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Influence of Arm Crank Ergometry on Development of Lymphoedema in Breast Cancer Patients After Axillary Dissection: A Randomized Controlled Trial

Thorsten Schmidt, Jette Berner, Walter Jonat, Burkhard Weisser, Christoph Rocken, Marion Van Mackelenbergh, Christoph Mundhenke

Journal of Rehabilitation Medicine, 2017; 49: 78-83.

Objective: To investigate the safety and efficacy of

arm crank ergometry in breast cancer patients after

axillary lymph node dissection, with regard to

changes in bioelectrical impedance analysis, arm

circumference, muscular strength, quality of life and

fatigue.

Design: Randomized controlled clinical intervention

trial.

Subjects: Forty-nine patients with breast cancer after

axillary lymph node dissection.

Methods: Arm crank ergometer training twice-weekly

was compared with usual care over 12 weeks.

Results: The arm crank ergometer group improved

significantly in terms of lean body mass and skeletal

muscle mass, and showed a significant decrease in

body fat. In the arm crank ergometer group, as well

as the usual care group, a significant increase in armpit

circumference was detected during the training

period. The magnitude of the gain was higher in the

usual care group. For all other measured regions of

the arm a significant decrease in circumference was

seen in both groups. Muscular strength of the upper

extremity increased significantly in both groups,

with a greater improvement in the arm crank ergometer

group. In both groups a non-significant trend

towards improvement in quality of life was observed.

The arm crank ergometer group showed significant

improvements in physical functioning, general

fatigue and physical fatigue.

Conclusion: These results confirm the feasibility of

arm crank ergometer training after axillary lymph

node dissection and highlight improvements in

strength, quality of life and reduced arm symptoms

with this training.

  1. Researchers in this study set out to explore whether
  1. progressive resistive exercise affected upper extremity lymphedema.
  2. strength and endurance training affected upper extremity lymphedema. (p82, paragraph 1)
  3. aerobic exercise affected upper extremity lymphedema differently than usual exercise.
  4. aerobic exercise affected upper extremity lymphedema in contrast to progressive resistive exercise.
  1. Researchers assert that limb response to crank ergometer exercise
  2. is difficult to compare to previously published exercise studies. (p 82, paragraph 1)
  3. replicates findings in previous studies involving supervised exercise trials.
  4. fits criteria in National Lymphedema Network position statement on exercise.
  5. shows similar findings compared with outcomes of progressive resistive exercise training.
  1. One limitation of this study includes
  1. small sample size. (p 82, paragraph 5)
  2. personal preferences for exercise.
  3. differences in group demographics.
  4. follow through with self-directed exercise.
  1. Lymphedema in this study is defined by
  2. 2 cm change at 2 point measurements.
  3. 10cm change at 2 point measurements
  4. 5% increase in the volume of the affected limb (p. 79 paragraph 10)
  5. 10% increase in the volume of the affected limb”
  1. Objective data collected on participants included baseline, in addition to
  2. 16 week follow up measures with bio impedance, volume, LLIS, DASH, and FACiT.
  3. 6 week and 16 week follow up measures with bio impedance, LYMQoL, DASH, and FACiT.
  4. 12 week follow up measures with bio impedance, circumference, quality of life and fatigue. (p 79, paragraph 3)
  5. 12 week and 6 month follow up measures with bio impedance, volume, quality of life and fatigue.
  1. The Borg Scale is an indicator for
  2. limb size change.
  3. perceived exertion. (p. 79 paragraph 10)
  4. functional outcomes.
  5. staging lymphedema.
  1. In comparison with participants in the arm crank ergometer (ACE) group, participants assigned to the usual care (UC) group
  2. had fewer participants.
  3. had statistical means of older age and greater BMI.
  4. showed greater increase in UE circumference at the armpit measurement. (p 80, paragraph 3 & table 3)
  5. averaged greater reduction in UE circumference at the elbow measurement.
  1. Experimental and control group assignment was
  2. recommended via clinician.
  3. randomized via computer. (p 79 paragraph 1)
  4. sampled by convenience.
  5. chosen by participant.
  1. Quality of life (QoL) outcomes measured in this study
  2. refuted prior reports of reduced QoL in individuals who have BCRL.
  3. showed greater improvement in the ACE group compared with the UC group.
  4. confirmed findings of studies focused on exercise interventions in management of BCRL. (p82, paragraph 3)
  5. demonstrated endurance-based exercise yields greater QoL compared with progressive resistive exercise.
  1. Statistically significant changes were found for the following data points
  2. no change in skeletal muscle mass and body fat for the usual care group.
  3. increase in skeletal muscle mass and increase in body fat for the ergometry group.
  4. increase in skeletal muscle mass and decrease in body fat for the ergometry group. (p 80, paragraph 2)
  5. increase in skeletal muscle mass and increase in body fat for the usual care group.