Effect of Supervised Resistance Training on Arm Volume, Quality of Life and Physical Perfomance Among Women at High Risk for Breast Cancer-Related Lymphedema: A Study Protocol for a Randomized Controlled Trial (STRONG-B)

The effect of muscles in the treatment of lower limb lymphedema: respiratory muscles or leg muscles?

PURPOSE

This study aimed to compare the effects of manual lymphatic drainage and bandaging (MLDB) combined with calf muscle exercise training (CMT) and/or inspiratory muscle training (IMT) on edema, muscle strength, functional capacity, functionality, and quality of life (QoL) in patients with secondary lower limb lymphedema (LLL).

METHOD

A total of 76 patients (mean age: 47.06 ± 16.16 years; 84.2% female) with LLL were included in the study and randomized into four groups: MLDB alone (Group 1), MLDB + CMT (Group 2), MLDB + IMT (Group 3), and MLDB + CMT + IMT (Group 4). The training programs were administered for 30 min per day, five days per week, over three weeks. Edema was assessed using circumference measurements (CM) and tissue dielectric constant (TDC). Muscle strength was evaluated using maximum inspiratory/expiratory pressure (MIP/MEP) and a dynamometer. Functional capacity was assessed with the 6-Minute Walk Test (6MWT), functionality with the Lower Extremity Functional Scale (LEFS), and QoL with the Lymphedema Quality of Life Scale (LYMQOL).

RESULTS

In the intra-group analyses, all assessments improved in all groups, except for MIP, MEP, and gastrocnemius muscle strength in Group 1 and MIP in Group 2 (p < 0.05). In the inter-group analyses, Group 3 showed the largest effect sizes (ES) for reductions in TDC (ES: 2.34) and improvements in LYMQOL (ES: 1.74), MEP (ES: 1.46), and LEFS (ES: 1.44) (p < 0.001 for all). Group 4 had the largest ES for increases in MIP (ES: 1.42, p < 0.001). Group 2 showed the largest ES for improvements in gastrocnemius muscle strength (ES: 1.41, p < 0.001). However, there were no significant differences among the groups in CM or 6MWT results (p > 0.05).

CONCLUSION

Compared to enhancing leg muscle strength, improving respiratory muscle function in addition to MLDB had a greater impact on reducing edema and enhancing functionality and QoL.

TRIAL REGISTRATION NUMBER

NCT05609526. Registration Date: 14.11.2022.

Breast Cancer-related Lymphedema in Valle del Cauca, Colombia: Prevalence, Risk Factors, and Characterization

Background

Breast cancer-related lymphedema (BCRL) significantly affects patients' quality of life. Prevalence estimates in Latin America, particularly Colombia, remain inconsistent because of the limited research. This study aimed to determine the prevalence of BCRL and characterize its clinical and surgical aspects, as well as potential risk factors, in southwestern Colombia.

Methods

This multicenter case-control study included 334 women diagnosed with unilateral breast cancer between 1997 and 2019. The patients underwent standardized medical interviews, physical examinations, and data collection regarding clinical variables. Statistical analyses included descriptive statistics, bivariate logistic regression, and multivariable logistic regression to identify risk factors.

Results

The prevalence rate of BCRL was 23.9%. Patients with BCRL had a significantly higher body mass index and were more likely to have infiltrating ductal carcinoma. The surgical and treatment characteristics did not differ significantly between the groups. Multivariate analysis identified body mass index and arm swelling as risk factors for BCRL.

Conclusions

This study provides crucial data on the prevalence and risk factors of BCRL in Colombia, which will guide future research in developing a reproducible, easily accessible method for early lymphedema detection in remote populations. This, in turn, will enable timely referrals to centers equipped for proper management. Additionally, the findings can inform public policies aimed at preventing and improving the treatment of this complication.

Randomized Trial Assessing Prospective Surveillance and Exercise for Preventing Breast Cancer-Related Lymphedema in High-Risk Patients

OBJECTIVE

To evaluate if combining a prospective surveillance model (PSM) with a supervised multimodal exercise program prevents breast cancer-related lymphedema (BCRL) and its effect on the functional capacity and quality of life (QoL) of high-risk breast cancer (BC) patients undergoing treatment.

DESIGN

Two-arm parallel superiority randomized controlled trial.

SETTING

Outpatient physical therapy service in a public hospital.

PARTICIPANTS

116 adult women (N=116; age ≥18y) diagnosed with stage I-III BC were enrolled. Inclusion criteria included recent surgery and indication for adjuvant chemotherapy. Exclusion criteria were significant arm volume difference, previous cancer, exercise contraindications, and extreme body mass index values.

INTERVENTIONS

Participants were randomized into experimental (n=61) or control groups (n=55) in a 1:1 ratio. The experimental group received PSM with a supervised multimodal exercise program for 12 weeks. The control group received PSM alone.

MAIN OUTCOME MEASURES

Arm volume, grip strength, 6-minute walk test, and QoL were blindly assessed at baseline, 3, 6, and 9 months.

RESULTS

The combination of PSM with a supervised multimodal exercise program significantly reduced arm volume and body weight and improved grip strength, functional capacity, and the QoL of patients.

CONCLUSIONS

Combining PSM and physical exercise reduces arm volume, prevents BCRL, and improves physical performance and QoL in high-risk patients. The combination of PSM and STRONG-B was superior to PSM alone, validating the study's superiority design.

