Progressive resistance exercise for preventing breast cancer-related lymphedema after breast cancer surgery: A systematic review and meta-analysis

Breast cancer-related lymphedema (BCRL) is a prevalent and debilitating complication following breast cancer surgery. Progressive resistance exercise (PRE) has been proposed as a preventive strategy, yet evidence from randomized controlled trials (RCTs) remains inconclusive. This meta-analysis aimed to evaluate the impact of PRE on the incidence of postoperative BCRL. We conducted a comprehensive search of PubMed, Cochrane Library, Embase, and Web of Science for RCTs comparing PRE with non-PRE interventions in adults undergoing breast cancer surgery without baseline lymphedema. Risk ratios (RRs) with 95% confidence intervals (CIs) were aggregated using a random-effects model to address potential heterogeneity. A total of eleven RCTs involving 1,450 women were included in the analysis. The findings indicated that PRE significantly reduced the risk of BCRL compared to control groups (RR = 0.68, 95% CI: 0.53-0.88; p = 0.003), with no significant heterogeneity observed (I² = 0%). The results were consistent in leave-one-out sensitivity analyses and remained robust after excluding two high-risk studies (RR = 0.65, 95% CI: 0.49-0.85). Furthermore, subgroup analyses revealed no significant modifications in results based on age, baseline body mass index, axillary lymph node dissection status, timing of PRE initiation, intervention duration, follow-up length, or diagnostic criteria (all p for subgroup difference > 0.05). Egger's test showed no significant risk of publication bias (p = 0.68). The certainty of evidence was rated as moderate, primarily downgraded due to the risk of bias associated with the open-label design of the included RCTs. In conclusion, PRE may be linked to a reduced incidence of BCRL following breast cancer surgery, supported by moderate-certainty evidence. Therefore, PRE should be considered as a component of postoperative rehabilitation and a potential strategy for lymphedema prevention, although further high-quality studies are necessary to validate these findings.