Effects of football fitness training on lymphedema and upper-extremity function in women after treatment for breast cancer: a randomized trial.
BACKGROUND
Breast cancer survivors are encouraged to be physically active. A recent review suggests that football training is an effective exercise modality for women across the lifespan, positively influencing health variables such as strength, fitness and social well-being. However, football is a contact sport, potentially posing an increased risk of trauma-related injury. Against this backdrop, breast cancer survivors are advised to avoid trauma or injury to the affected or at-risk arm in order to protect against lymphedema onset or exacerbation. The aim of this study was therefore to evaluate the feasibility and safety of Football Fitness training in relation to lymphedema and upper-extremity function after treatment for breast cancer.


MATERIAL AND METHODS
Sixty-eight women aged 18-75 years, who had received surgery for stage I-III breast cancer and completed (neo) adjuvant chemotherapy and/or radiotherapy within five years, were randomized (2:1) to a Football Fitness group (FFG, n = 46) or a control group (CON, n = 22) for twelve months. Secondary analyses using linear mixed models were performed to assess changes in upper-body morbidity, specifically arm lymphedema (inter-arm volume % difference, dual energy X-ray absorptiometry; extracellular fluid (L-Dex), bioimpedance spectroscopy), self-reported breast and arm symptoms (EORTC breast cancer-specific questionnaire (BR23) and upper-extremity function (DASH questionnaire) at baseline, six- and twelve-month follow-up.


RESULTS
We observed similar point prevalent cases of lymphedema between groups at all time points, irrespective of measurement method. At the six-month post-baseline assessment, reductions in L-Dex (extracellular fluid) were found in FFG versus CON. These significant findings were not maintained at the twelve-month assessment. No difference between groups was observed for inter-limb volume difference %, nor any of the remaining outcomes.


CONCLUSION
While superiority of Football Fitness was not observed, the results support that participation in Football Fitness training is feasible and suggests no negative effects on breast cancer-specific upper-body morbidity, including lymphedema.


TRIAL REGISTRATION
The trial was registered at ClinicalTrials.gov. NCT03284567.
['Bloomquist|Kira|K|https://orcid.org/0000-0001-7434-0532', 'Krustrup|Peter|P|https://orcid.org/0000-0002-1461-9838', 'Fristrup|Bjørn|B|https://orcid.org/0000-0002-8146-5170', 'Sørensen|Victor|V|', 'Helge|Jørn Wulff|JW|https://orcid.org/0000-0001-9724-5423', 'Helge|Eva Wulff|EW|https://orcid.org/0000-0002-4351-0137', 'Soelberg Vadstrup|Eva|E|', 'Rørth|Mikael|M|', 'Hayes|Sandra C|SC|https://orcid.org/0000-0002-7005-5184', 'Uth|Jacob|J|https://orcid.org/0000-0003-0619-7134']
D000293:Adolescent D000328:Adult D000368:Aged D001943:Breast Neoplasms D015444:Exercise D005260:Female D005538:Football D006801:Humans D008209:Lymphedema D008875:Middle Aged D034941:Upper Extremity D055815:Young Adult
lymphedema Breast cancer exercise upper-body morbidity soccer