Weightlifting: PAL study

There is not much information for weightlifting athletes who want to return to their pre-diagnosis activities. The research study described below is about small weights, starting with 1-2 pounds (= 0.1 to 1 kg) dumbbells and lowest possible settings on the resistance machines, and increases were in small increments. But there was that no set upper limit for the weight.  Before this women were told not to ever lift more than 5-15 pounds (= 2 to 7 kg).

My theory: strength exercises are controlled movements, where one pays attention to correct form and gains strength. This transfers to normal daily activities, which can be much more complex. It is to be expected that the trained group can do such activities better than the no exercise group, thus leading to favorable outcomes.

The Physical Activity and Lymphedema (PAL) trial assessed the safety of strength training in breast cancer patients without an upper limit on the weight.

Participating women were 1-15 years post breast cancer diagnosis with stable or no lymphedema. There were 148 women in the exercise group (71 with lymphedema) and 147 in the control group that did not exercise (70 with lymphedema). Recruitment was from 2005-2007. The study protocol called for biweekly training, with supervision during the first 13 weeks and unsupervised training the following 9 months. 

OUTCOME: The amount of weight lifted did not make lymphedema worse, the weightlifting group had fewer and less severe flare-ups. Among the women without lymphedema at the start of the study 11% of the WL group vs 17% of non-exercise group developed lymphedema within the 12 months of the study (defined by increase in arm swelling).

PROTOCOL:  The weightlifting sessions lasted 60-90 minutes with 10 min cardiovascular warm-up, followed by stretching, then 5-15 min core exercises (for injury prevention),  strength exercises, and then finished with stretching (for injury prevention). For the strength portion both resistance machines and free weights were used (for muscles of the chest, back, shoulders, quadriceps, hamstrings, and gluteals, as well as biceps and triceps).
If there were no changes in lymphedema, the weight was increased after one week (0.5-1 pound increase). If there was a worsening, exercises were skipped or weight was reduced until symptoms cleared up. If 2 or more sessions were missed, the weights and exercises were reduced due to the possibility of de-conditioning.


References:
Schmitz.  Weightlifting and lymphedema: Clearing up misconceptions (about interpretations of the PAL trial with  7 guidelines)

Schmitz et al. Physical Activity and Lymphedema (The PAL Trial): Assessing the safety of progressive strength training in breast cancer survivors. Contemp Clin Trials. 2009 May ; 30(3): 233–245.

Schmitz et al Weightlifitng for women at risk for breast cancer related lymphedema. JAMA. 2010;304(24):2699-2705

The National Lymphedema Network: Position paper on exercise