Can Exercise Raise Lymphedema Risk After Breast Cancer?

Research shows that exercise started slowly and built up gradually does not raise lymphedema risk after breast cancer, and it may lower risk for some women. In a randomized trial in JAMA, 11% of women in a slow weight lifting program developed lymphedema, compared with 17% of women who did not exercise. Talk with your care team about the right program for you.

Key takeaways

• Large reviews and trials have found no increase in lymphedema from exercise after breast cancer.
• Slowly progressive weight lifting did not raise lymphedema risk and lowered flare-ups in women who already had it.
• The National Cancer Institute calls exercise a natural pump for the lymph system.
• Starting slow, building gradually and watching for changes are the keys.
• New swelling, heaviness or signs of infection need a call to your doctor.

For background on the condition itself, start with our overview of breast cancer-related lymphedema.

What is lymphedema, and why does it happen after breast cancer?

Lymphedema is swelling caused by a buildup of lymph fluid between the skin and muscle. After breast cancer, it most often affects the hand, arm or chest on the side where lymph nodes were removed or treated.

The lymph system is a network of vessels and small glands, called lymph nodes, that carries a clear fluid called lymph and helps the body fight infection. The National Cancer Institute (NCI) explains that surgery can disrupt the flow of lymph fluid, and radiation can cause scar tissue that blocks it. Breast cancer treatment often removes one or more lymph nodes from the underarm, which raises the risk.

NCI lists other risk factors, including infection, slow healing after surgery, past surgeries or radiation, advanced cancer, and being overweight or having obesity. Lymphedema can appear soon after treatment or years later, and it most often develops slowly. Our post on risk factors for developing breast cancer-related lymphedema goes into more detail, our overview of breast cancer-related lymphedema explains the basics, and our lymphedema exercise and recovery guide brings together early signs, exercise by phase and treatment.

Why did people worry that exercise could cause lymphedema?

Weight lifting was long discouraged for women after breast cancer. Research since then has tested that advice directly.

When the 2009 and 2010 Schmitz trials were published, the authors noted that weight lifting had generally been proscribed for women with breast cancer-related lymphedema, and that guidelines for survivors without lymphedema advised against upper body exercise. That advice kept many women from the known benefits of strength training, such as increases in bone density. To test it, researchers ran randomized controlled trials, which assign people by chance to exercise or no exercise and then compare results. This is the strongest way to test whether exercise causes harm.

What does the research show about exercise and lymphedema risk?

Trials and reviews have found that exercise does not raise lymphedema risk, and in some groups the risk was lower with exercise. These findings come from programs that started slowly and progressed gradually.

The Physical Activity and Lymphedema trial by Schmitz and colleagues, published in JAMA in 2010, included 154 breast cancer survivors with at least 2 lymph nodes removed and no signs of lymphedema. Half did a slowly progressive weight lifting program with 13 weeks of supervised instruction. After 1 year, new lymphedema occurred in 11% of the weight lifting group and 17% of the control group. Among women with 5 or more nodes removed, the numbers were 7% and 22%.

A Cochrane review by McNeely and colleagues pooled 24 trials with 2,132 participants and found no evidence of increased lymphedema risk from exercise at any time point. The UK PROSPER trial, with 392 women at higher risk of arm problems, found no increase in lymphedema with a physiotherapy-led exercise program that started 7 to 10 days after surgery.

Is weight lifting safe if you already have lymphedema?

For women with stable lymphedema, a slowly progressive weight lifting program did not increase swelling and lowered the number of flare-ups in a major trial. Supervision and a fitted compression garment were part of that program.

In a 2009 trial in the New England Journal of Medicine, Schmitz and colleagues studied 141 women with stable arm lymphedema. Participants lifted weights twice a week, starting light and building slowly, and wore a well-fitted compression garment while lifting. A compression garment is a snug sleeve that helps move lymph fluid along.

After 1 year, a swelling increase of 5% or more happened in 11% of the weight lifting group and 12% of the control group. Lymphedema flare-ups, called exacerbations, were 14% in the weight lifting group and 29% in the control group. The weight lifting group also reported fewer lymphedema symptoms and gained strength.

