Date of Award

2012

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department

Physician Assistant Studies

Department Chair

John Cavenagh, PhD, PA-C

Abstract

OBJECTIVE: The objective of this selective EBM review is to determine whether or not weight lifting is effective in reducing lymphedema in breast cancer survivors.


STUDY DESIGN: Systematic review of three English language primary studies published in 2009 and 2010.

DATA SOURCES: Three single blind, randomized controlled trials comparing progressive weight lifting and other treatments in breast cancer survivors were found using the Cochrane Database of Systematic Reviews and PubMed.

OUTCOMES MEASURED: Incidence of breast cancer-related lymphedema onset measured by blinded certified lymphedema therapists using a standardized clinical evaluation derived from the Common Toxicity Criteria version 3.0, comprising of interlimb differences, patient symptoms, and variation in arm tissue tone or texture. Incidence of lymphedema exacerbations measured by blinded certified lymphedema specialists using a standardized evaluation. Number and severity of lymphedema symptoms measured through participant-reported validated surveys evaluating the occurrence and severity of 14 lymphedema-related arm symptoms: rings too tight, watch too tight, bracelet too tight, clothing too tight, puffiness, knuckles or veins not visible, leathery skin, tired arms, pain, pitting, swelling after exercise, difficulty writing, or other. Pain and heaviness sensation in affected arm measured with the visual analogue scale (VAS). Change in arm and hand swelling determined by water volume displacement.

RESULTS: Sagen et al (2009) did not find weight lifting to be effective in reducing lymphedema onset in breast cancer survivors. Schmitz et al (2009) did find a significant relationship between weight lifting and reduced lymphedema exacerbations when considering evaluations by certified specialists and patient-reported validated surveys. Schmitz et al (2010) did not show a significant relationship between weight lifting and reduced lymphedema when using clinician-defined lymphedema onset.

CONCLUSIONS: The studies in this review provide inconclusive evidence in determining whether weight lifting is effective in reducing lymphedema in breast cancer survivors. Future RCTs are needed to evaluate the efficacy of weight lifting and lymphedema.

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