The Immediate Effect of Upper Arm Exercise Compared With Lower or Combined Upper and Lower Arm Exercise on Arm Volume Reduction in Women With Breast Cancer Related Lymphedema: A Randomized Preliminary Study

Background: Breast cancer-related lymphedema (BCRL) treatment includes lengthy arm exercise sequences. Previous studies have shown that lymphatic response to exercise differed (1) when upper or lower arm muscles exercise was performed and (2) between lymphedematous and nonlymphedematous arms. Objective: To measure immediate volume change following different exercise programs--upper arm exercise, lower arm exercise, and combination of upper arm exercise followed by lower arm exercise in lymphedematous and contralateral arms in women with unilateral BCRL. Design: A randomized selfcontrolled, multiple intervention clinical trial. Setting: Outpatient physical therapy clinic. Subjects: Women (n=16) in the maintenance phase of BCRL treatment were randomly allocated to one of two exercise groups. Methods: One exercise session was performed during each of 3 weeks. First and second sessions included random order of upper or lower arm exercise. Upper arm exercise was followed by lower arm exercise in the third session. Measurements: Volume calculation with assessors blinded to exercise performed. Results: Lymphedematous arm--upper arm and combined upper and lower arm--exercise caused significant volume reduction (33.5 mL, 95% CI 16.0-54.1), nonsignificant effect resulted from hand and lower arm exercise (18.9 mL, 95% CI 0.6-36.4). Limitations: Participants had small swelling volume reducing external validity. Exercise with a compression garment may have caused a systematic bias throughout the study conditions. Conclusion: Upper arm exercise caused significant decrease in lymphedematous arm volume. This information may be helpful when providing exercise instruction to women with BCRL.