A 2020 meta-analysis by Hasenoehrl and colleagues reviewed 29 studies of resistance exercise, which is any exercise where muscles work against weight or a band. It concluded that resistance exercise does not have a systematic negative effect on lymphedema and potentially decreases it.

Is it safe to exercise soon after surgery?

Gentle range-of-motion exercise is usually started soon after surgery, and resistance training starting a few weeks later did not trigger lymphedema in a trial. Your care team will set the timing.

In a 2012 trial by Kilbreath and colleagues, 160 women started an 8-week program of stretching and progressive resistance training 4 to 6 weeks after surgery for early breast cancer. The exercise group gained more shoulder motion and abductor strength. The authors reported that resistance training after surgery did not precipitate lymphedema.

The American Cancer Society says that strength training usually begins about 4 to 6 weeks after surgery and starts with light weights. Our post on treating shoulder problems related to lymphedema explains how a therapist rebuilds shoulder function step by step.

How do you exercise safely if you are at risk of lymphedema?

Start slowly, build up gradually, and watch your arm for changes. Working with a trained professional can help.

The international exercise guidelines for cancer survivors, published in 2019, concluded that exercise training is generally safe for cancer survivors and that every survivor should avoid inactivity. NCI suggests talking with your doctor to find an exercise program you enjoy that is safe for you, and asking whether a certified lymphedema therapist could help. A certified lymphedema therapist, or CLT, is a therapist with extra training in managing lymph swelling.

Practical habits that fit the research:

• Start with light weights or bands and increase slowly over weeks.
• Ask your team whether you should wear a compression sleeve while exercising.
• Notice how your arm feels during and after each session.
• Pause and check in with your team if you notice new heaviness or swelling.
• Protect the skin on the affected arm from cuts and burns, as NCI advises.

Our post on treatment of lymphedema covers compression, manual lymph drainage and other options if swelling appears.

When to call your doctor

Contact your doctor promptly if you notice:

• A heavy, full or tight feeling in the arm, hand, fingers or chest on the surgery side
• Swelling that makes one arm look larger than the other
• Difficulty moving the arm, or new weakness
• Numbness or tingling in the affected area

Call your doctor right away if you have signs of cellulitis, a skin infection that NCI describes as potentially life-threatening. Signs include pain, tenderness, redness and swelling, skin that feels warm to the touch, and fever.

Talk with your clinician before you start or change an exercise program.

How RangeMaster products fit

Gentle, regular range-of-motion work is part of many programs after breast cancer surgery. The PinkPulley Cancer Care Shoulder Pulley is designed for that kind of home practice, with a smooth nylon roller, wooden handles, a 77-inch adjustable line and a breast cancer patient guide. Use it only within the timing, range and precautions provided by your care team.

When your team clears you for light strengthening, the Cancer Recovery Strength and Mobility Kit (Pink) adds the ShoulderWand and ShoulderFit resistance tools to the PinkPulley, so you can move, stretch and strengthen at a slow, steady pace.

Related reading

• Breast cancer related lymphedema: exercise and recovery guide
• Breast cancer-related lymphedema
• Treatment of lymphedema
• Risk factors for developing breast cancer-related lymphedema
• Research in a nutshell: lymphedema after treatment of breast cancer

Your next step

If your care team has cleared you for gentle range-of-motion work, the PinkPulley Cancer Care Shoulder Pulley can help you keep a steady home routine.

Common questions

Can I lift weights after breast cancer surgery?

Many women can, once their care team says it is OK. Trials have used slowly progressive programs that start light, and they did not find an increase in lymphedema.

Does a sentinel node biopsy lower lymphedema risk?

Sentinel node biopsy removes fewer lymph nodes than a full axillary dissection. Our research summary on lymphedema risk after sentinel node biopsy explains what one study found.

Should I wear a compression sleeve when I exercise?

In the 2009 NEJM trial, women with lymphedema wore a fitted compression garment while lifting. Ask your doctor or lymphedema therapist whether you need one.

Can exercise help lymphedema that I already have?

NCI notes that exercise can improve the flow of lymph fluid and may help treat lymphedema. Work with your care team or a lymphedema therapist on the right plan.

Can I carry a heavy bag on my affected arm?

NCI suggests avoiding carrying handbags or other items with an arm that has lymphedema. Ask your team about your own limits.