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Water-Based Exercise for Patients with Chronic Arm Lymphedema: A Randomized Controlled Pilot Trial

Johansson, Karin PhD, RPT; Hayes, Sandi PhD; Speck, Rebecca M. PhD, MPH; Schmitz, Kathryn H. PhD, MPH, FACSM

American Journal of Physical Medicine & Rehabilitation: April 2013 - Volume 92 - Issue 4 - p 312–319
doi: 10.1097/PHM.0b013e318278b0e8
Original Research Articles

Objective The aim of this study was to evaluate the feasibility and effect of a water-based exercise program on lymphedema status and shoulder range of motion among women with breast cancer–related lymphedema.

Design This was a single-blinded, randomized controlled pilot trial. Twenty-nine eligible breast cancer survivors (median, 10 yrs after surgery) with arm lymphedema (median, 21% interlimb difference) were included and randomized into the intervention (n = 15) or control (n = 14) group. Twenty-five participants completed the study. The intervention was at least twice-weekly water-based exercise for 8 wks, initially supervised but performed independently during the study period. Outcomes of interest were feasibility as measured by retention and adherence; lymphedema status as measured by optoelectronic perometry, bioimpedance spectroscopy, and tissue dielectric constant; and shoulder range of motion as measured by goniometer.

Results Four participants were not measured at postintervention and were not included in the analysis (retention). Four participants in the intervention group did not perform the minimum water-based exercise criteria set (adherence). No effect was found on lymphedema status. Compared with the control group, median range of motion change for flexion was 6 (1–10) degrees (P < 0.001) and 6 (0–15.5) degrees (P = 0.07) for external rotation.

A clinically relevant increase in the intervention group was found for 36% in flexion (P ≤ 0.05) and 57% in external rotation (P ≤ 0.05) compared with controls.

Conclusions This study shows that water-based exercise is feasible for breast cancer survivors with arm lymphedema and that shoulder range of motion can be improved years after cancer treatment has been completed.

Supplemental digital content is available in the text.

From the Institution of Health Science, Department of Physiotherapy, Lund University, Lund, Sweden (KJ); School of Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, QLD, Australia (SH); Department of Biostatistics and Epidemiology and Department of Anesthesiology, University of Pennsylvania, Philadelphia (RMS); and Division of Clinical Epidemiology, Department of Biostatistics and Epidemiology, and Department of Family Medicine and Community Health, University of Pennsylvania School of Medicine, Philadelphia (KHS).

All correspondence and requests for reprints should be addressed to: Karin Johansson, PhD, RPT, Lymphedema Unit, SOK-Skane University Hospital, 221 85 Lund, Sweden.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

This research was financially supported by the Swedish Cancer Society, the National Breast Cancer Foundation (Australia), and the YMCA of Philadelphia and Vicinity.

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Editor’s Note: The appendix for this article containing instructions and diagrams is posted as PDF at

© 2013 Lippincott Williams & Wilkins, Inc.