International Journal of Exercise Science 15(3): 1444-1456, 2022. Phase angle (PhA) is an index of cell membrane integrity and prognostic indicator of survival and quality of life in cancer survivors. The efficacy of exercise-based cancer rehabilitation programs (ExCR) on PhA is unknown. To assess the effect of ExCR on PhA in breast cancer survivors. Fifty-nine female breast cancer survivors (61 ± 9 years) were referred to the ExCR by their oncologist and participated in one-on-one exercise-based training for 90 minutes, 3 times a week, for 12 weeks. Training sessions included 45 minutes of resistance training at intensities between 40-85% of 1-repetition maximum with a rate of perceived exertion (RPE) between 3-8, 30 minutes of cardiorespiratory training at intensities between 40-85% of heart rate reserve with an RPE between 3-8, and 15 minutes of flexibility training. Participants completed pre- and post-measurements of body composition, cardiorespiratory endurance, flexibility, muscular endurance, muscular strength, and PhA (Inbody 770). PhA significantly increased (p < 0.05) after ExCR (PhApre = 4.56; PhApost = 4.64; Δ = 1.8%). Changes in measures of muscular strength have a weak but significant positive relationship (r = 0.20-0.39; p < 0.05) with changes in PhA. There was no relationship between changes in PhA and changes in cardiorespiratory endurance or muscular endurance. A 12-week ExCR significantly improves PhA in breast cancer survivors. Training muscular strength may be an integral component of ExCR with the objective of improving PhA.

Background: Breast cancer, the most common type of diagnosed cancer in women worldwide, is often associated with the development of lymphedema as a treatment-related effect. Patients undergoing surgery, radiation, or chemotherapy present a higher risk for this side effect. Historically, patients are often not referred to rehabilitation for lymphedema management until the swelling is visible and has progressed, which reduces the chance of reversing the disease progression. Surveillance is key to identifying the earliest signs of breast cancer–related lymphedema, initiating treatment, reversing the disease process, and reducing the impact on function. Objective: The primary goal of this study was to assess the feasibility of monitoring fluid levels in patients with cancer using a bioimpedance analysis home device and to detect any relevant changes that may correlate with an increased risk of developing lymphedema. Remote monitoring by a clinician has not previously been possible, and a comparable bioelectrical water analyzer device has never been available to patients within the comfort of their homes. Methods: The study included 8 adult patients diagnosed with unilateral breast cancer who underwent unilateral lumpectomy or mastectomy, bilateral mastectomy, or reconstruction and were followed for 12 months. Patients also underwent radiation or chemotherapy as part of their treatment before the study and, in some cases, during participation in the study. Clinic visits were required every 3 months, with standard care treatment administered by the clinician, as well as daily fluid monitoring, using the extracellular to total body water (ECW/TBW) ratio obtained with the home device. Results: Preliminary findings from the 8 cases showed that daily monitoring with the home device is possible, and may aid in the detection of fluid changes due to interventions like radiation or chemotherapy; these changes typically subside after treatment, compared to a permanent fluid increase that may indicate lymphedema. While one participant developed lymphedema, there is insufficient data to generalize the feasibility of early detection using the home device. A significant difference between ECW/TBW ratio measurements taken in the morning and evening (P values<.016) was observed for 6 participants, with morning values being higher than evening ones. Additionally, 7 participants showed a higher ECW/TBW ratio in the affected arm compared to the unaffected arm. On average, the ratio between the two values was higher than 1, approximately 75% of the time. The daily monitoring empowered patients to take charge of their health, with more than half expressing a desire to continue using the home device beyond the end of the study period. Conclusions: This case report shows the feasibility of daily remote monitoring for patients at risk of developing BCRL using a home bioimpedance analysis device.

