Core components of physical activity interventions in the prevention and management of breast cancer-related lymphoedema (BCRL): A scoping review

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.