Can resistance exercise prevent breast cancer-related lymphoedema? A systematic review and metanalysis protocol

INTRODUCTION

Evidence shows that resistance training (RT) reduces lymphoedema in patients with breast cancer-related lymphoedema (BRCL), making it a safe and efficient intervention. However, it is uncertain if RT is safe and effective in patients at risk of developing BRCL. This systematic review (SR) protocol aims to describe all methodological aspects in order to evaluate the short-, medium- and long-term effects of RT on the prevention of BCRL.

MATERIALS AND METHODS

Throughout 2024, randomised clinical trials (RCTs) will be identified in electronic databases MEDLINE/PubMed, Embase, Cochrane Central Register of Controlled Trials, PEDro and LILACS. Only studies in English, Spanish and Portuguese will be included. Grey literature and clinical trial registration will also be reviewed. The primary outcome will be the occurrence of lymphoedema and quality of life. Second, pain intensity, upper limb function, range of movement, grip strength and adverse events will be considered. The individual studies' risk of bias will be evaluated using the Cochrane Risk of Bias 2.0 tool. Pairwise meta-analyses using a frequentist approach and random effects model will be conducted. The Grading of Recommendations Assessment, Development and Evaluation system will be used to evaluate the certainty of the evidence.

ETHICS AND DISSEMINATION

This protocol does not require the approval of an ethics committee, as it is a secondary study. The results will be disseminated through peer-reviewed publications.

PROSPERO REGISTRATION NUMBER

CRD42023455720.

Promoting precision health using fitness wearable and apps among breast cancer survivors: Protocols of a smart health management trial

BACKGROUND

Annually, approximately 1.7 million women are diagnosed with breast cancer worldwide. Engaging in regular physical activity (PA) post-diagnosis brings significant health benefits, enhancing breast cancer survivors' (BCS) prognosis and overall health-related quality of life (HRQoL). Despite these benefits, a low percentage of Chinese BCS adhere to the recommended moderate-to-vigorous PA levels. This highlights the need for innovative PA interventions tailored for BCS management. eHealth technology, such as fitness wearables and apps, presents an opportunity to improve BCS healthcare by offering personalized exercise programs.

METHODS

This study focuses on developing a precision eHealth PA program for 200 Chinese BCS in Guangdong Province, using a custom micro-application and a smart band for a 12-month trial. All participants will receive a Huawei Smart Band and be divided into 1) a personalized intervention group, receiving daily PA tracking and feedback, and 2) a control group receiving standard care. The primary outcome is PA and secondary outcomes include biomarkers, weight and body composition, functional fitness, HRQoL, and individual beliefs. Outcomes will be assessed at baseline, 6 months, and 12 months (endpoint). Successful outcomes could revolutionize PA programs for Chinese BCS, providing a model for future eHealth interventions.

Upper-Limb Disability and the Severity of Lymphedema Reduce the Quality of Life of Patients with Breast Cancer-Related Lymphedema

Breast cancer-related lymphedema (BCRL) is characterized by arm swelling, pain, and discomfort, reducing the quality of life (QoL) of affected individuals. BRCL is caused via the blockage or disruption of the lymphatic vessels following cancer treatments, leading to an accumulation of fluid in the affected arm. While current BCRL rehabilitation treatments seek to reduce arm swelling, our study aimed to examine the impact of both the magnitude of lymphedema (ΔVolume) and arm disability on three dimensions of QoL: social, physical, and psychological. Using the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) and the Upper Limb Lymphedema 27 questionnaire (ULL) in a group of 30 patients, we found that the magnitude of lymphedema (ΔVolume) was associated with the social dimension of QoL (r = 0.37, p = 0.041), but not with other dimensions. On the other hand, arm disability was associated with all evaluated dimensions of QoL (social, physical, and psychological: p < 0.001, p = 0.019, and p = 0.050 (borderline), respectively). These findings suggest that BCRL rehabilitation strategies should not only aim to reduce the magnitude of lymphedema but should also seek to improve or preserve arm functionality to enhance the QoL of BCRL patients.

Baduanjin’s impact on quality of life and sleep quality in breast cancer survivors receiving aromatase inhibitor therapy: a randomized controlled trial

Purpose

The aim of the current study is to investigate the impact of Baduanjin, a traditional Chinese exercise, on quality of life and sleep quality in breast cancer survivors receiving aromatase inhibitor (AI) therapy.

Methods

A total of 72 breast cancer survivors who had received AI treatment for more3 than 6 months were enrolled in the current study using non-probability consecutive sampling procedure. Participants were randomly assigned in a 1:1 ratio to a 12-week Baduanjin exercise program or to a wait-list control group. The Baduanjin exercise group performed two 90-min supervised sessions per week. The primary outcomes were changes in quality of life measured by the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 30 (EORTC QLQ-C30) and in sleep quality evaluated using the Pittsburgh Sleep Quality Index (PSQI).

Results

A total of 68 participants completed the trial (Baduanjin exercise group: n = 33; control group: n = 35). Baseline values for quality of life did not differ between groups. Both global quality of life and physical functioning scores increased significantly by 12.39 (P < 0.001) and 8.48 (P < 0.001) in the Baduanjin exercise group compared with those in the control. Overall PSQI score also decreased by 4.85 (P < 0.001) in the Baduanjin exercise group, whereas it increased by 0.34 in the control group.

Conclusion

Baduanjin exercise training led to improvement in the quality of life and sleep quality of breast cancer patients undergoing AI therapy.