Background: Breast cancer–related lymphedema (BCRL) is a chronic complication that impairs quality of life through persistent fluid accumulation. While clinical guidelines recommend longitudinal surveillance, implementation is often limited by the logistical challenges of frequent in-clinic visits. Bioelectrical impedance analysis (BIA), specifically the segmental extracellular water–to–total body water (ECW/TBW) ratio, offers a noninvasive method for tracking fluid status. However, the technical agreement between in-clinic and patient-led home-based BIA systems, as well as the feasibility of long-term self-monitoring in real-world settings, remains to be fully established. Objective: Our primary objective was to evaluate the agreement between in-clinic and home-based BIA systems for key body composition and fluid-related parameters. Our secondary objective was to characterize longitudinal fluid patterns and diurnal variations in ECW/TBW ratios to assess the feasibility of home-based monitoring. Methods: This prospective, patient-driven, 12-month observational study enrolled breast cancer survivors at risk for lymphedema. Agreement between the in-clinic BIA system (InBody 770) and the home-based device (BWA ON) was assessed using Bland-Altman analysis, intraclass correlation coefficients (ICCs), and the Lin concordance correlation coefficient (CCC). Longitudinal home-based ECW/TBW measurements were analyzed using linear mixed-effects models to evaluate diurnal differences (before-noon vs after-noon) across groups defined by limb dominance and BCRL status (International Society of Lymphology [ISL] stage 0 vs stage 1). Results: Over 12 months, ECW/TBW ratios measured by the home-based device demonstrated strong agreement with in-clinic measurements, showing minimal bias and high ICC/CCC values. Longitudinal analysis revealed that ECW/TBW changes did not follow uniform patterns within ISL stage categories, showing substantial physiological heterogeneity even among clinically stable groups. Diurnal analysis identified a small but statistically significant decrease in ECW/TBW ratios in the afternoon ( P <.001). The magnitude of this decrease differed by limb dominance and BCRL status, with the most pronounced reduction observed in participants whose dominant arm was affected and who had a history of stage 1 lymphedema. ECW/TBW variability was driven more by within-individual factors (eg, measurement timing) than by between-individual differences. Conclusions: Home-based segmental bioimpedance provides reliable longitudinal data and reveals granular fluid patterns not captured by conventional ISL staging alone. The significant impact of diurnal variation, particularly in relation to limb dominance, underscores the need for standardizing measurement protocols. Standardizing home-based measurements to a fixed monitoring time can minimize physiological noise and enhance the interpretability of long-term self-monitoring strategies for breast cancer survivors.

Background: While exercise is critical for breast cancer survivors, identifying prescriptions that promote long-term adherence is a challenge. This study evaluated whether survivors could maintain fitness gains during a 6-month self-managed phase following two distinct 12-week supervised programs. Specifically, we compared whether transitioning from one-on-one training to either individualized (Ind) or group-based (Gr) sessions influenced a participant’s ability to sustain improvements in strength, range of motion (ROM), and cardiorespiratory endurance (VO₂peak). Methods: Thirty breast cancer patients from diverse backgrounds completed an initial 12-week supervised individual training program. They were then randomized into either Ind (n = 13) or Gr (n = 17) supervised sessions for a second 12-week phase. Fitness assessments were conducted at baseline, 3 months (post-initial training), and 1 year (after the 6-month self-managed phase). Data were analyzed using generalized estimating equations to evaluate the effects of time and training format. Results: Significant improvements were observed across all fitness categories over time. Muscular strength (bench press, plank, and squats) and VO₂peak increased significantly by 3 months and were successfully maintained at the 1-year follow-up mark. Shoulder ROM also showed significant improvement at 1 year. Notably, the training format (group vs. individual) had no significant impact on these outcomes, with the exception of one ROM metric. Conclusions: Initial supervised exercise leads to significant fitness gains that breast cancer survivors can successfully maintain for at least six months through self-management. These gains are sustained regardless of whether the preceding supervised training was delivered in a group or individual format, suggesting flexibility in clinical exercise prescriptions.

BACKGROUND Breast cancer-related lymphedema (BCRL) is a common complication of surgery. Although guidelines for diagnosing and staging lymphedema exist, the exact classification may differ among clinicians. Additionally, patients are often referred for treatment once symptoms are reported, which, in some cases, may be too late. OBJECTIVE The first aim of this study was to confirm the effectiveness of the home-based body water analyzer used for daily patient monitoring after breast cancer surgery. To accomplish this, we first confirmed the reliability of the home device compared to a professional bioelectrical impedance analysis (BIA) device. Then we determined the best time of day for the test (Before-Noon or After-Noon) for daily monitoring. Finally, we wanted to determine how patients felt about the home device, as they would be the ones testing themselves daily to enable remote monitoring. METHODS Thirty-seven breast cancer patients who underwent surgery, putting them at risk of lymphedema, participated in a study that included five clinic visits and daily monitoring with an at-home BIA device for one year. Participants were asked to test themselves twice daily, Before-Noon and After-Noon. During the first visit, participants were tested using a professional BIA device and the home device they would use for daily testing. A total of 4 study sites in the US were included in the study. RESULTS Participants were categorized according to lymphedema status. The no-lymphedema group, meaning no changes or symptoms were reported at any time, and the subclinical lymphedema (S0) group, which means a change in one of the measurements at some point in time, were grouped as the No-BCRL group, while lymphedema cases (S1) is the BCRL group, with denotes permanent changes in several measurements used to assess lymphedema. Significant differences were found between Before-Noon (BN) and After-Noon (AN) measurements, with BN extracellular water to total body water (ECW/TBW) values higher than AN values. This suggests that a consistent time of day for testing is necessary to track changes in body water components effectively. Additionally, patients tended to test themselves more often in the morning than later in the day. A high intraclass correlation coefficient was found between the outputs of the professional and home BIA devices (the lowest ICC was>.95), indicating the validity of the home device results. CONCLUSIONS The home BIA device proved to be a reliable measuring tool when compared to the professional device. Testing time is essential for continuous patient follow-up. The home device proved to be a reliable tool for patient assessment, with which patients also had positive responses to its use. CLINICALTRIAL N/A