Heavy resistance training and lymphedema: Prevalence of breast cancer-related lymphedema in participants of an exercise intervention utilizing heavy load resistance training

Figures & data

Figure 1. Flow chart depicting selection of the study population derived from women treated for breast cancer who had participated in ‘Body and Cancer’ from January 2010 through December 2011.

Table I. Strength outcomes after six weeks in ‘Body and Cancer’.

					Total Population				AND Population
	Total Population				No BCRL		BCRL			No BCRL		BCRL
Variable	n	Baseline Mean (SE)	6 weeks Mean (SE)	∆ Mean Mean (SE)	n	∆ Mean (SE)	n	∆ Mean (SE)	p-value^†	n	∆ Mean (SE)	n	∆ Mean (SE)	p-value^†
1RM Chest Press (kg)	125	27.2 (0.66)	31.9 (0.70)	4.7 (0.43)*	93	4.6 (0.47)	32	5.0 (0.98)	0.68	41	4.3 (0.69)	31	4.5 (0.88)	0.82
1RM Leg Press (kg)	132	76.0 (2.00)	94.8 (2.45)	18.8 (1.75)*	96	16.5 (1.82)	36	24.7 (4.07)	0.07	45	14.9 (2.48)	35	23.7 (4.06)	0.06

∆ Change between baseline and 6 weeks. *(p-value < 0.05). ^†No BCRL as reference.

Table II. Point prevalence of self-reported diagnosed lymphedema and arm circumference measurements in relation to participation in the intervention. Values are numbers of participants (percentages).

Time in relation to participation in ‘Body and Cancer’	Diagnosed BCRL Total population (n = 149)	Circumference ≥ 2 Total population (n = 146)^†	Diagnosed BCRL AND population (n = 90)	Circumference ≥ 2 AND population (n = 87)^†
During intervention	9 (6.0)	5 (3.4)	9 (10.0)	5 (5.8)
Within 1 month post-intervention	16 (10.7)	10 (6.8)	16 (17.8)	10 (11.5)
1–2 months post-intervention	21 (14.1)	11 (7.5)	21 (23.3)	10 (11.5)
2–3 months post-intervention	23 (15.4)	13 (8.9)	23 (25.6)	12 (13.7)
3–4 months post-intervention	26 (17.4)	15 (10.3)	25 (27.8)	14 (16.1)
Total at study*	41 (27.5)	18 (12.3)	40 (44.4)	17 (19.5)

*On average 14 months (4–26 months) post-intervention. ^†Circumference measurements not available for 3 participants.

Table III. Characteristics of participants with and without BCRL (n = 149). Values are numbers (percentages) unless stated otherwise.

Demographic characteristics	No BCRL (n = 108)	BCRL (n = 41)	p-value
Age mean (SD)	47.8 (8.7)	47.7 (7.9)	0.939
Children in care < 7 years	18 (16.7)	4 (9.8)	0.438
Married, cohabitating or in a relationship	79 (73.1)	28 (68.3)	0.548
Education > secondary school	90 (83.3)	38 (92.7)	0.190
Employed (full/part time)	80 (74.1)	30 (73.2)	1.00
Not physically demanding work	50 (46.3)	20 (48.8)	0.936
Moderately physically demanding work	25 (23.1)	9 (22.0)
Very physically demanding work	5 (4.6)	1 (2.4)
Health and medical characteristics
Baseline BMI > 25*	43 (40.2)	20 (50.0)	0.350
Current BMI > 25	33 (31.0)	21 (51.2)	0.023
Breast ablation	44 (40.7)	18 (43.9)	0.871
Axillary node dissection	50 (46.3)	40 (97.6)	0.000
Non-dominant arm	56 (51.9)	24 (58.5)	0.581
Chemotherapy
3 × CE − 3 × docetaxel	73 (67.6)	29 (70.7)	0.620
6 × CT	28 (25.9)	11 (26.8)
Other	7 (6.5)	1 (2.4)
Received radiotherapy	81 (75.0)	39 (95.1)	0.005
Received endocrine treatment	85 (78.7)	34 (82.9)	0.652
Received trastuzumubab	21 (19.4)	2 (4.9)	0.040
Physical activity level (self-reported)
Pre-illness^†
Sedentary	4 (3.9)	1 (2.8)	0.585
Walking or cycling for pleasure	27 (26.0)	9 (25.0)
Regular physical exercise, at least 3 h/week	66 (63.5)	23 (63.9)
Intense physical activity > 4 h/week	7 (6.7)	5 (4.6)
Present time
Sedentary	2 (1.9)	1 (2.4)	0.473
Walking or cycling for pleasure	19 (17.6)	10 (24.4)
Regular physical exercise at least 3 h/week	55 (50.9)	15 (36.6)
Intense physical activity > 4 h/week	32 (29.6)	15 (36.6)
Training
Performed exercises prescribed post-surgery^‡
No	32 (31.7)	3 (7.5)	0.010
3 × weekly	16 (15.8)	7 (17.5)
Daily	53 (52.5)	30 (75.0)
PRT between surgery and ’Body and Cancer’^‡	18 (17.8)	10 (25.0)	0.355
PRT 3 months after ’Body and Cancer’	56 (51.9)	23 (56.0)	0.715
Utilized 2–3 sets of 5–8 RM	29 (26.9)	15 (37.5)	0.325
Adherence ≥ 70% while in ‘Body and Cancer’	70 (64.8)	20 (48.8)	0.092

