https://orcid.org/0009-0002-1150-6974
Figures
Abstract
Background
Breast cancer-related lymphoedema, a chronic and debilitating swelling condition, can occur as a sequela of breast cancer treatment. Physical activity is a key recommendation of cancer survivorship guidelines. However, uncertainties that remain around physical activity and breast cancer-related lymphoedema management, have potentially contributed to low physical activity levels in this population.
Aim
The aim of this scoping review was to explore the core components of physical activity interventions to prevent or manage breast cancer-related lymphoedema and to understand the context in which they are developed and delivered.
Methods
This scoping review was conducted in accordance with the Joanna Brigg’s Institute methodology. A systematic search of the literature was conducted across five databases (Medline, CINAHL, Embase, SportsDiscus, Scopus) including grey literature. Primary research studies with physical activity, both structured and unstructured, as the main intervention and an outcome for breast cancer-related lymphoedema were included.
Results
After full title and abstract screening, 79 studies were charted. The majority were randomised controlled trials (n = 44; 55.7%), incorporated resistance exercise (n = 43; 54.4%), typically lasted 12 weeks (n = 21; 26.6%), and were supervised (n = 34; 43%). Participants included were most frequently diagnosed with stage II breast cancer (n = 17; 21.5%) and had received the breast cancer treatments axillary node surgery (n = 64; 81%) and/or radiotherapy (n = 55; 69.6%). Lymphoedema was most frequently measured by arm circumference (n = 43; 54.4%). Motivational strategies (n = 27; 34.2%) or behavioural change theories (n = 5; 6.3%) were included to encourage physical activity participation.
Conclusions
Physical activity interventions focused on short-term lymphoedema goals at the expense of encouraging long-term physical activity behaviour. To improve physical activity levels in this population, five future research recommendations have been proposed: recognise the physical activity preferences of this population; explore the impact of lymphoedema risk factors; target research early in the cancer timeline; apply behavioural change theories; explore lymphoedema outcomes.
Citation: Henry L, Wilson JS, Wilson JJ, Beck ER (2026) Core components of physical activity interventions in the prevention and management of breast cancer-related lymphoedema (BCRL): A scoping review. PLoS One 21(9): e0355189. https://doi.org/10.1371/journal.pone.0355189
Editor: Ka Ming Chow, Chinese University of Hong Kong, HONG KONG
Received: November 10, 2025; Accepted: July 16, 2026; Published: September 2, 2026
Copyright: © 2026 Henry et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its supporting information files.
Funding: LH- Received funding from The Department of the Economy Northern Ireland (https://www.economy-ni.gov.uk/), as part of wider PhD studies. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: LH- Received funding from The Department of the Economy Northern Ireland as part of wider PhD studies. However, the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
Introduction
Rationale
Breast cancer occurs in 1 in 7 women in the United Kingdom [1]. The common breast cancer treatments, namely axillary lymph node dissection (ALND) and regional lymph node radiation (RLNR), can damage the lymphatics resulting in the chronic and debilitating condition breast cancer-related lymphoedema (BCRL) [2]. BCRL typically presents as swelling of the upper limb, chest wall or trunk and may be associated with heaviness, stiffness, numbness, tightness, fatigue, weakness and decreased coordination and mobility in the affected arm [3]. Research reports that up to 30.1% of breast cancer survivors (BCS) who receive both ALND and RLNR will experience BCRL within five years of treatment [2]. However, with no internationally agreed definition of BCRL, nor a gold standard measuring tool, determining who will develop BCRL and confirming a diagnosis can be difficult [4].
Physical activity (PA) commonly defined as “any bodily movement…..that requires energy expenditure” [5] is one of the key recommendations in cancer survivorship guidelines [6] as it improves quality of life (QOL), reduces anxiety [7]; reduces cancer reoccurrence and mortality [8]; and reduces treatment–related side effects such as fatigue and depression [9]. However, for BCS, the historical anecdotal assumption that over-exertion of the affected limb could fatigue or overload the lymphatics, resulting in swelling [10], may have contributed to PA caution amongst healthcare professionals and patients alike [11]. Interestingly, self-reported PA levels of BCS with BCRL, measured via the International Physical Activity Questionnaire- Short Form (IPAQ-SF), have been reported as significantly lower (p = 0.046), when compared to healthy controls [12]. Whilst recent 2025 United Kingdon (UK) breast cancer lymphoedema guidance [13] now advises that PA is safe and may improve QOL for those at risk of, or living with BCRL, they do not provide tailored PA guidance to this population but refer to previous generic PA guidance for healthy adults [14,15].
To further understand the gaps within the literature surrounding PA and BCRL, a preliminary search of MEDLINE, CINAHL, PROSPERO and Open Science Framework was conducted between September 2024 and November 2024. Previous systematic reviews and meta-analyses on this topic have focused on evaluating the safety and efficacy of PA or exercise interventions on lymphoedema outcomes [16–28]. Others have tried to determine the optimal exercise dosage to reduce or prevent BCRL [29], or determine the need for those with BCRL to wear compression armsleeves [30]. However, in this preliminary search there were no systematic or scoping reviews that considered the core components of PA interventions for those at risk of, or living with, BCRL.
Therefore, it is the aim of this scoping review to explore the core components of PA interventions to prevent or manage BCRL and to understand the context in which they are developed and delivered. This will be achieved through five objectives:
- 1. What are the characteristics of the included participants (e.g., age, BMI, cancer stage)?
- 2. What are the characteristics of the PA interventions, e.g., type, frequency, duration, intensity?
- 3. What outcomes are measured?
- 4. What are the participants’ volumes and patterns of PA at baseline, during and post PA intervention?
- 5. What are the knowledge gaps and areas for further research?
Methods
A systematic scoping review conducted in accordance with the Joanna Brigg’s Institute (JBI) methodology for conducting scoping reviews [31] was chosen to explore and synthesise the literature regarding PA and BCRL. A scoping review which aims to map multiple types of evidence, was felt most appropriate in order to identify gaps and priorities for further research [32]. This approach was reported in line with the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews) checklist (S1 Table) [33]. The web-based software programme Covidence was used to streamline the data extraction process [34,35].
Protocol and Registration
The scoping review protocol was registered with Open Science Framework on 25-11-24, updated on 22-01-25 and can be found at: https://doi.org/10.17605/OSF.IO/T6CUQ.
Inclusion Criteria
Eligibility criteria were informed by the participant, concept, context (PCC) questions development framework.
Participant
Studies that included: 1) ≥18 year old adult participants; 2) who had treatment for breast cancer which included, removal of one or more lymph nodes and/or radiotherapy to the chest or axilla and therefore were considered at risk of BCRL; 3) or those who had a formal diagnosis of BCRL by a healthcare professional. Participants with active malignant disease, or acute oedema were excluded.
Concept
Studies that include all types of PA, both structured and unstructured, as the main primary intervention and stated a recognised outcome measure for lymphoedema.
Search Strategy
Two concepts defined the search strategy, 1) Physical Activity. 2) Breast Cancer Lymphoedema. A combination of free-text term and Medical Subject Heading (MeSH) were used where available. Truncation (* or #) was used to account for different spellings of similar terms and Boolean terms (AND, OR) was used to combine different search terms. Results were searched from the year 2000, the year when there was a shift in research regarding PA as a contraindication for BCRL (35), to the current year and were limited to primary research studies in the English language where full text was available. The search strategy was initially developed and piloted in two databases, Medline and CINAHL to identify any further keywords and index terms in the title and abstract of retrieved papers. A Subject Librarian (KC) was consulted throughout this process. Once the final search strategy was defined and completed in Medline and CINAHL, it was translated onto a further three databases Embase, SportsDiscus and Scopus.
