a physically demanding job. And being told to pamper one arm is not great news when more women are trying to engage in weight-bearing exercise to build muscle mass and strengthen bones.
Now, newer research has health experts re-evaluating their philosophy of limited activity. In fact, studies are now proving that gentle and controlled weightlifting is not only safe, but it greatly improves lymphedema. The key is to do it carefully and correctly. The largest body of related research, the Physical Activity and Lymphedema (PAL) Study at the University of Pennsylvania, recruited 141 women who developed lymphedema after treatment for unilateral breast cancer. The women were divided into two groups: half observed traditional restrictions with no exercise, while the other half embarked on a carefully controlled program of gentle strength training while wearing custom-fitted compression sleeves. Specially-educated fitness professionals first determined the appropriate starting weight for each of the women and then supervised their workout routines. The exercise group participated in 90-minute weightlifting sessions twice a week, beginning with very light weights. Each session included stretching and an aerobic warm-up, followed by three sets of 10 repetitions of seated row, chest presses, lateral or front raises, bicep curls, and tricep pushdowns. The program focused on gradually increasing weight and repetitions while building strength. No upper limit was placed on the weight a woman could lift, and the women were regularly monitored for swelling or pain. After 13 weeks, the women continued the sessions on their own.
Results were impressive. Although the nature of some women’s lymphedema ruled out participation and a few women developed swelling soon after they began the program, after one year, the women who stuck with the weightlifting workouts increased their arm strength and had fewer episodes of lymphatic swelling compared to women who didn’t exercise. When symptoms did appear among women in the exercise group, they were less severe. This research shows that breast cancer survivors no longer have to avoid doing routine tasks that are a part of life or give up activities they enjoy. And they needn’t fear their lymphedema will decline or become disabling. Experts expect the traditional recommendations to soon change.
What should you do?
If you have lymphedema, you may be excited to begin trying anything to keep your symptoms at bay, but don’t rush to the gym and start pumping iron. The wrong workout can do more harm than good, and experts warn against starting any exercise program on your own. It is particularly important for someone with lymphedema to begin supervised weightlifting sessions with a physical therapist who knows how to properly perform these upper body exercises. Although more therapists are trained each year in lymphedema management, many are unaware of the weightlifting protocol for someone who is prone to arm swelling. If your physical therapist doesn’t have the appropriate training—most don’t—Dr. Kathryn Schmitz, the leader of the PAL study, suggests interested therapists (not patients) contact her (schmitz@mail.med.upenn.edu). If you would like to see if weightlifting can improve your symptoms, here’s how you can proceed:
- First, ask your primary physician or oncologist for a referral to a certified physical therapist who works with lymphedema patients.
- Don’t start lifting weights unless the therapist determines an appropriate starting weight for you and teaches you how to properly lift weights.
- Always wear a custom-fitted compression sleeve on the affected arm while lifting weights.
- Steadily increase weight in small increments to build up strength without overtaxing your arm.
- Never work to the point of exhaustion or pain.
- Stop lifting if you develop swelling, discomfort or pain. Resume only after your symptoms are resolved.
Doctors advise women who may develop lymphedema to pay attention to other traditional cautions. Avoid any needles in the surgery arm, including IV lines, flu shots and acupuncture, which opens the skin and leaves your arm prone to infection. Keep your skin well moisturized, particularly during the winter, to avoid small cuts, and use insect repellent to avoid mosquito and bug bites.
Women experience different levels of lymphedema symptoms. It’s important to recognize which actions overtax your arm or bring on symptoms. If you can carry your toddler or tote a five-pound purse without symptoms, you’re good to go. But if either tires your arm and causes swelling or discomfort, it is something you should avoid, at least until your arm is stronger and can handle the weight without problem. If you suffer from lymphedema, start a gradual strengthening program and stick with it, so that your symptoms no longer control or disrupt your life.
Read the National Lymphedema Network’s position paper on exercise and lymphedema
(PDF) for more information. Another tip: Ask if your local YMCA has trainers who are knowledgable about the LIVESTRONG program for cancer survivors.