Benefits of Combined Upper Body Exercise and Compression Therapy for Breast Cancer Related Lymphedema: A Systematic Review

Purpose:This systematic review aimed to examine the benefit of combined upper body exercise and compression therapy for breast cancer related lymphedema. Method:Electronic searches were performed in Medline, EMBASE, CINAHL, SPORTDiscus, and PEDRO. We included randomized and controlled clinical trials that examined the effect of upper body exercise with use of compression therapy on arm lymphedema. Where data were available, effect sizes were calculated. Risk of bias was assessed using the Cochrane risk-of-bias tool. The quality of evidence was rated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results:Of 444 studies, 11 met all inclusion criteria. Two cross-over trials examined single bouts of upper body exercise with or without compression, three intervention trials examined non-resisted upper body exercise and compression, and six intervention trials examined upper body resistance exercise and compression. Only two studies reported statistically significant benefit from the combined intervention for arm lymphedema volume. Seven studies provided adequate data to allow for calculation of effect size; however, heterogeneity precluded pooling of data. The quality of evidence was moderate in intervention trials comparing combined upper body exercise and compression to standard care (n = 1) or to exercise alone (n = 1). For all other trials the grade of evidence was low, with quality ratings downgraded due to small sample sizes and/or high or unclear risk of bias. Conclusions:No clear conclusions could be made regarding the benefit of combined upper body exercise and compression for breast cancer related lymphedema. Further high-quality trials are warranted.