Grey literature was extensively searched across a list of relevant home pages for key societies and professional organisations (S4 Table). This list was compiled by the main author (LH), a Clinical Specialist in Lymphoedema and Oncology and a second independent Lymphoedema and Oncology expert (DW) was consulted. Targeted website searching via Google Scholar was also carried out, to locate webpages and/or documents published on the internet. The grey literature databases of PROSPERO, TRIP, OpenGrey, Web of Science and Scopus Proquest Conference Papers Index were searched. Institutional repositories and journals were sought from CORE, and any relevant completed clinical trials were sought from Clinical trials.gov. Reference lists of retrieved full-text articles were screened for any additional content. The search was then rerun on 11th June 2025 before data charting was completed. The search strategy from the database Medline is presented in Table 1 and the search strategy from the database CINAHL is presented in S5 Table.
Study selection
All relevant results were imported onto the software management tool, Covidence, for removal of duplications and screening [34]. Two reviewers (LH and JSW) independently pilot screened the title and abstract of the first 25 articles, ordered by their Covidence ID, i.e., the ID assigned to them by the software Covidence. Once 75% agreement was reached, further title and abstract screening was completed. These two reviewers also conducted full text article screening, according to eligibility criteria. Any disagreements were resolved by discussion with the third and fourth reviewers (JJW and ERB).
Data Charting
A data extraction table was developed in agreement with the research team to systematically collect and organise the data. It was initially piloted by two authors (LH and JSW) and further modifications were made in consultation with the full research team. From the initial review of the included studies, it was identified that most of the included interventions were planned, structured and repetitive, thus resembling exercise which is defined as a subset of PA [36]. Therefore to better consolidate the data from the reported interventions, the data chart was adapted to include the 16 items, internationally endorsed, Consensus on Exercise Reporting Template (CERT) [37]. This template was designed to aid replication of exercise prescription for research reports [38]. The inclusion of CERT in this scoping review was not to evaluate the included interventions but to identify gaps in reporting [37].
How PA intensity was reported varied within the studies. Therefore to aid charting of this data, the American College of Sports Medicine (ACSM) approximate classification of exercise intensity was consulted [39]. This chart was developed based upon commonly used methods of reporting intensity in practice such as %HRmax (percent of maximal heart rate) or %1RM (percentage of 1 repetition maximum). Other assumptions and simplifications made to assist with data charting included: 1) The timepoint to when participants were recruited to the interventions was categorised according to the weeks/months since breast cancer diagnosis or active breast cancer treatment. 2) Outcomes of interest reported, other than lymphoedema outcomes, focused on QOL, pain, strength, fatigue, function/disabilities, range of motion (ROM), PA levels, cardiovascular function, perceived exertion, intervention feedback or qualitative interviews.
All data chartered was in alignment with the study objectives to ensure the following data was captured:
- i. Participant characteristics
- ii. PA intervention characteristics
- iii. Outcome measures
- iv. Participants’ PA behaviours
Where data was missing or when additional data was required, the authors of five papers were contacted. Two authors responded and clearly answered the questions [40,41], two authors were not contactable but the data from their studies was included in the scoping review as the authors agreed that comprehensive data charting could still take place [42,43]. The final author contacted did not respond to email contact and as data from this study could not be comprehensively charted, it was excluded from the final number of studies for review.
Results
The initial literature search across the five databases and grey literature led to 2,277 records. A further search of the reference list of full-text articles was completed, and the search strategy was rerun across all databases on 11th June 2025. This identified a further 18 records, resulting in a total of 2295 records, 830 of which were removed due to duplication (Fig 1). The title and abstract of 1465 records were subsequently screened according to eligibility criteria. This resulted in full text screening of 173 records with a total of 79 finally included [40–118]. Main reasons for non-inclusion at this stage were: did not meet the PCC criteria as defined above (n = 51) and wrong study design (n = 40). Unless noted, the total number of studies (n = 79) was used as the denominator to calculate percentages.
Adapted from Covidence systematic review software, Veritas Health Innovation, Melbourne, Australia. Available at www.covidence.org [34].
The 79 studies included in this scoping review came from 26 worldwide countries and were published between 2003 and 2025 (S6 Table), with 50.6% (n = 40) published since 2017 highlighting the popularity this topic has gained in recent years. The most common study type, RCT, accounted for 55.7% (n = 44) of the studies. Other study types included: single group 19% (n = 15), randomised crossover 10.1% (n = 8), non-RCT 10.1% (n = 8), cohort 2.5% (n = 2), case report 1.3% (n = 1) and longitudinal follow up of RCT 1.3% (n = 1).
Participant characteristics
Sample sizes of the interventions spanned a wide range, from n = 3 [113] to n = 1000 [117]. Participants included in the interventions as shown in S6 Table, were most frequently (n = 46; 58.2%) 50–60 years (mean or median age of the total sample, or the total of all groups), diagnosed with stage II breast cancer (n = 17; 21.5%) (S1 Fig.) [41,42,44,48,50,58,63,83,88,90,96,97,102,106,108,111,114], were less than 6 months post diagnosis or surgery (n = 21; 26.6%) or in contrast beyond 60 months post active treatment, surgery or diagnosis (n = 21; 26.6%) and were classified as overweight or obese (where BMI was reported within national obesity guidance categories [119]). There was only one male participant reported in one study [54].
Participants received a range of breast cancer treatments (S2 Fig.). Considering the risk factors associated with BCRL, it is not surprising that the majority of studies reported participants received surgery to the axillary nodes (n = 64; 81.0%) [40,43–61,63,65,67,71,73–76,78,79,82–92,94–96,98–106,108–118], radiotherapy (n = 55; 69.6%) [41,44–47,51,52,54–62,66,69,71,73–77,79–87,89,90,92,94–96,98,100,102–106,109–116,118] and chemotherapy (n = 54; 68.4%) [41,43–47,50–54,56–62,64,69,71,73–77,82–85,87–90,92,94–96,98,100–102,104–106,109–116,118].
Physical Activity Intervention Characteristics
With the inclusion of all types of PA in this scoping review, both structured and unstructured, the results demonstrated a wide variety of PA interventions. The majority of the studies (n = 43; 54.4%) incorporated some form of resistance exercise (RE) which focused primarily on strengthening of the upper body (n = 20; 25.3%), with a few (n = 11; 13.9%) considering both upper and lower body strengthening (S6 Table). 15.2% (n = 12) of the interventions resembled PA recommendations found in a PA guideline [120] by incorporating both a detailed RE and aerobic exercise (AE) element (S6 Table).
Other types of PA interventions ranged from those incorporating gentle arm exercises to improve shoulder ROM and/or lymphatic drainage (n = 11; 13.9%) [55,58,65,72,73,76,91,94,96,114,117] to those with a holistic, whole-body approach (n = 25; 31.6%) (S6 Table) such as: aquatic therapy (n = 7; 8.9%) [41,45,63,79,87,112,113]; Yoga (n = 6; 7.6%) [66,68,89,92,100,116]; Nordic or pole walking (n = 4; 5.1%) [42,80,81,90]; dragon boat racing (n = 2; 2.5%) [54,85]; Pilates (n = 2; 2.5%) [107,111]; aquatic therapy versus Pilates (n = 1; 1.3%) [97]; football (n = 1; 1.3%) [52]; Qigong (n = 1; 1.3%) [69]; virtual reality games (n = 1; 1.3%) [48].
Considering the intensity and frequency of the interventions, this again ranged greatly. Intensity varied from very light to near maximal and frequency varied from a single Qigong session (6 minutes long) [69] to 18 months of 15 minutes daily arm exercises [96]. Interventions were most frequently (n = 20; 26.6%) reported as 12 weeks/ 3 months in length (S6 Table).
