Issue 24-2, 2025

Microcirculatory Response to Strength Training in Postmastectomy Lymphedema: an Interventional Comparative Study

^* Varvara V. Krasnikova, Olga V. Fionik, Maria L. Pospelova, Mikhail M. Galagudza, Albina M. Makhanova, Samvel N. Tonyan, Alexandra E. Nikolaeva, Anastasia O. Milder, Mark S. Voynov, Ekaterina E. Vyalykh, Elena A. Demchenko

¹ Almazov National Medical Research Centre, Saint Petersburg, Russia

ABSTRACT

INTRODUCTION.  Postmastectomy upper limb lymphedema is a common complication of radical treatment for breast cancer, leading to a significant reduction in the quality of life. Physical exercises are one of the most important components of rehabilitation for lymphedema. However, there are currently no recommendations for selecting the optimal parameters of physical training, particularly strength training, in this clinical group. One way to assess the safety of using strength loads in patients with postmastectomy upper limb lymphedema may be to analyze the adaptive response of the microcirculatory bed to the exercise regimen.

AIM.  To analyze the adaptive response of the microcirculatory bed to strength training in patients with postmastectomy upper limb lymphedema.

MATERIALS AND METHODS.  A cohort comparative interventional study was conducted, which included 36 patients with postmastectomy upper limb lymphedema, divided into the main group (n = 16, stage I–II postmastectomy upper limb lymphedema) and the comparison group (n = 20, stage 0 postmastectomy upper limb lymphedema), as well as 18 healthy female volunteers. Patients in the main and control groups underwent a physical examination and indirect lymphoscintigraphy of the upper limbs. The intervention consisted of a set of strength exercises with free weights (dumbbells) for the muscles of the upper shoulder girdle and upper limbs. To assess the adaptive response of the microcirculatory bed to strength loads in the main group, comparison group, and control group, laser Doppler flowmetry was performed before the exercises, 10 minutes, and 20 minutes after the exercise complex.

RESULTS AND DISCUSSION.  In the main group, a change in the functioning of the microcirculatory bed was detected: a decrease in nutritive blood flow to 2.52 and signs of stagnation in the venous segment. In the comparison group, a reduction in the neurogenic component of microcirculation to 9.4 was observed, which may indicate a decrease in blood filling at the arteriole level as one of the pathogenetic mechanisms of PMLC progression. In the main group, an improvement in microcirculatory function was noted after performing a set of resistance exercises, manifested by an intensification of nutritive blood flow to 2.89, as well as a reduction in signs of stagnation in the resorptive segment.

CONCLUSION.  Strength training in patients with postmastectomy upper limb lymphedema leads to an improvement in the functioning of the microcirculatory bed in the early post-exercise period due to the intensification of nutritive blood flow and a reduction in pressure in the resorptive segment of the microcirculatory bed.

KEYWORDS: postmastectomy lymphedema, breast cancer, strength training, microcirculation

FOR CITATION:

Krasnikova V.V., Fionik O.V., Pospelova M.L., Galagudza M.M., Makhanova A.M., Tonyan S.N., Nikolaeva A.E., Milder A.O., Voynov M.S., Vyalykh E.E., Demchenko E.A. Microcirculatory Response to Strength Training in Postmastectomy Lymphedema: an Interventional Comparative Study. Bulletin of Rehabilitation Medicine. 2025; 24(2):20–28. httpshttps://doi.org/10.38025/2078-1962-2025-24-2-20-28 (In Russ.). 

FOR CORRESPONDENCE:

Varvara V. Krasnikova, Е-mail: krasnikova_vv@almazovcentre.ru>

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This is an open article under the CC BY 4.0 license. Published by the National Medical Research Center for Rehabilitation and Balneology.