Lymphedema, a common and feared negative effect of breast cancer treatment, is generally described by arm swelling and dysfunction. Risk averse clinical recommendations guided survivors to avoid use of the affected arm. This may lead to deconditioning and, ironically, the very outcome women seek to avoid. Recently published studies run counter to these guidelines.

The results of completed studies support the safety of upper-body exercise among breast cancer survivors with and at risk for lymphedema. There is ample evidence that disuse leads to atrophy and decreased maximal and functional capacity of any musculoskeletal tissue. Such decreased capacity might be hypothesized to place the arms of breast cancer survivors concerned with lymphedema at greater risk than a supervised program of slowly progressive exercise training. The physiologic and structural response of the lymphatics to this type of training has yet to be completely described. The specifics of all types of upper-body exercise are not yet tested, but several general premises of progressive exercise training seem to hold with this population. Training should start supervised, at a low dose, increase according to symptom response, and is likely to increase maximal and functional capacity of the affected arm. Future research should include assessment of efficacy and safety of additional modes of exercise popular with breast cancer survivors (e.g., yoga, Pilates) as well as assessment of the timing to start exercise after surgery.