To further understand exercise prescription, the 79 interventions were mapped against CERT [37] (S2 Table). This highlighted that interventions were most likely to be supervised (n = 34; 43%) [41–43,45,50–55,57,59–61,63,71–73,80,82,88,93,95,97,98,101–103,107–109,112,113,116], in a group (n = 23; 29.1%) [41–43,50–52,54,55,60,63,75,80,85,87,97,98,101,107,108,112–114,116] by a Physiotherapist (n = 25; 31.6%) [40,46,50–52,55,56,63,69,70,72–75,80,81,83,96,98,101,102,107,112–114] and carried out in a research facility such as a hospital, clinic, rehabilitation unit, university or research centre (n = 27; 34.2%) [40,46,48–50,52,53,55,56,58,59,63,65,69,71–73,76,83,84,88,90,91,100,102,107,114]. Compression to the arm, either as a compression armsleeve or compression bandage, at participants choice or mandatory, was the most frequently included non-exercise component (n = 31; 39.2%) [44,45,47,49,55,57–60,62,64,68,72,73,75,76,78,80,81,87,89,93,96,98,104–108,110,118]. 53.2% (n = 42) of the studies provided a detailed description of how adherence to the intervention was measured and reported and 34.2% (n = 27) gave a detailed description of any motivational strategies incorporated (S2 Table).
The rationale upon which the PA interventions were designed was also charted. This demonstrated that the majority were developed upon the scientific rationale of previous studies (n = 50; 63.3%) and/or the physiological rationale that PA encourages muscle-pump action and lymph drainage (n = 34; 43%) (S3 Table). 8 studies (10.1%) included the ACSM exercise guidelines for cancer survivors [121] in their design of [51,60,62,63,67,88,101,103] and only five studies reported including a traditional behavioural change theory: the social cognitive theory (n = 4; 5.1%) [50,104–106] and transtheoretical model (n = 1; 1.3%) [74].
Outcome measures
S6 Table provides a summary of the lymphoedema outcomes and other main outcomes measured. There were seven objective measures of lymphoedema reported. These included: bioimpedance spectrometry (BIS), water displacement, perometry, dual-energy x-ray absorptiometry (DXA), tissue tonometry, ultrasound (US) and the most common, arm circumference (n = 43; 54.4%). 53.2% (n = 42) of the studies also included a self-report measure of BCRL, however, only 8.9% (n = 7) included clinical examination of the affected limb as a reported outcome [46,53,96,104–106,117].
Other outcomes mostly commonly measured included: QOL 48.1% (n = 38); strength 40.5% (n = 32); ROM 22.8% (n = 18); function/disability 26.6% (n = 21); pain 20.3% (n = 16); fatigue 6.3% (n = 5); anxiety/depression/mood 6.3% (n = 5).
Intervention acceptability was only reported in 17.7% (n = 14) of the studies. This was through comments received (n = 4) [70,76,93,113], questionnaire evaluation (n = 5) [40,58,62,63,111] or qualitative enquiry (n = 5) [50,56,57,75,89]. Where reported, this feedback was both positive, e.g., “participants reported more confidence in using the affected upper limb …. they were less often reminded of having lymphedema” [70] and negative, e.g., “….feeling of getting cold when only exercising at slower speeds ….preferred more active classes” [63].
Participants’ volumes and patterns of PA
Less than a quarter of the studies recorded PA levels of the participants at baseline (21.5%; n = 17) via various different self-report measures such as the International Physical Activity Questionnaire (IPAQ) (n = 3; 3.8%) [40,104,105] (S6 Table). However, where published (6.3%; n = 5) most recorded participants as active [46,57,62,65,78]. Throughout the intervention, two studies measured daily step activity of the main intervention group via a smart bracelet [67,101] and one via a pedometer [47].
At the end of the intervention 8.9% (n = 7) of the studies reported if PA levels had differed from baseline. No significant change in PA level was reported in three studies [95,104,105] whereas in contrast, three studies reported an increase in PA levels [51,76,101]. In another study despite an initial increase in PA level at 3 and 6 months, this increase was not sustained at 2years [102].
Discussion and Areas for Further Research
The traditional approach to PA research to prevent and manage BCRL has focused on the safety and effectiveness of PA on lymphoedema outcomes. Thus, clinical practice guidelines now recommend that PA is safe for this population [13]. However, in order to further understand how research in this area could be translated into real-life scenarios, this scoping review explored the core components of 79 PA intervention studies for those at risk of, or living with, BCRL from across the globe.
The participants most frequently included in the interventions were 50–60 years old females (58.2%), diagnosed with stage II breast cancer (21.5%), had received the breast cancer treatments axillary node surgery (81%), radiotherapy (69.6%) and chemotherapy (68.4%), and were overweight or obese (65.8%). While these demographics represent those most at risk of breast cancer and BCRL [122,123], reflecting those easiest to recruit to such studies, it does highlight gaps within the literature with regarding understudied populations. For example, around 390 men are diagnosed with breast cancer each year in the UK and this population was not adequately represented [122].
BCRL risk is also associated with the extent of lymph node removal, site of radiotherapy [2] and the time since breast cancer diagnosis and treatment [124]. Most studies recruited participants less than 6 months post diagnosis or surgery (26.6%) or beyond 60 months (5 years) post active treatment, surgery or diagnosis (26.6%). This may be attributed to studies investigating lymphoedema prevention recruiting participants early in the cancer timeline, i.e., before BCRL develops and studies investigating lymphoedema management recruiting participants later in the cancer timeline, i.e., when there is a confirmed diagnosis of BCRL. However BCRL risk is reported to peak between 12 and 30 months postoperatively [124]. Therefore, future PA and BCRL research would benefit from longitudinal studies, recruiting participants from time of diagnosis and following them up for a number of years post treatment with consideration given to lesser researched risk factors, e.g., the extent of lymph node removal and understudied populations.
With the historical assumption that over-exertion of the affected limb could result in swelling [10], it is not surprising that in the attempt to prove that PA is safe for those at risk of, or living with BCRL, the majority of studies included in this scoping review focused on supervised (43%), upper body RE (25.3%), carried out in a research type facility (34.2%) as the main mode of enquiry. Similarly in a study of 48 BCS with BCRL the majority (79.1%) reported that they prefer exercise to be supervised however, in contrast the majority preferred this to be in a clinic/sports centre (50%) and the type of PA to be walking or jogging (66.6%) [12]. With 50% of this population self-reporting as inactive [12], future research would benefit from not only considering the PA preferences of this population but also investigating how to reduce sedentary time to promote positive survivorship.
The inclusion of the CERT into this scoping review identified that 34.2% of the studies included motivational strategies to encourage PA participation which is unsurprising given the limited use of behaviour change theory in the design of just five studies (6.3%). With most interventions instead based primarily upon scientific (63.3%) and/or physiological rationale (43%) it is important to recognise that PA behaviour has been negatively associated with a BCRL diagnosis. For example, in a 5 year longitudinal study, PA levels (self-reported as regular, occasional or none) of BCS were found to be significantly (p = 0.004) lower in those with a BCRL diagnosis when compared to those without a BCRL diagnosis [125]. These findings, alongside the infrequent reporting of intervention acceptability (17.7%) and the inconsistent reporting of PA levels at baseline or throughout the studies, highlights a limited understanding of PA behaviours amongst BCS at risk of, or living with, BCRL. Future research that incorporates behavioural change theory would enable better understanding of long-term PA behaviour in this population.
The outcomes measured in the included studies ranged from seven different objective lymphoedema measures to several outcomes associated with common cancer treatment-related side effects, e.g., strength. This range reflects the multifaceted outcomes and benefits associated with PA after breast cancer treatment. Arm circumference was the most popular objective lymphoedema outcome measure (54.4%) most likely due to its wide availability and low cost [126]. However, how best to measure, diagnose, and monitor BCRL remains the subject of international debate [127] with the heterogeneity in lymphoedema outcome measures cited as a limitation in a previous PA and BCRL systematic review [16]. One suggestion has been that to avoid BCRL misdiagnosis in up to 50% of BCS, BCRL diagnosis should include not only an objective measurement but also self-reported symptoms and clinical examination [128]. Whilst self-report measures were used in 53.2% of the included studies, clinical examination was reported much less frequently, in only 8.9% of the studies. Future research would benefit from addressing the diversity of outcomes and gaining international agreement on standardised lymphoedema outcomes.
