乳がん後のリンパ浮腫に対する筋トレ

乳がん後のリンパ浮腫に対する筋トレの効果をみた論文を紹介します。

Kim DS, Sim Y-J, Jeong HJ, Kim GC. Effect of active resistive exercise on breast cancer–related lymphedema: a randomized controlled trial. Arch Phys Med Rehabil 2010;91:1844-8.

両群とも複合的理学療法を実施し、介入群ではその後にさらに上肢の筋トレを1日15分、週5回、8週間実施したというRCTです。

結果ですが、介入群で上腕体積が対照群より統計学的に有意に低くなり、SF-36の8項目のうち、身体の健康（physical health）と全般的健康感（general health）の2項目は介入群で対照群より統計学的に有意に改善しました。ただし、前腕やSF-36の他の6項目には統計学的有意差を認めませんでした。

下肢の複合的理学療法では十分に歩行することができますが、上肢の複合的理学療法では歩行に見合うような十分な上肢運動はないので、筋トレを追加することでさらなる効果を期待できる可能性があります。栄養状態が良好（少なくとも低栄養ではない）で栄養管理も適切であれば、複合的理学療法の中に筋トレを追加してもよいのかもしれません。順番としてはリンパドレナージ、圧迫療法のほうがもちろん優先ですが。

また、低栄養や栄養管理が不適切の場合には、筋トレを追加することは不適切だと考えます。筋トレより栄養改善が優先されます。

Abstract

Objective
To investigate the differences between the effects of complex decongestive physiotherapy with and without active resistive exercise for the treatment of patients with breast cancer–related lymphedema (BCRL).

Design
Randomized control-group study.

Setting
An outpatient rehabilitation clinic.

Participants
Patients (N=40) with diagnosed BCRL.

Interventions
Patients were randomly assigned to either the active resistive exercise group or the nonactive resistive exercise group. In the active resistive exercise group, after complex decongestive physiotherapy, active resistive exercise was performed for 15min/d, 5 days a week for 8 weeks. The nonactive resistive exercise group performed only complex decongestive physiotherapy.

Main Outcome Measures
The circumferences of the upper limbs (proximal, distal, and total) for the volume changes, and the Short Form-36 version 2 questionnaire for the quality of life (QOL) at pretreatment and 8 weeks posttreatment for each patient.

Results
The volume of the proximal part of the arm was significantly more reduced in the active resistive exercise group than that of the nonactive resistive exercise group (P<.05). In the active resistive exercise group, there was significantly more improvement in physical health and general health, as compared with that of the nonactive resistive exercise group (P<.05).

Conclusions
For the treatment of patients with BCRL, active resistive exercise with complex decongestive physiotherapy did not cause additional swelling, and it significantly reduced proximal arm volume and helped improve QOL.