Purpose: This systematic review and meta-analysis was to evaluate the effect of exercise on the prevention of cancer-related lymphedema.
Methods: A search of 6 electronic databases was undertaken to identify intervention studies published up to May 2025. Studies included individuals at risk of cancer-related lymphoedema, comparing exercise to no exercise, and reporting lymphoedema outcomes. Given the lack of a gold standard for lymphoedema measurement, all assessment methods were included, though data from objective measures were prioritised over self-report where both were available. Meta-analyses using random effects models estimated the pooled effect of exercise on cancer-related lymphoedema.
Results: Seventeen studies (published 2002-2024), involving 2740 individuals were included. Most (88%, n=15) studies focused on upper-limb lymphoedema post-breast cancer, and two studies investigated risk of lower-limb lymphoedema post-ovarian (n=1) and cervical (n=1) cancer. Studies varied widely in sample characteristics, interventions, outcome measures, risk of bias and timing of assessment. Lymphoedema cases were defined using circumferences (n=4), arm volumes (n=5), bioelectrical impedance analysis (n=3), self-report (n=2), or a combination of these methods and/or clinician diagnosis (n=3). Relative risk (RR) of developing cancer-related lymphoedema for those in the exercise group compared with the non-exercise group was 0.71 (95% confidence interval (CI), 0.51 to 0.97). However, participant sample of 9 studies (53%) included between 1-38% of people with evidence of lymphoedema at baseline. When the meta-analysis was rerun excluding data from these studies, the RR of developing lymphoedema was 0.65 (95%CI 0.39-1.10).
Conclusions: Results support the role of exercise in the prevention of cancer-related lymphoedema. However, to ensure evidence can be used to guide lymphoedema prevention guidelines and practice, there is a clear need for increased scientific rigour in future lymphoedema prevention research.