// Research reviews - Breast cancer

by Dr Mike Climstein

Title: ‘Physical Activity and Lymphedema (PAL trial): Assessing the safety of progressive strength training in breast cancer survivors’. Authors: Drs Schmitz et al., (University of Pennsylvania School of Medicine and Mayo Clinic, USA).
Source: Journal of Contemporary Clinical Trials, 2009.

I was undecided on which recent research findings I would write about in this issue, and had almost opted for a completely different topic when I had something of an epiphany.

I am just completing a research study involving combined exercise (aerobic and progressive resistance training) in a mature age population (average age 80 years). Due to the location in which I was carrying out the study, I agreed to answer any questions from locals about exercise, health and fitness. One young woman I saw reminded me that I should address the important women’s health issue of breast cancer and exercise at the first possible opportunity. This young lady was about to undergo a mastectomy followed by chemotherapy and/ or radiation therapy as she had been recently diagnosed with breast cancer (her mother also had breast cancer) and she wanted to know what benefits she may attain from a clinical exercise program and what exercises were appropriate. I was simply amazed at the positive attitude she displayed and her forethought, at what must be a very stressful time, about what benefits she might receive from rehabilitative exercise.

Shamefully, I had forgotten about addressing breast cancer and exercise until watching a recent NRL game when I saw the referees in their pink shirts. It was clearly an omen and appropriate that I report on the recent publication by Dr Schmitz and her colleagues who investigated the benefi ts of resistance training in breast cancer survivors.

For readers unfamiliar with breast cancer, here are some startling facts from the Australian Clinical Best Practice web site (www.nbcc.org.au) to consider:

• Breast cancer is the most common invasive cancer among Australian women

• The risk of breast cancer increases with age: ~24 per cent of new breast cancer cases were in women younger than 50 years of age, 50 per cent were in women aged 50 to 69 years, and 26 per cent in women aged over 70 years

• Breast cancer is the most common cause of cancer related death in Australia

• The five years survival rate is estimated at 87.8 per cent and the one year survival rate is 96.7 per cent.

Introduction: The authors begin with a description of lymphedema (very common in breast cancer survivors) as a chronic disease that is characterised by swelling of the arm, shoulder, neck or torso, commonly on the side of the body on which the women have undergone breast cancer treatment. This results in disruption of the lymphatic channels where the surgical resection or radiation therapy has occurred. The swelling may range from mild to severe, such that it becomes disabling, associated with decreased range of motion and decreased muscular strength. The authors report that breast cancer survivors have found the lymphedema more distressing than the mastectomy and that its associated loss of arm function negatively affects the breast cancer survivors’ daily lives. Unfortunately, at present there is no cure for lymphedema.
Methodologies: The researchers recruited 288 breast cancer survivors who were separated into two groups; 144 who had lymphedema and 144 without lymphedema. The subjects were approximately 56 years of age and had been diagnosed with cancer ~5 years previously.
Those in the exercise group completed a 10-minute traditional warm up, 60 to 90 minutes of strength training exercises (nine exercises in total, three sets of 10 to 12 reps), stretching of the major muscles used in the resistance training, spinal stabilisation/abdominal muscle training, and finally stretching as a cool down. This exercise regime was completed two days per week for 12 months. Most importantly, all of the women in the exercise group were checked on a weekly basis to determine if there were any changes to arm swelling or symptoms. All exercise sessions were delivered by qualifi ed fitness professionals at YMCA community centres.

Results: The authors report an average 88 per cent compliance in the exercise groups. Fourteen per cent of the exercisers self-referred themselves to the lymphedema therapist; however, no subjects left the study due to either onset of lymphedema or flare-up of lymphedema. The subjects in the weight training group displayed decreased body fat, increased strength and an improvement to their health-related quality of life.

Pros: Excellent study, demonstrates that resistance training can be utilised in breast cancer survivors. Any fi tness professionals interested in working with breast cancer survivors should read this article, taking particular note of the low initial weights that were utilised and the progression used.

Cons: None.  


Dr Mike has an academic appointment with the School of Exercise Science, Australian Catholic University (NSW) and a clinical appointment as Director of Chronic Disease Rehabilitation at the Vale Medical Clinic, NSW. He is recognised as one of Australia’s leading clinical exercise physiologists working with patients suffering from a wide array of chronic diseases and disorders. For more information on any of the Research Reviews e-mail