Lymphatic Response to Resistance Exercise in Breast Cancer Survivors

N/ANot Yet RecruitingNCT06113627

University of Malaga170 enrolled

Overview

The objective of this study is 1) to study the acute and chronic effect of resistance therapeutic physical exercise (RTPE) in the prevention of breast cancer-related lymphedema (BCRL) in breast cancer survivors at risk using variables related to the lymphatic response; 2) Study the possible relationship between changes in body composition at a local and regional level and volume changes produced by RTPE in patients at risk of suffering from BCRL.

Nowadays, research studies that confirm the safety and preventive effect of resistance or strength exercise in breast cancer-related lymphedema (BCRL) have been limited to the study of changes in variables related to the lymphatic response, such as bioimpedance spectroscopy , X-ray absorptiometry, perometry or water displacement after completion of a resistance exercise program (chronic effect). To better understand the preventive effect of resistance exercise on the BCRL, in addition to studying the variables that are globally accepted and studied at a regional level such as the volume due to water displacement, variables that measure changes at a regional level related to body composition, such as such as echogenicity and ultrasound thickness, local tissue water and mechanical properties of tissues. Furthermore, this would allow us to detect possible changes in different body regions of the upper quadrant (upper extremity, but also breast or back), and not only taking global changes into account. On the other hand, the lymphatic response should be studied in the short term (acute effect), in the long term after an exercise program (chronic effect), as well as in the short term after the training period with possible adaptations to the lymphatic system that could explain the preventive effect. Therefore, although there is a strong degree of scientific evidence to include therapeutic strength physical exercise as a preventive tool for LACM, the possible physiological mechanisms involved are unknown. The aim of the present project is to tudy the acute and chronic effect of resistance therapeutic physical exercise (RTPE) in the prevention of breast cancer-related lymphedema (BCRL) in breast cancer survivors at risk using regional but also local variables related to the lymphatic response, as well as to study between changes in these variables, body composition at a local and regional level and volume changes produced by RTPE in breast cancer survivors at risk of suffering from BCRL

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Conditions

Breast Cancer Lymphedema Survivorship Lymphedema of Upper Limb

Interventions

Resistance Therapeutic ExerciseOTHER

Strength exercises will be aimed at large muscle groups, such as the shoulder, chest, back and also muscle groups of the lower extremities. In the initial 2 weeks, intervention will start with low intensities of around 55-65% of 1RM, which allows to perform around 15-20 repetitions. The first week there will be performed 2 series, while in the second week it will be 3 series. Moderate intensity in the 2nd week, corresponding to 65-75% of 1RM and allowing for around 8-12 repetitions. 3 series will be maintained throughout this period of time.In addition to the progressive change in intensity, throughout the intervention the load will be increased by 5-10% when the patient performs the exercise too easily or when they can perform more repetitions than estimated. Rest between sets will be 2-3 minutes.

Eligibility

Sex: FEMALEMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Women diagnosed with breast cancer * Being of legal age * Histologically confirmed primary Breast Cancer (I-IIIA) (without the presence of metastasis) with a diagnosis in the last year * Unilateral involvement * Surgery for the tumor at least 6 weeks before the start of the intervention * WHO performance status of 0 (asymptomatic, complete and ambulatory activity) * Correct understanding of Spanish * Approval by signing the informed consent; * Mus be considered at risk for developing LACM: 1) Have undergone surgery that includes axillary dissection; 2) Have received or are undergoing regional lymph node radiation; 3) BMI \>30 kg/m2. . These patients are considered to have stage 0, subclinical or latent according to the International Society of Lymphology (ISL) , since they will not present signs or symptoms, but lymphatic transport will be altered by the treatments themselves Exclusion Criteria: * Women already diagnosed with LACM in stage I, II or III according to the ISL or if they present an L-Dex ratio \> 10 or a difference in volume equal to or greater than 10% between both extremities * Suffer from or have been diagnosed with any other lymphatic-venous disease in the upper extremity, such as venous insufficiency, thrombosis or lipedema; * Suffer from conditions that prevent resistance exercise of the upper body * Participation in regular (\>1 time/week) and intense exercises involving the upper extremity during the last month * Suffer from heart disease * Inability to complete questionnaires; * A physical condition that prevents them from making hospital visits * Taking any drug that may affect the lymphatic and circulatory system, such as diuretics or corticosteroids * Women which presents some type of wound or infection on the skin.

Locations (1)

Cristina Roldán Jiménez

Málaga, Spain

Outcomes

Primary Outcomes

Changes in volume difference between extremities (%)

The volume of both extremities will be measured to obtain the difference between both, which will be used as a relative criterion to determine the preventive effect of the intervention, determining the appearance of LACM as those cases in which the patient reaches a difference after one year of follow-up. volume equal to or greater than 10% between both extremities. It will be measured using water displacement volumetry, considered the gold standard for measuring the volume of the affected limb.

Time frame: Six measures: Baseline, before and 24 hours after the day 5 of exercise session, before and 24 hours after the 24 day of exercise session; after 3 month once completed the whole intervention, and after 1 year

Secondary Outcomes

Changes in extracelular fluid (ECF)

The EFC of the affected and contralateral side (liters, l) will be obtained. Which will allow establishing the ECF radius between the extremities. This ratios will be allowed to estimate L-Dex. The L-Dex ratio ranges between -10 and +10, taking into account the ratio between the dominant and non-dominant arms, which is equivalent to impedance ratios of 0.935 to 1.139 for the dominant arms at risk and from 0.862 to 1.066 for non-dominant arms at risk, respectively. It will be obtained through bioimpedance spectroscopy

Changes in Percentage Water Content (PWC)

Local tissue water will be measured by bilateral tissue dielectric constant (TDC). values on the forearm and biceps using the MoistureMeterD Compact. PWC%= 100%x(TDC-1)/77.5. It will be measured on the anterior and posterior aspects of the arm and forearm, on the breast, on the lateral aspect of the shoulder and in the dorsal area.

Data from ClinicalTrials.gov

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