Purpose: This study aimed to determine whether the Physical Activity and Lymphedema (PAL) trial weight training program for breast cancer survivors at risk of or with breast cancer-related lymphedema provided skeletal benefits. Methods: Of the 295 participants in the randomized controlled PAL trial, 258 (weight training; N = 128; control, N = 130) had complete measures of bone mineral density (BMD (in grams per square centimeter)) of the proximal femur and lumbar spine and were also categorized by T scores. Women in the weight training group performed slowly progressive weight training 2 days/week for 12 months compared to women in the control group who maintained their usual physical activities. Results: There were no significant differences in the rate of BMD change at any skeletal site between weight training and control groups, regardless of menopausal status. Distribution of bone health categories was not significantly different between groups at baseline, but became different at 12 months (p < 0.03) among postmenopausal women due to an increase in the percentage of controls who became osteopenic (35 to 44 %) compared to stable bone health in weight lifters. Conclusions: The PAL weight training program that increased muscle strength without exacerbating or causing lymphedema among breast cancer survivors was not as efficacious at improving skeletal health. The skeletal loads produced from the PAL program may be insufficient to notably shift BMD, but may have a subtle osteogenic effect. Implications for cancer survivors: The safety and efficacy of rigorous weight training programs for improving skeletal health in women at risk for or with breast cancer-related lymphedema remain to be determined.
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