Adapted physical activity protocol for the management of breast cancer-related upper limb lymphedema

Purpose: Secondary upper limb lymphedema (LE), which is among the most dreaded chronic complications in breast cancer (BC) treatment’s outcomes, with risk proportional to the extent of axillary lymph node dissection and radiotherapy, results from lymphatic system obstruction or disruption. In BC survivors, chronic LE can cause psychophysical sequelae jeopardizing quality of life (QoL) and, owing to the lack of effective therapies, represents a major challenge for healthcare professionals. Recent researches support the positive effects deriving from regular participation in structured adapted physical activity (APA) programs in preventing or attenuating cancer treatment-related impairments with an overall improvement of QoL. In this context, the aim of our study was to investigate the possible effects of an APA intervention in reducing LE and improving both upper limb’s strength and mobility, as well as QoL of BC survivors. Methods: BC survivors (n = 16) with chronic moderate/severe LE attending the Cancer Rehabilitation Center in Florence were assessed before and after 8-week APA. The protocol, consisting of both APA specialist-supervised and self-leaded sessions, was centered on a specific motor gesture performed using an innovative purpose-designed proprioceptive board named ‘‘Hand Walk’’. Body mass index and bioimpedance parameters were measured. Indirect upper limb volume measurement and ultrasonography were also performed and functional tests (i.e. wrist flexion/extension and hand strength) were executed. QoL, depression/anxiety and pain intensity were evaluated by ULL27, HADS, distress thermometer and NRS questionnaires, respectively. Results: Although the bioimpedance measurements unchanged, the ultrasound and volumetric measures revealed a trend toward a LE reduction after the APA protocol. of note, wrist mobility, hand strength, pain perception, depression and QoL were all significantly ameliorated after APA. Conclusions: Our findings suggest that a multidisciplinary treatment approach, also involving APA professionals, is required in the management of BC-related LE in order to improve patient psychophysical outcomes and QoL.