I was wondering if anyone had some thoughts on a woman with breast cancer beginning training after mastectomy with several lymph nodes removed and the risk of lymphedema. I’ve read about the PAL study and while the conclusion has led many in the medical community to relax on their recommendation to NOT exercise the arm on the affected side, they still believe there could be an increased risk from weight lifting. They use general recommendations like “lift light” and maybe compression sleeves may be helpful but make sure you get the right kind. All vague recommendations come with the advice of having a PT develop an exercise plan for you.
I was wondering if you had any experience with or knowledge of this risk and could give some more practical advice to begin training.
Additional info if relevant: Bilateral mastectomy early July. Chemo completed in December. Radiation completed early March. Energy high. 40yo. No lymphedema swelling to this point.
The weak/nonspecific recommendations are typical in situations where 1) the person giving recommendations is highly risk-averse, and doesn’t want to get sued, and 2) we don’t have direct evidence regarding the situation at hand.
So we can’t give you direct medical recommendations through this forum, obviously. With that said, we have trained people in this situation and they have done fine. We’ll see if anyone else in the community can chime in with their experience.
My mother (aged 60) recently completed chemotherapy, radiation, a second mastectomy, and lymph node removal for Her2 positive breast cancer. The recommendations from her oncologist re: lymphedema were similar to the ones you’ve listed, and she did indeed work with a PT to regain some overhead range of motion on the operated side.
Roughly around the same time my mother began working with a PT, I encouraged her to begin barbell training with a coach, and she has been able to perform the main lifts for almost a year without exacerbating her lymphedema (she had some swelling at baseline shortly after her procedure).
I can’t speak for the experience you or your loved one may have beginning training after completing treatment, but my mother was able to achieve full ROM in all of the barbell movements in a couple of months after starting conservatively with respect to intensity and exercise selection.
Hope this helps, and congratulations to whom it may concern for completing treatment!
Range of motion has been a non-issue thankfully. I assume, and maybe Austin you could tell me otherwise, that squat and deadlift are not going to in any way cause a problem with lymphedema since they do not put a load on the arm and aren’t stressing the muscles around the armpit. With squat and deadlift I should be able to continue increasing the weight by 5 lbs. But the real concern should be the presses. I’m thinking on those two start with bar despite an ability to do more, and instead of 5 lb increases, 2.5 lb increases to allow slower progress. I have made an appointment with a PT since at this point I’m far past my deductible, it will be free and potentially a compression sleeve will be prescribed. I’m not really certain exactly how that prevents training from causing lymphedema, but it can’t hurt.
Does this slow plan on presses sound safe? Does my assumption that squat and deadlift are harmless to my situation seem sound, or am I missing something there?
What about reps? is 3x5 too much stress on the arm? Should I do less reps and more sets like 5x3 instead? Or maybe even less, 3x3? Or is it inconsequential?
I assume, and maybe Austin you could tell me otherwise, that squat and deadlift are not going to in any way cause a problem with lymphedema since they do not put a load on the arm and aren’t stressing the muscles around the armpit.
Again, you must understand that you aren’t going to get a “guarantee” on much of anything from us when it comes to medical advice through this medium. Yes, I think it would be fine assuming you start at appropriately conservative loads and increment accordingly, but we have to be clear with our language.
I think your plan is reasonable, and I wouldn’t make changes to a standard set/rep scheme based on concern of “stress on the arm”. Again, starting with conservative loads and incrementally working up is a fine approach.