Exercise Modalities to treat Lymphedema - Norton School

1. Exercise Modalities to treat Lymphedema Lymphedema is a malfunctioning of the lymphatic system due to the accumulation of protein-rich fluid. Lymphedema causes include trauma, surgery, radiation or abnormal development, that impairs the normal functioning of the lymphatic system. Symptoms include swelling, which affects the upper or lower extremities. Historically lymphedema patients were advised against using their affected limbs for exercise, however, research by physical activities and lymphedema Trial (1) has shown exercise is not only safe but can be included in the treatment plan. The intensity of exercise should be considered and it is best to exercise under the supervision of a trained physiotherapist. An effective exercise program in combination with a healthy, calorie-controlled diet is the most effective way to manage lymphedema. The lymphedema therapist and physician customize exercise protocols to meet individual goals for patients affected by lymphedema. The specific exercise protocols are determined by considering the stage and type of lymphedema, specific restrictions and limitations of joint and muscle activity, and additional medical conditions. Medicare guidelines for lymphedema treatment elaboared here What is an effective exercise program for lymphedema? 1. Decongestive Excercise The essential part of the treatment plan for lymphedema is active, non-resistive, and repetitive exercises. The lymphatic system does not have an active pump to propel lymphatic fluid back into the bloodstream. Effective lymph flow depends on sufficient muscle and joint activity, especially if the functioning of the lymphatic system is impaired. Decongestive exercises are most effective if performed when wearing compression garments or bandages. 2. Abdominal Breathing exercises The downward and upward movement during diaphragmatic breathing aids in propelling lymphatic fluid back into the bloodstream. Patients affected by lymphedema of the leg can benefit significantly from diaphragmatic breathing exercises. The movement of the diaphragm, combined with the outward and inward movements of the abdomen, rib cage, and lower back promotes general well-being, peristalsis, and return of venous blood back into the heart. 3. Resistive Exercises Exercises in combination with resistance greatly improve muscular power and increase strength in ligaments, tendons, and bones. Resistive exercises are typically performed in a repetitive manner against an opposing load. Strength exercises are beneficial for lymphedema patients

2. and should always be performed wearing a compression garment or bandage in place. Resistive exercises using inappropriate weights present a risk for injury or overuse and should promptly be discussed with the treating therapist and physician. 4. Aerobic Exercise Aerobic exercises performed repetitively provide some long-term benefits including a decrease in resting heart rate, improved muscular strength, weight control, and increased return of venous and lymphatic fluids. It is important to understand that certain aerobic exercises and recreational activities could trigger an increase in swelling and should be avoided by patients with lymphedema. Examples of these high-risk activities include soccer, kickboxing, or step-aerobics for lower extremity lymphedema, and tennis or golf for lymphedema affecting the arms. Beneficial activities include swimming, walking, water aerobics, easy biking, and yoga. 5. Aquatic Exercises The buoyancy effect of water on the musculoskeletal system makes movement more comfortable. Range of motion and flexibility are increased when in a warm water pool and the cardiovascular system works more effectively, so an aerobic workout is possible. Additionally, the hydrostatic pressure acts like a “full-body garment” and helps to reduce swelling. Exercises in the water geared towards the treatment of lymphedema are resistive, assistive/supportive, compressive, relaxing, and comforting. 6. Stretching and Flexibility Stretching is good for the body and soul. Movement can be a key to treating and preventing lymphedema so incorporate stretching and flexibility exercises into your daily routine. The anti-estrogen pills, such as tamoxifen and anastrozole, that women take to treat breast cancer, can cause joint pains, likewise, aging can stiffen joints. Stretching exercises and flexibility can lessen the pain and discomfort associated with lymphedema, cancer treatments, and aging. Increase your activity level gradually The goal of regular exercise and movement is to maintain the normal function and mobility of your swollen limb. Depending on the symptoms and causes increase activity level gradually. Physiotherapy can improve your mobility and joint function. It also supports lymphedema treatment after cancer therapy to reduce pain, treat scar tissue, and maintain or restore limb function. Here are a few things that you should keep in mind ● ● ● ● ● Start slowly and increase gradually. Avoid overexertion – this can increase edema. Always warm up and cool down. Avoid hot tubes, saunas, or steam rooms – these can increase swelling. Stop when limbs feel tired, uncomfortable, or aches.

3. ● ● ● Recovery is important – rest and elevate your limbs at night. Always wear compression garments while exercising. Besides exercise, balanced nutrition is another key element of a healthy lifestyle. Lifestyle modification Leg Lymphedema can be aggravated by sedentary jobs and gravity, for instance sitting at a desk all day. Spending hours standing like retail workers or nurses may find swelling at the end of the shift. If your occupation requires you to sit or stand for a prolonged period try calf raises every hour to prevent foot and ankle edema and consider using a footstool at your desk to elevate your feet if possible. Discuss with the physiotherapist to formulate an exercise treatment plan to help effectively manage lymphedema. Consult Norton School of Lymphedema, a premier school for lymphedema therapy certification for therapist referrals.