In a novel research study to begin this week at the Abramson Cancer Center of the University of Pennsylvania, Kathryn Schmitz, PhD, MPH, Assistant Professor in Epidemiology, will help to determine the extent to which a slowly progressive program of strength-training exercises is safe for breast cancer survivors with and without symptoms of lymphedema. Lymphedema, which is characterized by a painful swelling of an affected arm and resulting loss of arm function, is one of the most common and feared side effects of breast-cancer treatments that involve lymph-node removal and/or radiation therapy.

Actions of the lymph system include regulating the balance of fluids in the limbs and fighting infections. When lymph nodes in the armpit are removed or damaged, patients can no longer appropriately regulate the fluid in their affected arm - which leads to swelling that can range from mild to extensive (bordering on elephantitis) and quite disfiguring. "Statistically, this is a public health problem," says Schmitz. "It affects up to one-half of the nearly two million breast-cancer survivors alive in the U.S. today - which means that there may be as many as one million women suffer from some form of lymphedema."

"Further, the psychological effects are enormous," adds Schmitz. "Indeed, many women have reported that they would rather have another mastectomy than lymphedema - because it's a painful, constant, and debilitating reminder of their breast cancer."

Current clinical guidelines advise lymphedema sufferers to not participate in any vigorous upper-body exercise; and, in particular, to not lift objects that weigh more than five to 15 pounds. "A gallon of milk weighs eight pounds," notes Schmitz, "so, basically, you're telling women, 'Don't carry your own groceries � don't pick-up your own grandchildren � don't live your own lives!' And the guidelines are based on air � on nothing. There's no scientific evidence to suggest that they're correct."

Strength training, believes Schmitz (an exercise physiologist), is an intriguing intervention for breast-cancer survivors as there is evidence that exercise improves health parameters and quality of life. Based on data from her own previous study (as well as other reports in the medical literature), a program of slowly-progressive weight-lifting exercises permits women to gradually increase the physical capacity of the damaged arm in a controlled setting, making it less likely that the occasional activities of daily living that require strenuous upper-body work - such as shoveling snow or carrying children - would over-stress the injured lymphatic system.

Weight Training to Be Done at Area Fitness Facilities

Schmitz's current randomized clinical-trial will seek to recruit 288 breast-cancer survivors (144 with lymphedema; 144 without). For those with lymphedema, the study is designed to determine whether or not upper-body strength training is safe - Schmitz believes it is. For those without, it will determine whether strength-training can be undertaken without fear of bringing on lymphedema. The primary outcome of the study will be arm volume measured by having participants put their arms into a tank of water, a method called 'water displacement.' Other measures will include arm circumferences, many other clinical assessments related to lymphedema, body fat percentage, and risk factors for chronic diseases such as osteoporosis, heart disease, and diabetes.

Since each study participant will be required to perform a carefully-controlled program of weight-training exercises twice a week for one year, Schmitz had partnered with approximately 11 fitness facilities throughout the Philadelphia region - including Sisters in Shape Fitness (in Logan); the Pottruck Center at the University of Pennsylvania; and nine YMCA sites in the greater metropolitan area.

Women interested in learning more about participating in this study should contact Amy Rogerino, at (215) 898-5112 or arogerincceb.med.upenn.edu.

Re-Empowering Women

In Schmitz's pilot study involving 86 women, which was funded by the Susan Komen Foundation, she found that an increase in quality-of-life was highly correlated to the amount of increase in upper-body strength. "We were able to literally re-empower women in their lives by re-empowering them physically!" she said. "These women discovered they were able and able-bodied� and very capable of doing physical things."

Schmitz's current trial is funded by a $2 million grant from the National Cancer Institute.

PENN Medicine is a $2.7 billion enterprise dedicated to the related missions of medical education, biomedical research, and high-quality patient care. PENN Medicine consists of the University of Pennsylvania School of Medicine (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System.

Penn's School of Medicine is ranked #2 in the nation for receipt of NIH research funds; and ranked #4 in the nation in U.S. News & World Report's most recent ranking of top research-oriented medical schools. Supporting 1,400 fulltime faculty and 700 students, the School of Medicine is recognized worldwide for its superior education and training of the next generation of physician-scientists and leaders of academic medicine.

The University of Pennsylvania Health System includes three hospitals [Hospital of the University of Pennsylvania, which is consistently ranked one of the nation's few "Honor Roll" hospitals by U.S. News & World Report; Pennsylvania Hospital, the nation's first hospital; and Penn Presbyterian Medical Center]; a faculty practice plan; a primary-care provider network; two multispecialty satellite facilities; and home care and hospice.

About the Abramson Cancer Center at the University of Pennsylvania The Abramson Cancer Center of the University of Pennsylvania was established in 1973 as a center of excellence in cancer research, patient care, education and outreach. It is one of a select group of only 39 NCI-designated Comprehensive Cancer Centers in the United States and is one of the top five in National Cancer Institute (NCI) funding. Home to one of the largest clinical and research programs in the world, the Abramson Cancer Center of the University of Pennsylvania has 300 active cancer researchers and 300 full-time Penn physicians involved in cancer prevention, diagnosis and treatment. For more information about specific types of cancer, cancer treatment, clinical trials, and research advances, visit the Abramson Cancer Center's resource on www.penncaner or OncoLink at oncolink.

Olivia Fermano
olivia.fermanouphs.upenn.edu
University of Pennsylvania School of Medicine
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