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Purpose A combined body weight loss and upper body/arm exercise programme is a potential strategy for managing Breast cancer related lymphoedema (BCRL), but there is limited data on the best method for delivery or its potential efficacy. Methods Fifty-seven women with overweight/obesity and BCRL were randomised to a 12 week supervised ( n  = 12) or home-based combined weight loss and upper body/arm exercise programme ( n  = 16), a home-based upper-body arm exercise only programme ( n  = 17) or standard care ( n  = 12). Primary outcomes were uptake, retention and changes in weight and change in Relative Arm Volume Increase (RAVI) using analysis of covariance (ANCOVA). Results Sixteen percent of women invited joined the study and 49 completed the trial (85% retention). Reductions in weight occurred in the supervised and home-based weight control and exercise programmes; Mean (95% CI) change compared to standard care − 1.68 (− 4.36 to − 1.00), − 2.47(− 4.99 to − 0.04) Kg. Reductions in perometer assessed RAVI were seen in the supervised and home-based combined weight control and arm exercise groups and the weight stable home-based arm exercise only group: mean (95% CI) change compared to standard care − 2.4 (− 5.0 to + 0.4),− 1.8 (− 4.3 to + 0.7), − 2.5(− 4.9 to − 0.05)%. Conclusion Women with BCRL and overweight and obesity engaged in diet and exercise weight loss programmes. Both weight loss/arm exercise programmes led to modest changes in weight and BCRL. Comparable reductions in BCRL were reported in the weight stable group undertaking arm exercise only. The independent and combined effects of weight loss and exercise on BCRL need further study. Trial registration ISRCTN86789850 https://doi.org/10.1186/ISRCTN86789850 , registered 2011.