Strengths and Limitations
Incorporating both structured and unstructured PA interventions into this scoping review enabled a comprehensive overview of both PA and exercise research in this area. With the majority of interventions being structured, thus resembling exercise, the CERT template was consulted to provide clarity in the data charting. Implementing the CERT in a scoping review is a novel method to aid with data charting of interventions in this area. Thus, research gaps around motivational strategies were identified. Another novel approach used in this study was utilising the ACSM classification of exercise intensity to categorise exercise intensity and this highlighted the sheer breadth of intensities and terminology used throughout these interventions.
Limitations of this scoping review include limiting the search strategy to the English language. The authors recognise the worldwide attention this topic receives however, this limitation was unavoidable due to language and time constraints of the authors. One study was excluded due to the data reported not being sufficient enough to chart. Despite best efforts, the author did not respond to contact. Although 79 other studies were charted, this is recognised as a limitation. Another limitation of this scoping review is the consideration of diverse populations. Whilst the gender of participants was explored, highlighting the omission of males from most studies, other demographics such as socioeconomic factors were not explored due to the volume of data to be chartered.
Also lymphoedema was not the main focus of all studies, but a secondary outcome of a larger study. This was not always clearly reported and difficult to ascertain at times. To try and fully understand the interventions, the authors searched for accompanying articles where available (e.g., study protocols or studies reporting other outcomes from the same study).
Conclusion
PA interventions for those at risk of, or living with, BCRL focus on short-term goals such as preventing lymphoedema or reducing lymphoedema arm volume. Research in this area is therefore commonly designed upon scientific or physiological rationale, includes populations easiest to recruit, is limited in duration and focuses on objective lymphoedema outcomes. Future research recommendations to encourage long-term PA behaviour are summarised below.
Recommendations
In summary this scoping review highlighted five gaps and recommendations for future research. These should be addressed to help bridge the gap between research informed clinical guidelines and real-world situations. These include:
- 1. Involve stakeholders early on in the research process. In particular recognising the PA preferences and behaviours of those at risk of, and living with, BCRL.
- 2. Recognise the impact risk factors for lymphoedema may have on BCRL severity and PA behaviours.
- 3. Target research early in the cancer treatment and survivorship timeline, when participants are most susceptible to BCRL development or progression.
- 4. Identify effective behavioural change theories to enhance long-term PA participation in this population.
- 5. Collaborate with stakeholders to investigate how best to diagnose and measure BCRL beyond objective measures alone.
Supporting information
S1 Table. PRISMA Checklist.
Preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) checklist.
https://doi.org/10.1371/journal.pone.0355189.s001
(PDF)
S2 Table. CERT checklist.
Consensus on Exercise Reporting Template.
https://doi.org/10.1371/journal.pone.0355189.s002
(XLSX)
S3 Table. Study characteristics.
Characteristics of 79 studies included.
https://doi.org/10.1371/journal.pone.0355189.s003
(PDF)
S4 Table. Grey literature.
Relevant home pages for key societies and professional organisations.
https://doi.org/10.1371/journal.pone.0355189.s004
(PDF)
S5 Table. CINAHL search strategy.
The search strategy from the database CINAHL.
https://doi.org/10.1371/journal.pone.0355189.s005
(PDF)
S6 Table. Study Summary.
[40–71,73–118]. Abbreviations: Resistance exercise (RE); Aerobic exercise (AE); Quality of life (QOL); Range of motion (ROM); Breast cancer specific quality of life questionnaire module of the European Organisation for Research and Treatment for Cancer (BR23); Bioimpedance Spectrometry (BIS); Metabolic Equivalent of Task (MET); International Physical Activity Questionnaire (IPAQ); Control group (CG); Intervention group (IG); Physical activity (PA); Community Healthy Activities Model Program for Seniors (CHAMPS). Visual analogue scale (VAS). Numerical rating scale (NRS). Dual-energy X-ray Absorptiometry (DXA). Lymphoedema and breast cancer questionnaire (LBCQ). Functional assessment of cancer therapy- breast cancer + arm subscale (FACT-B + 4). Body mass index (BMI). Breast cancer-related lymphoedema (BCRL). Ultrasound (US). Note: For the randomised controlled trials (RCT) group A is the intervention group and Group B is the control group except when there is more than one intervention group. In this case if three groups are reported Group A, Group B are the intervention group and Group C is the control group. If four groups are reported then Group A, Group B, Group C are the intervention group and Group D is the control group.
https://doi.org/10.1371/journal.pone.0355189.s006
(DOCX)
S1 Fig. Cancer staging.
The most frequently reported cancer stage of included participants per study.
https://doi.org/10.1371/journal.pone.0355189.s007
(TIF)
S2 Fig. Treatment type.
Graph to show the percentage of studies that reported participants received each type of breast cancer treatment.
https://doi.org/10.1371/journal.pone.0355189.s008
(TIF)
Acknowledgments
The authors would like to acknowledge the contribution made by:
1. Diane Wilson (DW), Lymphoedema and Oncology Physiotherapist, Western Health and Social Care Trust, for assisting in compiling a list of relevant home pages for key societies and professional organisations.
2. Kelly Coogan (KC), Assistant Subject Librarian – Life & Health Sciences, Ulster University, Belfast, for assisting with developing and conducting the search strategy.
References
- 1.
Cancer Research UK. Survival for breast cancer. About Cancer. https://www.cancerresearchuk.org/about-cancer/breast-cancer/survival. 2023. Accessed 2025 June 4.
- 2. Naoum GE, Roberts S, Brunelle CL, Shui AM, Salama L, Daniell K, et al. Quantifying the Impact of Axillary Surgery and Nodal Irradiation on Breast Cancer-Related Lymphedema and Local Tumor Control: Long-Term Results From a Prospective Screening Trial. J Clin Oncol. 2020;38(29):3430–8. pmid:32730184
- 3. Pappalardo M, Starnoni M, Franceschini G, Baccarani A, De Santis G. Breast cancer-related lymphedema: Recent updates on diagnosis, severity and available treatments. J Pers Med. 2021;11(5):402.
- 4. DiSipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol. 2013;14(6):500–15. pmid:23540561
- 5.
World Health Organization. Physical activity. Newsroom. https://www.who.int/news-room/fact-sheets/detail/physical-activity. 2024. Accessed 2026 March 18.
- 6. Foster J, Worbey S, Chamberlin K, Horlock R, Marsh T. Integrating physical activity into cancer care: evidence and guidance. UK: Macmillan Cancer Support. 2020. https://www.macmillan.org.uk/dfsmedia/1a6f23537f7f4519bb0cf14c45b2a629/1535-source/integrating-physical-activity-into-cancer-care-evidence-and-guidance-tcm9-339684.pdf
- 7. Sun M, Liu C, Lu Y, Zhu F, Li H, Lu Q. Effects of Physical Activity on Quality of Life, Anxiety and Depression in Breast Cancer Survivors: A Systematic Review and Meta-analysis. Asian Nurs Res (Korean Soc Nurs Sci). 2023;17(5):276–85. pmid:37944798
- 8. Cannioto RA, Hutson A, Dighe S, McCann W, McCann SE, Zirpoli GR, et al. Physical Activity Before, During, and After Chemotherapy for High-Risk Breast Cancer: Relationships With Survival. J Natl Cancer Inst. 2021;113(1):54–63. pmid:32239145
- 9. Loprinzi PD, Cardinal BJ. Effects of physical activity on common side effects of breast cancer treatment. Breast Cancer. 2012;19(1):4–10. pmid:21725654
- 10. Erickson VS, Pearson ML, Ganz PA, Adams J, Kahn KL. Arm edema in breast cancer patients. J Natl Cancer Inst. 2001;93(2):96–111. pmid:11208879
- 11. Henry L, Wilson JS, Wilson JJ, Beck ER. Physical activity and breast cancer-related lymphoedema: present trends. Br J Nurs. 2025;34(13):683–90. pmid:40601556
- 12. Yildiz Kabak V, Gursen C, Aytar A, Akbayrak T, Duger T. Physical activity level, exercise behavior, barriers, and preferences of patients with breast cancer-related lymphedema. Support Care Cancer. 2021;29(7):3593–602. pmid:33170403
- 13.
