Effect of Exercise on Breast Cancer–Related Lymphedema: What the Lymphatic Surgeon Needs to Know

Panchik D, J Reconstr Microsurg, 2019. PMID 29935493.

Key takeaways

• Exercise (aerobic, resistance, stretching, yoga, Pilates) is safe for women with or at risk of BCRL—no modality worsened swelling or symptoms.

• Meta‑analysis showed no significant change in limb volume after exercise.

• Upper‑extremity function (DASH) improved significantly with exercise.

• Benefits extend beyond edema control: better quality of life, strength, BMI, pain, mental health.

Background

Avoidance of upper‑limb exercise was long advised after breast cancer treatment. Emerging data challenge this paradigm and suggest an active role for exercise in BCRL care.

Methods

• Design: Systematic review & meta‑analysis (level 1 evidence).

• Search: 4 databases, 2005‑2017; 807 records → 26 strong‑quality studies (EPHPP quality tool).

• Participants: Women only, mean age 56 y.

• 50% had ≤50 participants.

  • Across the 26 included studies, 58 % specifically evaluated unilateral BCRL.

  • The rest allowed bilateral or mixed cases.

• Study types: 24 RCTs (92%), 3 cohorts.

• Interventions: Six exercise categories; most ≥8 weeks.

• Outcomes: Absolute/relative arm volume; Disabilities of Arm, Shoulder & Hand (DASH).

• Statistics: Fixed/random effects SMDs with SAS.

  
  

Results

• 46 % studies positive, 54 % neutral for edema; none negative.

• Absolute (4 studies) and relative (4 studies) limb‑volume meta‑analyses showed no significant pre/post difference.

• Pooled DASH data from five studies showed a statistically significant functional gain; the authors did not provide the pooled effect size, so the exact magnitude cannot be quantified from the published data.

• Ancillary gains: decreased pain; increased strength, QoL, BMI.

Conclusion

Multiple forms of exercise can be safely incorporated into BCRL management, improving function and patient‑reported outcomes without exacerbating swelling. Limb volume appears unaffected by exercise. 

Strengths & limitations

• Rigorous quality appraisal; majority RCTs.

• Broad range of exercise modalities broadens applicability.

• Small meta‑analysis sample sizes limit precision & introduce bias.

• Women‑only data; compression garment use inconsistently reported.

Clinical relevance

Lymphatic surgeons can confidently recommend aerobic, resistance, or mind‑body exercise as part of comprehensive CDT.