Study selection is reported according to PRISMA guidelines.33 Design • randomised trial Population • women with breast cancer diagnosis with or at risk of developing lymphoedema Intervention • weight-training exercises Outcomes • lymphoedema onset or exacerbation Comparison • sham exercise The quality of the included studies was assessed using the PEDro scale,34 which consists of 11 items that address external validity, risk of bias (internal validity) and interpretability. Although there are 11 items, the first item does not contribute to the total score because it is related

to external validity. The overall score is therefore calculated as the number of the remaining 10 items that the study achieves. Considering the nature of intervention studied in the included papers, blinding of participants and therapists Alisertib manufacturer would be impractical, so scores above eight would not be anticipated. The PEDro scale can detect potential bias with fair to good reliability34 and is a valid measure of methodological quality of trials.35 Only randomised trials were included in the review because they eliminate more sources

of potential bias than other study designs. The publication year to post 2001 was limited due to advances in the management of breast SP600125 clinical trial cancer. This review included studies of women of any age who had or were at risk of developing lymphoedema during or following breast cancer treatment. Breast cancer treatment was defined as any type of breast surgery, along with one of the following procedures to the axilla: axillary lymph node dissection, axillary lymph node sampling or sentinel lymph whatever node dissection with or without radiotherapy to the breast and/or axilla. Studies involving women with lymphoedema following local recurrence or metastasis were excluded. To be eligible for this review, trials were required to have studied the effects of weight training or resistance exercises. Studies with mixed exercises (apart from warm-up and cool-down), which could possibly moderate the effect of weight training, were not considered for inclusion. The

above-mentioned intervention was required to have been assessed against no intervention or against any of the control Modulators interventions listed in Box 1. The primary outcome was BCRL, analysed as either the incidence or severity of lymphoedema identified by comparing the volume difference between the operated-on and contralateral arms. Volume could be measured directly using the water displacement method or non-invasive optoelectronic scanning (ie, perometry), or calculated from a series of circumferential measurements using a measuring tape. Additionally, studies that used a simple circumference measurement of the arm were also considered for this review. The reported difference could either be absolute or relative. Absolute volume difference is the change of arm volume on the operated side, and relative change is the volume difference between the operated-on and contralateral arms.