Early and locally advanced breast cancer: diagnosis and management. https://www.nice.org.uk/guidance/ng101/resources/early-and-locally-advanced-breast-cancer-diagnosis-and-management-pdf-66141532913605. 2025. Accessed 2025 October 2.
- 14.
NICE. Physical activity: brief advice for adults in primary care. https://www.nice.org.uk/guidance/ph44/resources/physical-activity-brief-advice-for-adults-in-primary-care-pdf-1996357939909. 2013. Accessed 2024 December 6.
- 15.
UK Chief Medical Officers. UK chief medical officers’ physical activity guidelines. https://assets.publishing.service.gov.uk/media/5d839543ed915d52428dc134/uk-chief-medical-officers-physical-activity-guidelines.pdf. 2019. Accessed 2024 December 6.
- 16. Baumann FT, Reike A, Reimer V, Schumann M, Hallek M, Taaffe DR, et al. Effects of physical exercise on breast cancer-related secondary lymphedema: a systematic review. Breast Cancer Res Treat. 2018;170(1):1–13. pmid:29470804
- 17. Baumann FT, Reike A, Hallek M, Wiskemann J, Reimer V. Does Exercise Have a Preventive Effect on Secondary Lymphedema in Breast Cancer Patients Following Local Treatment? - A Systematic Review. Breast Care (Basel). 2018;13(5):380–5. pmid:30498426
- 18. Tendero-Ruiz L, Palomo-Carrión R, Megía-García-Carpintero Á, Pérez-Nombela S, López-Muñoz P, Bravo-Esteban E. The effect of therapeutic exercise in the prevention of lymphoedema secondary to breast cancer: a systematic review. Arch Med Sci. 2020;19(6):1684–92. pmid:38058721
- 19. Muñoz-Gómez E, Arnal-Gómez A, López Cascón A, Espí-López GV. Systematic review of aquatic therapeutic exercise efficacy in breast cancer survivors. Support Care Cancer. 2022;31(1):44. pmid:36525089
- 20. Sánchez-Lastra MA, Torres J, Martínez-Lemos I, Ayán C. Nordic walking for women with breast cancer: A systematic review. Eur J Cancer Care (Engl). 2019;28(6):e13130. pmid:31389108
- 21. Wei C-W, Wu Y-C, Chen P-Y, Chen P-E, Chi C-C, Tung T-H. Effectiveness of Yoga Interventions in Breast Cancer-Related lymphedema: A systematic review. Complement Ther Clin Pract. 2019;36:49–55. pmid:31383443
- 22. Cheema BS, Kilbreath SL, Fahey PP, Delaney GP, Atlantis E. Safety and efficacy of progressive resistance training in breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat. 2014;148(2):249–68. pmid:25324019
- 23. Paramanandam VS, Roberts D. Weight training is not harmful for women with breast cancer-related lymphoedema: a systematic review. J Physiother. 2014;60(3):136–43. pmid:25086730
- 24. Keilani M, Hasenoehrl T, Neubauer M, Crevenna R. Resistance exercise and secondary lymphedema in breast cancer survivors-a systematic review. Support Care Cancer. 2016;24(4):1907–16. pmid:26715294
- 25. Nelson NL. Breast cancer-related lymphedema and resistance exercise: a systematic review. J Strength Cond Res. 2016;30(9):2656–65.
- 26. Wanchai A, Armer JM. Effects of weight-lifting or resistance exercise on breast cancer-related lymphedema: A systematic review. Int J Nurs Sci. 2018;6(1):92–8. pmid:31406873
- 27. Hasenoehrl T, Palma S, Ramazanova D, Kölbl H, Dorner TE, Keilani M, et al. Resistance exercise and breast cancer-related lymphedema-a systematic review update and meta-analysis. Support Care Cancer. 2020;28(8):3593–603. pmid:32415386
- 28. Hasenoehrl T, Keilani M, Palma S, Crevenna R. Resistance exercise and breast cancer related lymphedema - a systematic review update. Disabil Rehabil. 2020;42(1):26–35. pmid:30638093
- 29. Luan B, Li Z, Yang Q, Xu Z, Chen Y, Wang M, et al. The effects of ACSM-based exercise on breast cancer-related lymphoedema: a systematic review and meta-analysis. Front Physiol. 2024;15:1413764. pmid:39108540
- 30. Singh B, Disipio T, Peake J, Hayes SC. Systematic Review and Meta-Analysis of the Effects of Exercise for Those With Cancer-Related Lymphedema. Arch Phys Med Rehabil. 2016;97(2):302-315.e13. pmid:26440777
- 31. Peters MDJ, Marnie C, Tricco AC, Pollock D, Munn Z, Alexander L, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020;18(10):2119–26. pmid:33038124
- 32. Khalil H, Jia R, Moraes EB, Munn Z, Alexander L, Peters MDJ, et al. Scoping reviews and their role in identifying research priorities. J Clin Epidemiol. 2025;181:111712. pmid:39924126
- 33. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467–73. pmid:30178033
- 34.
Covidence systematic review software. Melbourne (AU): Veritas Health Innovation. 2026.
- 35. Harris SR, Niesen-Vertommen SL. Challenging the myth of exercise-induced lymphedema following breast cancer: a series of case reports. J Surg Oncol. 2000;74(2):95–8; discussion 98-9. pmid:10914817
- 36. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985;100(2):126–31. pmid:3920711
- 37. Slade SC, Dionne CE, Underwood M, Buchbinder R. Consensus on Exercise Reporting Template (CERT): Explanation and Elaboration Statement. Br J Sports Med. 2016;50(23):1428–37.
