Design and implementation of exercise prescription for prevention of arm lymphedema in breast cancer survivors

Abstract

Objective: To introduce the design and effectiveness of the preventive exercise prescription of arm lymphedema in breast cancer survivors. Methods: According to the new theory of muscle-lymphatic-drainage pump, we advocate active and moderate arm exercises from the perspective of post-operative breast cancer survivors. Using the depth interview and participatory observation in qualitative research, developing the arm exercises and protective measures rooted in breast cancer survivors' self-care experiences and strategies in their daily lives, which enriched the preventive exercise rehabilitation intervention measures and experience of lymphedema. Following the exercise prescription principle (FITT-VP), a 12 week of preventive exercise prescription for breast cancer survivors to prevent arm lymphedema was developed under the guidance of the American exercise rehabilitation coach, including the strength training, aerobic exercise and flexibility exercise. A total of 106 breast cancer survivors were recruited, the control group consisted of 50 patients who received routine education, and the intervention group consisted of 56 patients who received exercise prescription, including 13 arm lymphedema patients. The arm lymphedema outcome, muscle strength and cardiopulmonary endurance were used to evaluate the effect of exercise prescription. Results: The breast cancer survivors in the intervention group not only didn't develop arm lymphedema, but their arm muscle strength and cardiopulmonary endurance were improved pre to post intervention. Moreover, the edema symptoms of the arm lymphedema patients subsided somewhat. Conclusion: The preventive exercise prescription of arm lymphedema can improve the muscle strength and the cardiopulmonary endurance of breast cancer survivors, and reduce the risk of arm lymphedema, and improve the symptoms in patients with arm lymphedema. 目的：介绍乳腺癌康复者预防上肢淋巴水肿运动处方的构建与实施效果。方法：从乳腺癌术后康复者的角度，利用最新的肌肉淋巴引流泵功能原理，提倡主动和适度的患侧上肢功能锻炼，采用质性研究中的深度访谈和参与性观察法，开发了根植于康复者生活经验的肢体功能锻炼和保护措施，丰富了淋巴水肿的预防性运动康复干预措施和经验。遵循运动处方的设计原则，开发了一套为期12周的乳腺癌康复者预防上肢淋巴水肿的运动处方，包括力量训练处方、有氧运动处方和柔韧性运动处方。采用非随机分组的类实验研究，招募到106例乳腺癌术后康复者，其中干预组56例（包括13例已出现上肢淋巴水肿的患者），实施预防上肢淋巴水肿运动处方。对照组50例，实施常规健康宣教。采用上肢淋巴水肿发生率、上肢肌肉力量、心肺耐力等指标评价运动处方的实施效果。结果：与对照组比较，干预组乳腺癌康复者没有新发生上肢淋巴水肿，其上肢肌肉力量和心肺耐力较实施前均提高；入组时已有上肢淋巴水肿的患者，其水肿症状有所消退。结论：预防上肢淋巴水肿的运动处方干预能够提高乳腺癌康复者的肌肉力量和心肺耐力，降低上肢淋巴水肿的发生风险，同时促进淋巴水肿患者的肢体康复。