Women who undergo surgical management of breast cancer, with or without axillary lymph node dissection (ALND), derive functional improvements with intensive resistance training, according to an analysis presented at the annual meeting of the American Society of Breast Surgeons.
The gains were not significantly influenced by breast cancer stage or whether women were treated with mastectomy, ALND, radiation therapy, or chemotherapy in a multivariable regression analysis.
Historically, women undergoing mastectomy and ALND have been restricted from lifting anything heavy, but that is changing, indicated Colin Champ, MD, radiation oncologist, certified strength and conditioning specialist (CSCS), and founder of the Allegheny Health Network’s Exercise Oncology and Resiliency Center in Pittsburgh, Pennsylvania.
“That is an evolving field, as modern data does support the safety of resistance training,” he said during a media briefing.
He and his colleagues performed a secondary analysis that pooled data from three prospective cohorts of women who completed intensive resistance training at their center. These women were between 20 to 89 years of age and were treated for ductal carcinoma in situ or invasive breast cancer with mastectomy or lumpectomy, with or without ALND.
After surgery, all women participated in a dose-escalated resistance training program supervised by Dr. Champ and a team of CSCSs. Pre- and postintervention assessments involved a functional movement screen (FMS), a balance test, and body composition measurements. For the 3 months of training, women completed several resistance exercises three times a week.
The analysis included 197 women, with most (57%) having been treated with lumpectomy; the rest underwent mastectomy. ALND was used in 13%.
Compared with women treated with lumpectomy, those who underwent mastectomy were significantly younger (median 51 vs 59 years; P<0.001), more likely to undergo ALND (24.7% vs 4.5%; P<0.001), and less likely to undergo radiation therapy (64.7% vs 83.9%; P=0.003). The rate of chemotherapy was numerically, but not significantly, higher in the mastectomy group (44.7% vs 26.8%; P=0.14). Mastectomy also was associated with a more advanced breast cancer stage.
Exercise loads at baseline and improvements across exercises after 12 weeks of resistance training did not differ based on the type of surgery. Changes in BMI, body fat percentage, muscle mass, basal metabolic rate, grip strength, and Godin score (a measure of activity) were similar in the two groups. Bone mineral content remained unchanged.
FMS scores and balance did not differ between the mastectomy and lumpectomy groups at baseline, with similar improvements in those measures observed with training irrespective of surgery type.
Older age and receipt of radiation therapy were associated with lower baseline FMS scores at baseline, with age being the only factor predictive of the magnitude of improvement with training. Older patients saw significantly smaller improvements in FMS, whereas those who underwent ALND had less-substantial gains in balance.
Overall, however, this study demonstrates “improvement in functional movement screen in all-comers, regardless of age, stage, grade, [and] treatment,” Dr. Champ said, adding that most women who entered the program had not done resistance training previously. “Anyone can basically do this if they can walk and get out of a chair.”
Ultimately, this study provides “evidence-based reassurance for surgeons counseling patients on postoperative exercise,” he said. “We do hope that this data is incorporated in the daily clinic.”
Image by Viktoriia Miroshnikova / Getty Images