- 38. Slade SC, Dionne CE, Underwood M, Buchbinder R, Beck B, Bennell K, et al. Consensus on Exercise Reporting Template (CERT): Modified Delphi Study. Phys Ther. 2016;96(10):1514–24. pmid:27149962
- 39. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee I-M, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–59. pmid:21694556
- 40. Ammitzbøll G, Lanng C, Kroman N, Zerahn B, Hyldegaard O, Kaae Andersen K, et al. Progressive strength training to prevent LYmphoedema in the first year after breast CAncer - the LYCA feasibility study. Acta Oncol. 2017;56(2):360–6. pmid:28084150
- 41. Salacinski AJ, Doyle EJ, Damon R, Acevedo RA, Broeder CE. Effects of 12 weeks of water aerobics on body composition in those affected by breast cancer. Support Care Cancer. 2021;29(3):1205–12. pmid:32607599
- 42. Di Blasio A, Morano T, Napolitano G, Bucci I, Di Santo S, Gallina S, et al. Nordic Walking and the Isa Method for Breast Cancer Survivors: Effects on Upper Limb Circumferences and Total Body Extracellular Water - a Pilot Study. Breast Care (Basel). 2016;11(6):428–31. pmid:28228712
- 43. Naczk A, Huzarski T, Doś J, Górska-Doś M, Gramza P, Gajewska E, et al. Impact of Inertial Training on Muscle Strength and Quality of Life in Breast Cancer Survivors. Int J Environ Res Public Health. 2022;19(6):3278. pmid:35328964
- 44. Ahmed RL, Thomas W, Yee D, Schmitz KH. Randomized controlled trial of weight training and lymphedema in breast cancer survivors. J Clin Oncol. 2006;24(18):2765–72. pmid:16702582
- 45. Ali KM, El Gammal ER, Eladl HM. Effect of Aqua Therapy Exercises on Postmastectomy Lymphedema: A Prospective Randomized Controlled Trial. Ann Rehabil Med. 2021;45(2):131–40. pmid:33849087
- 46. Ammitzbøll G, Johansen C, Lanng C, Andersen EW, Kroman N, Zerahn B, et al. Progressive resistance training to prevent arm lymphedema in the first year after breast cancer surgery: Results of a randomized controlled trial. Cancer. 2019;125(10):1683–92. pmid:30633334
- 47. Anderson RT, Kimmick GG, McCoy TP, Hopkins J, Levine E, Miller G, et al. A randomized trial of exercise on well-being and function following breast cancer surgery: the RESTORE trial. J Cancer Surviv. 2012;6(2):172–81. pmid:22160629
- 48. Atef D, Elkeblawy MM, El-Sebaie A, Abouelnaga WAI. A quasi-randomized clinical trial: virtual reality versus proprioceptive neuromuscular facilitation for postmastectomy lymphedema. J Egypt Natl Canc Inst. 2020;32(1):29. pmid:32537717
- 49. Balaji G, Senthil P. Effects of upper limb low resistance exercises along with manual lymphatic drainage in subjects with post radical mastectomy – a pilot study. Fiz Pol. 2024;24(2):42–9.
- 50. Bloomquist K, Adamsen L, Hayes SC, Lillelund C, Andersen C, Christensen KB, et al. Heavy-load resistance exercise during chemotherapy in physically inactive breast cancer survivors at risk for lymphedema: a randomized trial. Acta Oncol. 2019;58(12):1667–75. pmid:31354000
- 51. Bloomquist K, Karlsmark T, Christensen KB, Adamsen L. Heavy resistance training and lymphedema: prevalence of breast cancer-related lymphedema in participants of an exercise intervention utilizing heavy load resistance training. Acta Oncol. 2014;53(2):216–25. pmid:24195690
- 52. Bloomquist K, Krustrup P, Fristrup B, Sørensen V, Helge JW, Helge EW, et al. Effects of football fitness training on lymphedema and upper-extremity function in women after treatment for breast cancer: a randomized trial. Acta Oncol. 2021;60(3):392–400. pmid:33423594
- 53. Bloomquist K, Oturai P, Steele ML, Adamsen L, Møller T, Christensen KB, et al. Heavy-Load Lifting: Acute Response in Breast Cancer Survivors at Risk for Lymphedema. Med Sci Sports Exerc. 2018;50(2):187–95. pmid:28991039
- 54. Boeer B, Seller A, Schoenfisch B, Krainick-Strobel U, Dietrich A, Brucker SY, et al. The impact of rehabilitation sport on breast cancer-related lymphoedema and quality of life. Arch Gynecol Obstet. 2023;307(5):1529–37. pmid:35879447
- 55. Bracha J, Katz-Leurer M. The immediate effect of upper arm exercise compared with lower or combined upper and lower arm exercise on arm volume reduction in women with breast cancer related lymphedema: A randomized preliminary study. Rehabil Oncol. 2012;30(3):3EP – 8.
- 56. Bruce J, Mazuquin B, Canaway A, Hossain A, Williamson E, Mistry P, et al. Exercise versus usual care after non-reconstructive breast cancer surgery (UK PROSPER): multicentre randomised controlled trial and economic evaluation. BMJ. 2021;375:e066542. pmid:34759002
- 57. Buchan J, Janda M, Box R, Schmitz K, Hayes S. A Randomized Trial on the Effect of Exercise Mode on Breast Cancer-Related Lymphedema. Med Sci Sports Exerc. 2016;48(10):1866–74. pmid:27187092
- 58. Carretti G, Mirandola D, Maestrini F, Sequi L, Germano S, Muraca MG, et al. Quality of life improvement in breast cancer survivors affected by upper limb lymphedema through a novel multiperspective physical activity methodology: a monocentric pilot study. Breast Cancer. 2022;29(3):437–49. pmid:35025064
- 59. Cormie P, Galvão DA, Spry N, Newton RU. Neither heavy nor light load resistance exercise acutely exacerbates lymphedema in breast cancer survivor. Integr Cancer Ther. 2013;12(5):423–32. pmid:23439658
- 60. Cormie P, Pumpa K, Galvão DA, Turner E, Spry N, Saunders C, et al. Is it safe and efficacious for women with lymphedema secondary to breast cancer to lift heavy weights during exercise: a randomised controlled trial. J Cancer Surviv. 2013;7(3):413–24. pmid:23604998
- 61. Cormie P, Singh B, Hayes S, Peake JM, Galvao DA, Taaffe DR. Acute Inflammatory Response to Low-, Moderate-, and High-Load Resistance Exercise in Women With Breast Cancer-Related Lymphedema. Integr Cancer Ther. 2016;15(3):308–17.
- 62. Damato A, Rovnaya A, McGuigan P. Resistance training in patients with secondary lymphoedema: does it have any effect on functional and quality of life measures?. J Lymphoedema. 2023;18(1):8EP – 14.
- 63. Deacon R, de Noronha M, Shanley L, Young K. Does the speed of aquatic therapy exercise alter arm volume in women with breast cancer related lymphoedema? A cross-over randomized controlled trial. Braz J Phys Ther. 2019;23(2):140–7. pmid:30471966
- 64. Do JH, Kim W, Cho YK, Lee J, Song EJ, Chun YM, et al. Effects of resistance exercises and complex decongestive therapy on arm function and muscular strength in breast cancer related lymphedema. Lymphology. 2015;48(4):184–96. pmid:27164764
- 65. Dönmez AA, Kapucu S. The effectiveness of a clinical and home-based physical activity program and simple lymphatic drainage in the prevention of breast cancer-related lymphedema: A prospective randomized controlled study. Eur J Oncol Nurs. 2017;31:12–21. pmid:29173822
- 66. Douglass J, Immink M, Piller N, Ullah S. Yoga for women with breast cancer-related lymphoedema: A preliminary 6-month study. J Lymphoedema. 2012;7(2):30EP – 38.
- 67. Esteban-Simón A, Díez-Fernández DM, Rodríguez-Pérez MA, Artés-Rodríguez E, Casimiro-Andújar AJ, Soriano-Maldonado A. Does a Resistance Training Program Affect Between-arms Volume Difference and Shoulder-arm Disabilities in Female Breast Cancer Survivors? The Role of Surgery Type and Treatments. Secondary Outcomes of the EFICAN Trial. Arch Phys Med Rehabil. 2024;105(4):647–54. pmid:38043674
- 68. Fisher MI, Donahoe-Fillmore B, Leach L, O’Malley C, Paeplow C, Prescott T, et al. Effects of yoga on arm volume among women with breast cancer related lymphedema: A pilot study. J Bodyw Mov Ther. 2014;18(4):559–65. pmid:25440207
- 69. Fong SSM, Ng SSM, Luk WS, Chung JWY, Ho JSC, Ying M, et al. Effects of qigong exercise on upper limb lymphedema and blood flow in survivors of breast cancer: a pilot study. Integr Cancer Ther. 2014;13(1):54–61. pmid:23749481
- 70. Gautam AP, Maiya AG, Vidyasagar MS. Effect of home-based exercise program on lymphedema and quality of life in female postmastectomy patients: pre-post intervention study. J Rehabil Res Dev. 2011;48(10):1261–8. pmid:22234669
- 71. Giron PS, Haddad CAS, de Almeida Rizzi SKL, Elias S, Nazário ACP, Facina G. Exercise therapy, systemic acupuncture and silicon oxide tablets on muscular strength, lymphedema, and quality of life in breast cancer survivors: randomized clinical trial. Asian Pac J Cancer Prev. 2025;26(3):809–17.
