Is It Safe to Lift Weights After Breast Cancer Surgery?

Is it safe to lift weights after having breast cancer surgery?

Doctors frequently tell their patients to lay low after having breast cancer surgery. The concern is that overusing the afflicted arm (and armpit) ups the risk of lymphedema, a painful arm swelling that many survivors experience. But last week, a study by researchers at the University of Pennsylvania showed that participating in a supervised weight-training program after surgery doesn't increase the incidence of lymphedema -- and may actually decrease it. For many survivors, this study will be a real game changer.

The researchers followed more than 150 women who had been diagnosed with breast cancer within the previous five years and who had had at least two lymph nodes removed but did not have lymphedema for about a year. The women were divided into two randomly assigned groups. Under the guidance of an experienced personal trainer, the first group practiced a strength-training program using light weights, which gradually increased over a roughly three-month period, and then continued lifting at home for another nine months. The other group followed the conventional advice usually given to patients after breast cancer surgery and kept their activity to a minimum.

At the end of one year, weight lifters slashed their risk of developing arm swelling by 35 percent, according to lead author Kathryn Schmitz, an associate professor of epidemiology and biostatistics and a member of Penn's Abramson Cancer Center.

Only 11 percent of the group developed lymphedema, compared to 17 percent of those in the nonexercising group. The women who'd had the most lymph nodes removed -- five or more -- experienced a nearly 70 percent risk reduction, with 22 percent of inactive participants developing lymphedema, compared to just 7 percent in the exercising group.

The results surprised a lot of experts but not Schmitz. As she explained it, this research does for breast cancer survivors what medical research did for heart attack victims many years ago. "For decades we told people who'd had heart attacks, 'Don't exert yourself.' Then we figured out they needed rehab starting with very low intensity, highly supervised exercise to gradually increase their functional capacity for the various activities of daily life. Our research shows the same thing for women who have had lymph nodes removed as a result of breast cancer: When they gradually increase their capacity, they are better equipped to return to everyday activities."

This latest study builds on previous research by Schmitz's team, which showed that weight training is safe and effective for keeping lymphedema at bay if you are first evaluated by a trained professional (such as a licensed physical therapist) and then follow a customized strength-training routine. Schmitz hopes her work will put fears to rest for both doctors and patients about returning to activity.

Schmitz pointed out that these findings may prove to be the greatest revelation for African-American women. Currently half of all breast cancer survivors have some sort of arm and shoulder problems, but African-Americans are more frequently diagnosed with later-stage cancer, have more nodes removed in surgery and are more apt to return manual labor jobs after medical care. This makes them prime candidates for developing lymphedema and, without proper evaluation and rehabilitation, more liable to lose their jobs because of it.

With the release of this study, Schmitz called on all women to practice what she's dubbed "squeaky wheel medicine." If your doctor doesn't automatically prescribe a physical therapy assessment and subsequent rehab, demand it," she said.

One important note of caution here: Schmitz does not want women to indiscriminately pump iron immediately after they undergo the knife. Just like heart patients who spend time in cardiac rehab before exercising on their own, anyone who's had surgery for breast cancer should have a trained expert teach them the basics.

Once you get your prescription, tell your physical therapist to go to the University of Pennsylvania's website to download programs the team has specifically developed for any professional working with breast cancer patients. They'll be released to all qualified professionals free of charge, though not to the public. (Schmitz said this is necessary to ensure proper treatment and keep patients out of harm's way.) She also encourages every cancer survivor to review the exercise guidelines for cancer patients released earlier this year by the American College of Sports Medicine.

I'd love to hear what survivors think about this groundbreaking information. Schmitz and her team are certainly interested in your stories and feedback. Post your comments here or tweet me.