Exercise and metabolic disease/BCRL/Exercise Prescription

Thorough assessment and screening for cancer comorbidities and contraindications should be carried out with all cancer patients before an exercise program is started. At a minimum the screening tool developed by Exercise and Sports Science Australia (ESSA) should be used.

Please also note contraindications for patients with cancer on the Exercise Training page.

Following the re-evaluation of the traditional exercise clinical guidelines for women with BCRL, the following recommendations are accepted as safe exercise practices in this clinical group, as indicated through published research:

All training protocols require adequate instruction in safe and effective execution of warm up, prescribed exercises, cool down and stretching ^[1]

Slow Progressive Resistance Training Protocol

• Exercises can be either machine or free weights targeting multiple muscle groups of the arms, back, chest, buttocks and legs^[2] as well as abdominal exercises. ^[3] Examples of specific exercises can include chest presses, seated rowing and latissimus pull-downs.^[4] There is no evidence to suggest that avoidance of specific exercises promote or worsen lymphedema.^[5]

• Weight lifting exercises can be introduced with relatively low or no resistance.^[3] The number of repetitions can be performed 8 to 10 times building up to 3 sets for each exercise in the first 2 to 3 weeks of training with sessions lasting up to 60-90 minutes per session^[1] up to 3 times per week.^[1][3][6]

• A long term exercise resistance training program for up to 1 year has proven to show benefits in improving quality of life, increasing and maintaining strength gains as well as causing no risk in exacerbating or developing the onset of lymphedema.^[3]

• Stretching exercises can be implemented to improve range of motion also.^[1]

Aerobic Exercise Protocol^{[7] [8][9]}

Type

• Most exercises involving large muscle groups are appropriate. Cancer survivors do not need to be restricted to walking and stationary cycling.^[7]
• See contraindications on the Exercise Training page for when to avoid certain exercises

Frequency

• At least 3-5 times per week, daily is an option for deconditioned patients - lower intensity/shorter duration in their sessions

Intensity

• Moderate intesity is recommended, depending on medical treatments and current fitness levels
• 50-75% VO2 max or HR reserve, 60-80% HR max, or RPE of 11-14 on the original Borg scale

Duration

• 20-30 minutes continuous exercise - deconditioned patients or those experiencing severe side effects, may benefit from doing short bouts of exercise with rests in between

Progression

• Progression should be slower for deconditioned patients and those with severe side effects from treatment. Frequency and duration goals should be met before an increase in intensity is added. Declines in activity may be inevitable during some treatments, an exercise program can assist in minimising the declines

Note: Some experts have also recommended that women with lymphedema wear a compression sleeve during arm exercises.^[4][6][10]

Goal Setting'

Set patient goals, 3, 6 and 12 monthly as a minimum to ensure progression.

Social intergration and relationships correlate to a positive outcome for patients with BCRL, a great opportunity for interaction and support from other Breast cancer survivors is Dragons Abreast, a great recommendation for increased physical activity.

The information in this wiki is also designed to help the exercise physiologist understand and show empathy towards a patient with BCRL.

References

1. ↑ Ahmed, R.L., et al., Randomized controlled trial of weight training and lymphedema in breast cancer survivors. Journal of Clinical Oncology, 2006. 24(18): p. 2765-2772.
2. ↑ Schmitz, K.H., et al., Safety and efficacy of weight training in recent breast cancer survivors to alter body composition, insulin, and insulin-like growth factor axis proteins. Cancer Epidemiology Biomarkers & Prevention, 2005. 14(7): p. 1672-1680.
3. ↑ Schmitz, K.H., et al., Weight Lifting in Women with Breast-Cancer–Related Lymphedema. New England Journal of Medicine, 2009. 361(7): p. 664-673.
4. ↑ Harris, S.R. and S.L. Niesen‐Vertommen, Challenging the myth of exercise‐induced lymphedema following breast cancer: A series of case reports. Journal of Surgical Oncology, 2000. 74(2): p. 95-98
5. ↑ Harris, S.R., et al., Clinical practice guidelines for the care and treatment of breast cancer: 11. Lymphedema. Canadian Medical Association Journal, 2001. 164(2): p. 191-199.
6. ↑ Schmitz, K.H., et al., Physical activity and lymphedema (the PAL trial): Assessing the safety of progressive strength training in breast cancer survivors. Contemporary clinical trials, 2009. 30(3): p. 233-245.
7. ↑ Courneya, K. S., Mackey, J. R., & Jones, L. W. (2000). Coping with cancer: Can exercise help? The Physician and Sportsmedicine, 28(5), 49.
8. ↑ Hayes, S. C., Spence, R. R., Galvão, D. A., & Newton, R. U. (2009). Australian association for exercise and sport science position stand: Optimising cancer outcomes through exercise. Journal of Science and Medicine in Sport, 12(4), 428-434.
9. ↑ Gordon, N. F. (2009). ACSM's guidelines for exercise testing and prescription Lippincott Williams & Wilkins.
10. ↑ Brennan, M.J. and L.T. Miller, Overview of treatment options and review of the current role and use of compression garments, intermittent pumps, and exercise in the management of lymphedema. Cancer, 1998. 83(S12B): p. 2821-2827.

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