- 72. de Fatima Guerreiro Godoy M, Pereira de Godoy AC, Pereira de Godoy JM. Effect of exercise while utilizing a device with an arm compression sleeve to reduce lymphedema. Clin Exp Obstet Gynecol. 2017;44(1):17–9. pmid:29714859
- 73. Gülören G, Doğan Y, Özgül S, Gürşen C, Çinar GN, İpekten F, et al. Acute Effects of Remedial Exercises with and without Compression on Breast-Cancer-Related Lymphedema. Healthcare (Basel). 2023;11(22):2949. pmid:37998441
- 74. Harvie M, Livingstone K, McMulllan D, Pegington M, Lombardelli C, Adams J, et al. BE-WEL trial (breast: evaluation of weight and exercise for lymphoedema) testing weight control and exercise programmes for women with breast cancer related lymphoedema: a feasibility trial. Breast Cancer Res Treat. 2024;207(1):203–12. pmid:38758461
- 75. Hayes SC, Reul-Hirche H, Turner J. Exercise and secondary lymphedema: safety, potential benefits, and research issues. Med Sci Sports Exerc. 2009;41(3):483–9. pmid:19204604
- 76. Jeffs E, Wiseman T. Randomised controlled trial to determine the benefit of daily home-based exercise in addition to self-care in the management of breast cancer-related lymphoedema: a feasibility study. Support Care Cancer. 2013;21(4):1013–23. pmid:23073712
- 77. Johannson K, Piller N. Weight-bearing exercise and its impact on arm lymphoedema. J Lymphoedema. 2007;2(1):15–22.
- 78. Johansson K, Tibe K, Weibull A, Newton RC. Low intensity resistance exercise for breast cancer patients with arm lymphedema with or without compression sleeve. Lymphology. 2005;38(4):167–80. pmid:16515225
- 79. Johansson K, Hayes S, Speck RM, Schmitz KH. Water-based exercise for patients with chronic arm lymphedema: a randomized controlled pilot trial. Am J Phys Med Rehabil. 2013;92(4):312–9. pmid:23370582
- 80. Jönsson C, Johansson K. Pole walking for patients with breast cancer-related arm lymphedema. Physiother Theory Pract. 2009;25(3):165–73.
- 81. Jönsson C, Johansson K. The effects of pole walking on arm lymphedema and cardiovascular fitness in women treated for breast cancer: a pilot and feasibility study. Physiother Theory Pract. 2014;30(4):236–42. pmid:24175620
- 82. Kilbreath SL, Ward LC, Davis GM, Degnim AC, Hackett DA, Skinner TL, et al. Reduction of breast lymphoedema secondary to breast cancer: a randomised controlled exercise trial. Breast Cancer Res Treat. 2020;184(2):459–67. pmid:32812177
- 83. Kilbreath S, Refshauge K, Beith J, Lee M. Resistance and stretching shoulder exercises early following axillary surgery for breast cancer. Rehabil Oncol. 2006;24(2):9–14.
- 84. Kilbreath SL, Refshauge KM, Beith JM, Ward LC, Lee M, Simpson JM, et al. Upper limb progressive resistance training and stretching exercises following surgery for early breast cancer: a randomized controlled trial. Breast Cancer Res Treat. 2012;133(2):667–76. pmid:22286332
- 85. Iacorossi L, Gambalunga F, Molinaro S, De Domenico R, Giannarelli D, Fabi A. The Effectiveness of the Sport “Dragon Boat Racing” in Reducing the Risk of Lymphedema Incidence: An Observational Study. Cancer Nurs. 2019;42(4):323–31. pmid:29933309
- 86. Lane K, Jespersen D, McKenzie DC. The effect of a whole body exercise programme and dragon boat training on arm volume and arm circumference in women treated for breast cancer. Eur J Cancer Care (Engl). 2005;14(4):353–8. pmid:16098120
- 87. Letellier M-E, Towers A, Shimony A, Tidhar D. Breast cancer-related lymphedema: a randomized controlled pilot and feasibility study. Am J Phys Med Rehabil. 2014;93(9):751–9; quiz 760–1. pmid:24743455
- 88. Lin Y, Wu C, He C, Yan J, Chen Y, Gao L, et al. Effectiveness of three exercise programs and intensive follow-up in improving quality of life, pain, and lymphedema among breast cancer survivors: a randomized, controlled 6-month trial. Support Care Cancer. 2022;31(1):9. pmid:36512157
- 89. Loudon A, Barnett T, Piller N, Immink MA, Williams AD. Yoga management of breast cancer-related lymphoedema: a randomised controlled pilot-trial. BMC Complement Altern Med. 2014;14:214. pmid:24980836
- 90. Malicka I, Stefańska M, Rudziak M, Jarmoluk P, Pawłowska K, Szczepańska-Gieracha J, et al. The influence of Nordic walking exercise on upper extremity strength and the volume of lymphoedema in women following breast cancer treatment. Isokinet Exerc Sci. 2011;19(4):295–304.
- 91. Maraş Baydogan G, Sürme Y, Gök M. The impact of a self-care skills strengthening rehabilitation program on post-surgical lymphedema: A randomized controlled tele-health intervention. Eur J Oncol Nurs. 2025;76:102843. pmid:40043525
- 92. Mazor M, Lee JQ, Peled A, Zerzan S, Irwin C, Chesney MA. The Effect of Yoga on Arm Volume, Strength, and Range of Motion in Women at Risk for Breast Cancer-Related Lymphedema. J Altern Complement Med. 2018;24(2):154–60.
- 93. McKenzie DC, Kalda AL. Effect of upper extremity exercise on secondary lymphedema in breast cancer patients: a pilot study. J Clin Oncol. 2003;21(3):463–6. pmid:12560436
- 94. Moseley AL, Piller NB, Carati CJ. The effect of gentle arm exercise and deep breathing on secondary arm lymphedema. Lymphology. 2005;38(3):136–45. pmid:16353491
- 95. Nakamoto S, Iwamoto T, Taira N, Kajiwara Y, Kawada K, Takabatake D, et al. The effect of exercise and educational programs for breast cancer patients on the development of breast cancer-related lymphoedema: secondary endpoint from a randomized controlled trial in the Setouchi Breast Project-10. Breast Cancer. 2024;31(5):969–78. pmid:38980571
- 96. Naughton MJ, Liu H, Seisler DK, Le-Rademacher J, Armer JM, Oliveri JM, et al. Health-related quality of life outcomes for the LEAP study-CALGB 70305 (Alliance): A lymphedema prevention intervention trial for newly diagnosed breast cancer patients. Cancer. 2021;127(2):300–9. pmid:33079393
- 97. Odynets T, Briskin Y, Yefremova A, Goncharenko I. The effectiveness of two individualized physical interventions on the upper limb condition after radical mastectomy. Physiother Quart. 2019;27(1):12–7.
