Lymphedema and Exercise
This is a comment from April about yesterday's post regarding easing back into exercise after cancer treatment:
my question is regarding exercise and lymphodema. i was very active before bc, swimming, rock climbing, cycling, hiking, weight lifting. i had a mastectomy in june 08 with 10 nodes removed, one wiht involement. i've ready contradictory information about exercising my arm post-surgery and treatment. any thoughts?
She raises an excellent question for which there is not really a definitive answer. There are widely varying estimates about the incidence of lymphedema and equally unclear guidelines about prevention. There are a few absolute facts: it can happen anytime after breast/axillary surgery; it is more likely to happen to women who have had full axillary dissections (as opposed to sentinel node dissections), and radiation treatment also raises the risk. There is a lot to say about this issue, and I will write more in a later blog. Today's posting will be confined to the question of exercise.
Per above, April is at greater lifetime risk of developing lymphedema than other women who did not have a full axillary dissection. I don't know if she also had radiation therapy to that area. If so, the risk is a bit larger. However, and this is important, most women do not ever develop lymphedema. Clearly, it would be really helpful if physicians knew, beyond the general comments, who is most likely to develop this problem. In the absence of that information, we must all make our own best judgments.
Regarding exercise: the expressed concern is related to repetitive movements of the arm that involve weight. That includes free weights as well as a number of machines. The general advice is to work up slowly and gradually, to begin with lower weights and fewer reps. Some experts suggest never lifting more than ten to fifteen pounds with the affected arm; not everyone agrees with that restriction. I have also heard concern expressed about some yoga positions that place the full body weight on the arm(s) and even about cycling for long periods, leaning on the arms/handle bars.
Over the years, I have known hundreds, if not thousands, of women who had breast surgery. Only a few have developed lymhedema and I don't know any who did so post vigorous exercise. To the contrary, I know many active women who have not had this problem. The issue, of course, is that there is no way to be certain that you/we are not putting our arms at risk with heavy exercise--and the only way we know is if we develop lymhedema--that is, too late.
It seems, once again, that we are left to make our own best judgments. It probably is smart to discuss this with an informed physical trainer or PT. We probably should try to avoid certain yoga positions and most of us won't (anyway) be lifting hundred pound weights. Most certainly, if you ever feel tingling/heaviness/discomfort in that arm, back off and back down. Go slowly.
Since the benefits of exercise are so numerous for both our physical and emotional health, we need to stay active. And use our common sense.
Here is a good website for more information: http://www.lymphnet.org/
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