Shamsesfandabadi Parisa, Shams Esfand Abadi Mostafa, Yin Yue, Carpenter David J, Peluso Chris, Hilton Christie, Coopey Suzanne B, Gomez Janette, Beriwal Sushil, Champ Colin E
Department of Radiation Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania.
Department of Statistical Sciences, Wake Forest University, Winston-Salem, North Carolina.
JAMA Netw Open. 2025 Jun 2;8(6):e2514765. doi: 10.1001/jamanetworkopen.2025.14765.
Lymphedema is a common treatment-related adverse effect among breast cancer survivors that can limit activity and mobility. Although exercise is associated with improved outcomes after breast cancer treatment, data are limited on the association of intense physical activity, including strength training, with lymphedema.
To examine the association between resistance training and lymphedema among breast cancer survivors.
DESIGN, SETTING, AND PARTICIPANTS: In this cohort study conducted between September 15, 2022, and March 26, 2024, women from 3 prospective studies (EXERT-BC, EXERT-BCN, and EXERT-C) underwent thrice-weekly, dose-escalated resistance training for 3 months to promote strength, mobility, and hypertrophy.
Lymphedema was assessed at baseline and completion using bioimpedance analysis to evaluate fluid and body composition metrics, distinguishing among intracellular water, extracellular water, and total body water.
A total of 115 women completed the exercise regimen (median age, 54 years; range, 24-71 years). Ninety-six participants (83%) underwent sentinel lymph node biopsy, whereas 14 (12%) underwent axillary lymph node dissection. At baseline, 15 women (13%) had clinical lymphedema: 8 (8%) in the sentinel lymph node biopsy group and 7 (37%) in the axillary lymph node dissection group. No participants experienced subjective or clinical worsening of lymphedema after completing the exercise regimen. Bilateral arm lean mass significantly increased after resistance training (affected arm: median [IQR], 5.64 [4.98-6.20] lb; 95% CI, 5.40-5.84 lb) vs baseline (median [IQR], 5.45 [4.92-6.08] lb; 95% CI, 5.34-5.67 lb) (s = 1789.5; P < .001). The edema index (extracellular water to total body water ratio) significantly improved in all patients, signifying a reduction in lymphedema at the completion of exercise (mean, 0.383; 95% CI, 0.382-0.385) compared with baseline (mean, 0.385; 95% CI, 0.384-0.386) (t110 = 4.05; P < .001).
In this cohort study of breast cancer survivors, intense resistance training did not exacerbate lymphedema and was associated with improvements in fluid balance and lean mass in the upper extremities. These findings suggest support for the inclusion of structured resistance exercise as part of breast cancer treatment and survivorship care.
淋巴水肿是乳腺癌幸存者中一种常见的与治疗相关的不良反应，会限制活动和行动能力。尽管运动与乳腺癌治疗后改善预后相关，但关于包括力量训练在内的高强度体力活动与淋巴水肿之间的关联的数据有限。
研究乳腺癌幸存者中阻力训练与淋巴水肿之间的关联。
设计、背景和参与者：在这项于2022年9月15日至2024年3月26日进行的队列研究中，来自3项前瞻性研究（EXERT-BC、EXERT-BCN和EXERT-C）的女性接受了为期3个月的每周三次、剂量递增的阻力训练，以增强力量、提高活动能力和促进肌肉肥大。
在基线和训练结束时使用生物电阻抗分析评估淋巴水肿，以评估体液和身体成分指标，区分细胞内水、细胞外水和总体水。
共有115名女性完成了运动方案（中位年龄54岁；范围24 - 71岁）。96名参与者（83%）接受了前哨淋巴结活检，而14名（12%）接受了腋窝淋巴结清扫术。在基线时，15名女性（13%）有临床淋巴水肿：前哨淋巴结活检组8名（8%），腋窝淋巴结清扫组7名（37%）。完成运动方案后，没有参与者出现淋巴水肿的主观或临床恶化。与基线相比，阻力训练后双侧手臂瘦体重显著增加（患侧手臂：中位值[四分位间距]，5.64[4.98 - 6.20]磅；95%置信区间，5.40 - 5.84磅），而基线时为（中位值[四分位间距]，5.45[4.92 - 6.08]磅；95%置信区间，5.34 - 5.67磅）（s = 1789.5；P <.001）。所有患者的水肿指数（细胞外水与总体水的比率）显著改善，表明运动结束时淋巴水肿减轻（均值，0.383；95%置信区间，0.382 - 0.385），而基线时为（均值，0.385；95%置信区间，0.384 - 0.386）（t110 = 4.05；P <.001）。
在这项针对乳腺癌幸存者的队列研究中，高强度阻力训练并未加重淋巴水肿，且与上肢体液平衡和瘦体重的改善相关。这些发现支持将结构化阻力运动纳入乳腺癌治疗和生存护理的一部分。