- 98. Omar MTA, Gwada RFM, Omar GSM, El-Sabagh RM, Mersal A-EAE. Low-Intensity Resistance Training and Compression Garment in the Management of Breast Cancer-Related Lymphedema: Single-Blinded Randomized Controlled Trial. J Cancer Educ. 2020;35(6):1101–10. pmid:31243692
- 99. Pardo-Hernández R, Fernández-Solana J, González-Bernal JJ, Romero-Pérez EM, Horta-Gim MA, Riojas Pesqueira LE, et al. Effect of Strength Training on Body Composition, Volumetrics and Strength in Female Breast Cancer Survivors. Healthcare (Basel). 2024;13(1):29. pmid:39791636
- 100. Pasyar N, Barshan Tashnizi N, Mansouri P, Tahmasebi S. Effect of yoga exercise on the quality of life and upper extremity volume among women with breast cancer related lymphedema: A pilot study. Eur J Oncol Nurs. 2019;42:103–9. pmid:31479846
- 101. Ramírez-Parada K, Sánchez C, Cantarero-Villanueva I, Reyes Á, Pinto MP, Bravo ML, et al. Randomized Trial Assessing Prospective Surveillance and Exercise for Preventing Breast Cancer-Related Lymphedema in High-Risk Patients. Arch Phys Med Rehabil. 2025;106(8):1163–72. pmid:40081785
- 102. Sagen A, Kåresen R, Risberg MA. Physical activity for the affected limb and arm lymphedema after breast cancer surgery. A prospective, randomized controlled trial with two years follow-up. Acta Oncol. 2009;48(8):1102–10. pmid:19863217
- 103. Schmidt T, Berner J, Jonat W, Weisser B, Röcken C, van Mackelenbergh M, et al. Influence of arm crank ergometry on development of lymphedema in breast cancer patients after axillary dissection: A randomized controlled trail. J Rehabil Med. 2017;49(1):78–83. pmid:28101567
- 104. Schmitz KH, Ahmed RL, Troxel AB, Cheville A, Lewis-Grant L, Smith R, et al. Weight lifting for women at risk for breast cancer-related lymphedema: a randomized trial. JAMA. 2010;304(24):2699–705. pmid:21148134
- 105. Schmitz KH, Ahmed RL, Troxel A, Cheville A, Smith R, Lewis-Grant L, et al. Weight lifting in women with breast-cancer-related lymphedema. N Engl J Med. 2009;361(7):664–73. pmid:19675330
- 106. Schmitz KH, Troxel AB, Dean LT, DeMichele A, Brown JC, Sturgeon K, et al. Effect of Home-Based Exercise and Weight Loss Programs on Breast Cancer-Related Lymphedema Outcomes Among Overweight Breast Cancer Survivors: The WISER Survivor Randomized Clinical Trial. JAMA Oncol. 2019;5(11):1605–13. pmid:31415063
- 107. Şener HÖ, Malkoç M, Ergin G, Karadibak D, Yavuzşen T. Effects of Clinical Pilates Exercises on Patients Developing Lymphedema after Breast Cancer Treatment: A Randomized Clinical Trial. J Breast Health. 2017;13(1):16–22. pmid:28331763
- 108. Simonavice E, Kim J-S, Panton L. Effects of resistance exercise in women with or at risk for breast cancer-related lymphedema. Support Care Cancer. 2017;25(1):9–15. pmid:27516182
- 109. Singh B, Newton RU, Cormie P, Galvao DA, Cornish B, Reul-Hirche H, et al. EFFECTS OF COMPRESSION ON LYMPHEDEMA DURING RESISTANCE EXERCISE IN WOMEN WITH BREAST CANCER-RELATED LYMPHEDEMA: A RANDOMIZED, CROSS-OVER TRIAL. Lymphology. 2015;48(2):80–92. pmid:26714372
- 110. Singh B, Buchan J, Box R, Janda M, Peake J, Purcell A, et al. Compression use during an exercise intervention and associated changes in breast cancer-related lymphedema. Asia Pac J Clin Oncol. 2016;12(3):216–24. pmid:26935243
- 111. Stan DL, Rausch SM, Sundt K, Cheville AL, Youdas JW, Krause DA, et al. Pilates for breast cancer survivors. Clin J Oncol Nurs. 2012;16(2):131–41. pmid:22459522
- 112. Tidhar D, Katz-Leurer M. Aqua lymphatic therapy in women who suffer from breast cancer treatment-related lymphedema: a randomized controlled study. Support Care Cancer. 2010;18(3):383–92. pmid:19495810
- 113. Tidhar D, Shimony A, Drouin J. Aqua Lymphatic Therapy for Postsurgical Breast Cancer Lymphedema. Rehabilitation Oncology. 2004;22(3):6–14.
- 114. Todd J, Scally A, Dodwell D, Horgan K, Topping A. A randomised controlled trial of two programmes of shoulder exercise following axillary node dissection for invasive breast cancer. Physiotherapy. 2008;94(4):265–73.
- 115. Venugopalan M, Veyilmuthu R, R DVR, Bhuvaneswari CKV. Effect of scapular and shoulder strengthening exercises on prevention of upper limb lymphedema – a pilot study. Fiz Pol. 2024;24(4):124–8.
- 116. Lai Y-T, Hsieh CC, Huang L-S, Liu W-S, Lin S-H, Wang L-L, et al. The Effects of Upper Limb Exercise Through Yoga on Limb Swelling in Chinese Breast Cancer Survivors - A Pilot Study. Rehabil Nurs. 2017;42(1):46–54. pmid:25980790
- 117. Zhang L, Fan A, Yan J, He Y, Zhang H, Zhang H, et al. Combining Manual Lymph Drainage with Physical Exercise after Modified Radical Mastectomy Effectively Prevents Upper Limb Lymphedema. Lymphat Res Biol. 2016;14(2):104–8. pmid:26824722
- 118. Zhang Z, Guo L, Zhou L, Hao X, Fan Y, Li H, et al. Preventive effects of progressive resistance training of different intensities on breast cancer-related lymphedema. Support Care Cancer. 2025;33(3):194. pmid:39953154
- 119.
How should I confirm if a person is overweight or obese?. Clinical Knowledge Summaries. https://cks.nice.org.uk/topics/obesity/diagnosis/identification-classification/. Accessed 2025 November 5.
- 120. Campbell KL, Winters-Stone KM, Wiskemann J, May AM, Schwartz AL, Courneya KS, et al. Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Med Sci Sports Exerc. 2019;51(11):2375–90. pmid:31626055
- 121. Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvão DA, Pinto BM, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010;42(7):1409–26. pmid:20559064
- 122.
Cancer Research UK. Risk factors for breast cancer. About Cancer. https://www.cancerresearchuk.org/about-cancer/breast-cancer/risks-causes/risk-factors. 2023. Accessed 2025 October 11.
- 123. Nassif TM, Brunelle CL, Gillespie TC, Bernstein MC, Bucci LK, Naoum GE, et al. Breast Cancer-Related Lymphedema: a Review of Risk Factors, Radiation Therapy Contribution, and Management Strategies. Curr Breast Cancer Rep. 2020;12(4):305–16.
- 124. McDuff SGR, Mina AI, Brunelle CL, Salama L, Warren LEG, Abouegylah M, et al. Timing of lymphedema after treatment for breast cancer: when are patients most at risk?. Int J Radiat Oncol Biol Phys. 2019;103(1):62–70.
- 125. Rey D, Touzani R, Bouhnik A-D, Rousseau F, Monet A, Préau M, et al. Evolution of physical activity and body weight changes in breast cancer survivors five years after diagnosis - VICAN 2 & 5 French national surveys. Breast. 2021;59:248–55. pmid:34315007
- 126. International Society of Lymphology. The Diagnosis and Treatment of Peripheral Lymphedema: 2023 Consensus Document of The International Society of Lymphology. Lymphology. 2023;56(4):133–51.
- 127. Moffatt CC, Sykorova M, Dring E, Murray S, Collard E, Gordon S, et al. An international survey to explore outcome measures in chronic oedema and lymphoedema. J Wound Care. 2021;30(Sup12b):19–30. pmid:39623666
- 128. Kassamani YW, Brunelle CL, Gillespie TC, Bernstein MC, Bucci LK, Nassif T, et al. Diagnostic Criteria for Breast Cancer-Related Lymphedema of the Upper Extremity: The Need for Universal Agreement. Ann Surg Oncol. 2022;29(2):989–1002. pmid:34505218