Exercise and Lymphedema--Clearing Up the Misconceptions

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2012 Focus On Melanoma Conference In this blog, she recaps the conference. You can view the conference in its entirety, including presentations here.

In 2010, Katie Schmitz, PhD, FACSM, associate professor of medicine at the Perelman School of Medicine, and a group of her colleagues published a study that changed how patients and doctors think about exercise and lymphedema in cancer patients.

Dr. Schmitz's Physical Activity and Lymphedema (PAL) study demonstrated that a slow, gradual, supervised program of weight lifting not only didn't make lymphedema worse in women who either had the condition or were at risk for it following treatment for breast cancer, it actually had measurable benefits.

These benefits were measured in terms of the ability of patients to function and their overall quality of life. For patients with lymphedema, the risk of flare-ups for patients on the exercise program was reduced by 50%, and for those patients at highest risk for developing lymphedema (those who had five or more nodes removed from their axilla), the expected incidence of lymphedema was 90% less than expected.

Until Dr. Schmitz's data was published, it was standard procedure to tell patients at risk of lymphedema to rest and avoid any kind of activity with the affected arm.

Dr. Schmitz doesn't mince her words. Exercise is important for everyone, including cancer patients. For cancer patients, to be safe and effective, it needs to be done in what she calls a "rehab" mode, meaning that it tailored to the individual needs and abilities and aimed at rebuilding or regaining lost conditioning.

Now, Dr. Schmitz is extending to her work to patients with other types of cancer and those at risk for lower extremity lymphedema, which often occurs in melanoma patients. Her LEG-UP Pilot study is recruiting patients to assess whether the same kind of exercise program is safe and effective for this group. Preliminary results demonstrate that this program works for lower extremity lymphedema as well, with participants experiencing increased strength, increased capacity to walk and no worsening of their condition.

Conditioning and deconditioning are the keys to treatment. When we have cancer and undergo treatment, it is normal to lose some level of strength and flexibility. The disease and its treatment, along with the emotional challenges that are part of the experience, can all lead to a body that is weaker, less able to respond to stress or resist infection and inflammation. The right kind of exercise rebuilds that strength, restores function and enhances overall health and the sense of well being.

Dr. Schmitz's advice to cancer patients, including those who are at risk for or have lymphedema: Find a supervised exercise program that works for you. Go slowly and gradually. Be evaluated on a regular basis by a physical therapist who is knowledgeable about cancer, and keep moving.

If you are concerned about lymphedema following cancer treatment, watch our new video,
"Cancer-related Lymphedema: What You Need to Know.” This video guide features experts from the Abramson Cancer Center and Good Shepherd Penn Partners, recognized as one of the nation's best and most comprehensive lymphedema treatment programs.