Schmitz Kathryn H, Ahmed Rehana L, Troxel Andrea, Cheville Andrea, Smith Rebecca, Lewis-Grant Lorita, Bryan Cathy J, Williams-Smith Catherine T, Greene Quincy P
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
N Engl J Med. 2009 Aug 13;361(7):664-73. doi: 10.1056/NEJMoa0810118.
Weight lifting has generally been proscribed for women with breast-cancer-related lymphedema, preventing them from obtaining the well-established health benefits of weight lifting, including increases in bone density.
We performed a randomized, controlled trial of twice-weekly progressive weight lifting involving 141 breast-cancer survivors with stable lymphedema of the arm. The primary outcome was the change in arm and hand swelling at 1 year, as measured through displaced water volume of the affected and unaffected limbs. Secondary outcomes included the incidence of exacerbations of lymphedema, number and severity of lymphedema symptoms, and muscle strength. Participants were required to wear a well-fitted compression garment while weight lifting.
The proportion of women who had an increase of 5% or more in limb swelling was similar in the weight-lifting group (11%) and the control group (12%) (cumulative incidence ratio, 1.00; 95% confidence interval, 0.88 to 1.13). As compared with the control group, the weight-lifting group had greater improvements in self-reported severity of lymphedema symptoms (P=0.03) and upper- and lower-body strength (P<0.001 for both comparisons) and a lower incidence of lymphedema exacerbations as assessed by a certified lymphedema specialist (14% vs. 29%, P=0.04). There were no serious adverse events related to the intervention.
In breast-cancer survivors with lymphedema, slowly progressive weight lifting had no significant effect on limb swelling and resulted in a decreased incidence of exacerbations of lymphedema, reduced symptoms, and increased strength. (ClinicalTrials.gov number, NCT00194363.)
对于患有乳腺癌相关淋巴水肿的女性，一般禁止进行举重运动，这使她们无法获得举重已被充分证实的健康益处，包括增加骨密度。
我们进行了一项随机对照试验，让141名手臂淋巴水肿稳定的乳腺癌幸存者每周进行两次渐进式举重训练。主要结局是1年后手臂和手部肿胀的变化，通过患侧和未患侧肢体的排水量来测量。次要结局包括淋巴水肿加重的发生率、淋巴水肿症状的数量和严重程度以及肌肉力量。参与者在举重时需穿着合身的加压服装。
举重组（11%）和对照组（12%）中肢体肿胀增加5%或更多的女性比例相似（累积发病率比，1.00；95%置信区间，0.88至1.13）。与对照组相比，举重组在自我报告的淋巴水肿症状严重程度（P = 0.03）以及上、下身力量方面（两项比较P均<0.001）有更大改善，并且经认证的淋巴水肿专家评估，举重组淋巴水肿加重的发生率更低（14%对29%，P = 0.04）。没有与干预相关的严重不良事件。
在患有淋巴水肿的乳腺癌幸存者中，缓慢渐进式举重对肢体肿胀没有显著影响，但可降低淋巴水肿加重的发生率、减轻症状并增强力量。（临床试验注册号，NCT00194363。）
