Effectiveness of Physical Exercise Programs in Reducing Secondary Lymphedema Associated with Breast Cancer: An...

Introduction: Breast cancer-related lymphedema (BCRL) is a disabling complication, and the effectiveness of exercise as treatment remains uncertain. Objective: We aimed to evaluate the effectiveness and safety of exercise in women with BCRL. Methods: A comprehensive search was conducted in MEDLINE, Embase, Cochrane Library, PEDro, and LILACS from database inception to March 2025, collating systematic reviews (SRs) of randomized controlled trials (RCTs) evaluating exercise, alone or combined with physiotherapy, in women with BCRL. Risk of bias was assessed using ROBIS and RoB 2, certainty of evidence (CoE) using GRADE, and overlap using GROOVE. Results: Of 2023 records, 9 SRs including 170 primary studies were included; after overlap management, eligible RCT data were synthesized by comparison and outcome. Supervised weightlifting probably reduced the risk of a ≥5% long-term increase in lymphedema volume (RR: 0.13; 95% CI: 0.07-0.25; moderate CoE), but evidence is very uncertain regarding ≥5% volume reduction (RR: 0.85; 95% CI: 0.44-1.66; very low CoE). Aquatic exercise may improve shoulder flexion (MD: 8.73 degrees; 95% CI: 3.55-13.91; low CoE) and shoulder abduction (MD: 6.87 degrees; 95% CI: 2.50-11.24; low CoE) compared with Pilates. No adverse events were reported, although they were not systematically defined or reported. Conclusions: Supervised weightlifting probably prevents increases in lymphedema volume, and aquatic exercise may improve shoulder mobility; however, the evidence remains uncertain, and the absence of adverse events does not confirm safety. Registration: PROSPERO (CRD42022334433).