Neither at-home weight loss nor exercise programs — nor a combination of the two — improved lymphedema beyond the standard of care in overweight women who had been treated for breast cancer, according to a study.
The research was published online on Aug. 15, 2019, by JAMA Oncology. Read the abstract of “Effect of Home-Based Exercise and Weight Loss Programs on Breast Cancer-Related Lymphedema Outcomes Among Overweight Breast Cancer Survivors: The WISER Survivor Randomized Clinical Trial.”
What is lymphedema?
Lymphedema is a potential side effect of breast cancer surgery, radiation therapy, and sometimes chemotherapy that can appear in some people months or even years after treatment ends.
Lymph is a thin, clear fluid that circulates throughout the body to remove wastes, bacteria, and other substances from tissues. Edema is the buildup of excess fluid. So, lymphedema occurs when too much lymph collects in any area of the body. If lymphedema develops in people who’ve been treated for breast cancer, it usually occurs in the arm and hand, but sometimes it affects the breast, underarm, chest, trunk, and/or back.
Breast cancer surgery — especially when several lymph nodes are removed — and radiation can cut off or damage some of the nodes and vessels through which lymph moves. Over time, the flow of lymph can overwhelm the remaining pathways, resulting in a backup of fluid into the body’s tissues.
Although lymphedema can affect the breast, chest, and underarm areas, it’s more common in the arm or hand on the same side as the breast cancer surgery. Because early swelling in the arm can be hard to notice, treatment guidelines recommend taking baseline measurements before surgery and then at regular intervals afterwards.
Earlier research has shown that lymphedema significantly lowers quality of life and consistently ranks as a big fear of women who’ve been treated for breast cancer.
The WISER study
The Women in Steady Exercise Research (WISER) Survivor study was designed to see if adding home-based exercise and weight-loss programs to standard lymphedema care would improve lymphedema outcomes.
The study included 351 overweight women in the Philadelphia area who had been treated for breast cancer and developed lymphedema. The women had no evidence of breast cancer and had completed treatment at least 6 months earlier. All the women had a BMI (body mass index) of 25 to 50, which classified them as overweight or obese. None of the women had any medical conditions that would prevent them from exercising.
About 62% of the women were white, 35% were black, and 3% were other races/ethnicities.
Kathryn Schmitz, Ph.D., professor of public health sciences at the Penn State Cancer Institute and member of the Breastcancer.org Professional Advisory Board, was the lead author of the WISER study.
All the women received two custom-fitted compression garments and lymphedema care from a certified lymphedema therapist at a cancer center or other institute during the year-long study.
The women were randomly assigned to one of four groups:
- 90 women received only the lymphedema treatment at a cancer institute or other facility and did no home-based exercise or weight loss program. This group was called the control group.
- 87 women also did a twice-weekly home-based resistance exercise program. The women were taught to do the exercises and were given dumbbells. This group also was asked to walk 90 minutes per week for the first 3 weeks, 120 minutes per week for week 4, 150 minutes per week for weeks 5 and 6, and 180 minutes per week for the rest of the study. The women received weekly support phone calls and did one resistance exercise class with other women once per month. This was the exercise group.
- 87 women also attended 24 weekly weight loss sessions led by a registered dietitian. For the first 20 weeks of the study, the women followed a meal replacement program that also included seven servings of fruits and vegetables each day. During weeks 21 through 24, the women learned how to shop for and prepare healthy food. From week 25 to week 52, the women met monthly for weigh-ins and to learn more about weight loss maintenance. The goal was for the women to lose 10% of their weight at the beginning of the study. This was the weight loss group.
- 87 women also did both the exercise and weight loss program. This was called the combined group.
The women’s arm volumes were measured before the study started and again a year later, at the end of the study. The women also reported how their arms felt at the beginning and end of the study.
The researchers found that there was no statistically significant difference in arm volume between the control group and the women in the other three groups. There was also no difference in the women’s reports between the control group and the other three groups.
The results contradict earlier studies suggesting that weight loss may help ease lymphedema. Still, these earlier studies were observational studies, which means the researchers only observed women and measured their arm volumes. No treatments or interventions were given.
"Contrary to the clinical recommendations commonly provided by leading national organizations for patients with breast cancer-related lymphedema, a 12-month weight-loss intervention, alone or in combination with a home-based exercise intervention, did not decrease arm swelling or improve the clinical attributes or symptoms of lymphedema," the researchers wrote. "While a home-based exercise program ... was found to be safe, previous research suggests that a supervised, facility-based resistance exercise program may provide greater lymphedema-specific benefits."
What this means for you
If you’ve been treated for breast cancer and have developed lymphedema, this study underscores the importance of being treated with the standard of care: seeing a certified lymphedema therapist at a cancer center or other institute and being custom-fitted for one or more compression garments.
Beyond that, it’s not clear if home-based exercise or weight-loss programs can help ease lymphedema.
But it is important to know that exercise and maintaining a healthy weight can help you be the healthiest version of yourself. Both regular exercise and maintaining a healthy weight can reduce the risk of breast cancer coming back, if you’ve been diagnosed, and reduce the risk of developing breast cancer if you’ve never been diagnosed. Exercise also can improve your mobility, give you more energy, and keep your bones healthy.
For more information on lymphedema, including symptoms and treatments, visit the Breastcancer.org Lymphedema pages.
To talk with others about lymphedema, join the Breastcancer.org Lymphedema discussion board forum.
Written by: Jamie DePolo, senior editor
Reviewed by: Brian Wojciechowski, M.D., medical adviser