Physical Activity and Lower Limb Lymphedema among Uterine Cancer Survivors

BROWN, JUSTIN C.1; JOHN, GABRIELLA M.2; SEGAL, SAYA3; CHU, CHRISTINA S.4; SCHMITZ, KATHRYN H.1

Medicine & Science in Sports & Exercise: November 2013 - Volume 45 - Issue 11 - p 2091–2097
doi: 10.1249/MSS.0b013e318299afd4
Epidemiology

Purpose: Physical activity (PA) is known to provide physical and mental health benefits to uterine cancer survivors. However, it is unknown if PA is associated with lower limb lymphedema (LLL), an accumulation of protein-rich fluid in the lower limbs. Therefore, we sought to examine the association between PA and LLL in uterine cancer survivors, with a focus on walking.

Methods: We conducted a cross-sectional study using mailed surveys among uterine cancer survivors who received care at a university-based cancer center. We asked about PA, walking, and LLL symptoms using validated self-report questionnaires. PA was calculated using MET-hours per week, and walking was calculated using blocks per day.

Results: The response rate to our survey was 43%. Among the 213 uterine cancer survivors in our survey, 36% were classified as having LLL. Compared with participants who reported <3 MET·h·wk−1 of PA, participants who reported ≥18.0 MET·h·wk−1 of PA had an odds ratio of LLL of 0.32 (95% confidence interval, 0.15–0.69; Ptrend = 0.003). Stratified analyses suggested the association between PA and LLL existed only among women with body mass index (BMI) <30 kg·m−2 (Ptrend = 0.007) compared with women with BMI ≥30 kg·m−2 (Ptrend = 0.47). Compared with participants who reported <4.0 blocks per day of walking, participants who reported ≥12 blocks per day of walking had an odds ratio of LLL of 0.19 (95% confidence interval, 0.09–0.43; Ptrend < 0.0001). Stratified analyses suggested the association between walking and LLL was similar among women with BMI <30 kg·m−2 (Ptrend = 0.007) and women with BMI ≥30 kg·m−2 (Ptrend = 0.03).

Conclusion: Participation in higher levels of PA or walking is associated with reduced proportions of LLL in dose–response fashion. These findings should be interpreted as preliminary and should be investigated in future studies.

1Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA; 2Department of Epidemiology, Columbia University, New York, NY; 3Division of Female Pelvic Medicine and Reconstructive Surgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; and 4Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA

Address for correspondence: Kathryn H. Schmitz, Ph.D., M.P.H., Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 423 Guardian Drive, 8th Floor, Blockley Hall, Philadelphia, PA 19104; E-mail: schmitz@mail.med.upenn.edu.

Submitted for publication March 2013.

Accepted for publication April 2013.

© 2013 American College of Sports Medicine