*(n = 141, (n = 40 BCRL, n = 107 no BCRL)) due to missing data; ^†[n = 141, (n = 36 BCRL, n = 104 no BCRL)] due to missing data; ^‡[n = 141, (n = 40 BCRL, n = 101 no BCRL)] participants receiving neo-adjuvant; (n = 5) or chemotherapy for advanced disease (n = 3) not included.

Table IV. Sub-analysis in the AND population (n = 90). Characteristics of participants with and without BCRL. Values are numbers (percentages) unless stated otherwise.

Demographic characteristics	No BCRL (n = 50)	BCRL (n = 40)	p-value
Age mean (SD)	49.2 (9.0)	47.8 (8.0)	0.436
Children in care < 7 years	9 (18.0)	4 (10.0)	0.371
Married, cohabitating or in a relationship	37 (74.0)	28 (70.0)	0.813
Education > secondary school	44 (88.0)	37 (92.5)	0.726
Employed (full/part time)	40 (80.0)	29 (72.5)	0.458
Not physically demanding work	27 (54.0)	19 (47.5)	0.832
Moderately physically demanding work	11 (22.0)	9 (22.5)
Very physically demanding work	2 (4.0)	1 (2.5)
Health and medical characteristics
Baseline BMI > 25**	13 (26.0)	20 (51.3)	0.017
Study BMI > 25*	9 (18.0)	21 (52.5)	0.001
Breast ablation	25 (50.0)	18 (45.0)	0.676
Non-dominant arm	32 (64.0)	23 (57.5)	0.664
Chemotherapy
3 × CE − 3 × docetaxel	33 (66.0)	29 (72.5)	0.508
6 × CT	13 (26.0)	10 (25.0)
Other	4 (8.0)	1 (2.5)
Received radiotherapy	46 (92.0)	38 (95.0)	0.689
Received endocrine treatment	45 (90.0)	33 (82.5)	0.358
Received trastuzumubab	8 (16.0)	2 (5.0)	0.175
Physical activity level (self-reported)
Pre-illness^†
Sedentary	1 (2.1)	1 (2.8)	0.717
Walking or cycling for pleasure	11 (22.9)	9 (25.0)
Regular physical exercise, at least 3 h/week	34 (70.8)	23 (63.9)
Intense physical activity > 4 h/week	2 (4.2)	3 (8.3)
Present
Sedentary	0 (0.0)	1 (2.5)	0.326
Walking or cycling for pleasure	7 (14.0)	10 (25.0)
Regular physical exercise at least 3 h/week	25 (50.0)	15 (37.5)
Intense physical activity > 4 h/week	18 (36.0)	14 (35.0)
Training
Performed exercises prescribed post-surgery^‡
No	10 (21.7)	3 (7.7)	0.192
3 × weekly	8 (17.4)	7 (17.9)
Daily	28 (60.9)	29 (74.4)
PRT 1-3x/wk between surgery and ’Body and Cancer’^‡	13 (28.3)	10 (25.6)	1.000
PRT 1-3x/wk 3 months after ’Body and Cancer’	24 (48.0)	22 (55.0)	0.532
Utilized 2–3 sets of 5–8 RM	14 (28.0)	14 (35.0)	0.769
Adherence ≥ 70% while in ‘Body and Cancer’	35 (70.0)	19 (47.5)	0.051

*[n = 84, (n = 39 BCRL; n = 50 no BCRL)] due to missing data; ^†(n = 84) due to missing data; ^‡[n = 85,(n = 39 BCRL; n = 46 no BCRL)] participants receiving neo-adjuvant (n = 4) or chemotherapy for advanced disease (n = 1) not included.