11 Guidelines advise to not lift heavy weights or children and to avoid doing repeated activities.2 and 20 Recent studies, however, have reported that weight training did not induce or exacerbate BCRL when it was performed under supervision with slow progression.21 and 22 This type of exercise results in robust functional, physiological, psychological CX5461 and clinical benefits.4 Progressive

weight training is intended to elicit benefits in health and performance by challenging skeletal muscles with controlled physiological stress to the onset of muscle fatigue. These weight-training sessions are followed by an optimal interval of rest, ranging from 48 to 72 hours; this allows physiological adaptation to occur.23 and 24 Aside from local effects at the arm, weight training has many other benefits, including: a reduction in cancer-related fatigue,25 and improvement in body weight, psychological well being,26 bone density,27 body image28 and survival.29 Some narrative19

and systematic4, 11, 18, 30 and 31 inhibitors reviews have been published on this topic. However, these reviews included studies with mixed exercise interventions30 or included non-randomised studies.4 and 18 Furthermore, at least two more randomised trials have been published since these previous reviews.4, 18 and 31 Therefore, this present review was considered to be necessary and sought to answer these research questions: 1. Is weight-training exercise safe for women with or at risk of lymphoedema after breast cancer? The following databases were searched electronically Pomalidomide purchase from inception to July/August 2012: PubMed, EMBASE, PsycINFO, CINAHL, AMED, Cochrane, PEDro, SPORTDiscus and Web of Science. Date restriction, female gender limit and peer review were applied to the results where possible. In addition, reference lists

of the identified studies GBA3 and previous reviews were searched for any potential articles. Furthermore, distinguished authors from this research area were contacted through email for any missed and relevant studies. Three key terms, ‘weight training’, ‘lymphoedema’ and ‘breast neoplasm’, were used to generate an exhaustive list of key words. Appendix 1 (see eAddenda) shows the full search strategies. Eligibility assessment of each study was conducted in a non-blinded and standardised manner by a single researcher (VP) under the supervision of the second author (DR) in three stages and every effort was undertaken to avoid subjective bias.32 In the first stage, articles obtained through the database searches were compared for duplicate entries using the de-duplicating facility of reference management softwarea and were manually cross checked. The titles and abstracts of the remaining articles were examined for eligibility against the pre-defined criteria, as presented in Box 1. Articles that were not definitely excluded by this screening were obtained in full text for further assessment.