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EXERCISE AND LYMPHEDEMA

Reprinted with permission from Lymph Notes (www.lymphnotes.com). 

Exercise is an essential component in the management of lymphedema because the movements of muscle and joint pumps increase the rate of lymph flow up to 15 times above the resting rate.  [1] However, due to the continued repetition of outdated information, there is still confusion about this important phase of lymphedema management.

Bad Information Hangs Around

This surgery was followed by heavy-duty chemotherapy and radiation treatment.  A common side effect for these patients was difficulty in regaining the use of their affected arm and the development of lymphedema.  At that time, often the only advice given to those with lymphedema was, “Do not lift anything heavier than five pounds and avoid performing strenuous or repetitive motions.”

Also, the type of radiation currently being used is not as damaging to the surrounding tissues.  With these treatment changes, there began to be questions about the ongoing need for the “avoid heavy lifting” rule.

Current Studies and Good News

Unfortunately even today, the old rule is all some individuals hear about the treatment of lymphedema.

Better Advice

With better understanding of the lymphatic system, researchers have discovered that the movement of the muscle pumps during exercise helps drain lymph out of the affected area and eventually into the bloodstream.  From there, the kidneys remove excess fluid in the form of urine. [2]

For this reason, an exercise program is an important component in the treatment and management of lymphedema.  Exercise is also part of a healthy lifestyle that increases your energy level and feeling of well-being.  Studies are being conducted to determine how much exercises is beneficial and what sports activities are safe to participate in.

Tissues affected by lymphedema do not always react to excessive stress immediately.  Instead, the reaction may be delayed.  For this reason, starting back to a favourite sport should be undertaken with caution and, ideally, with guidance from a qualified trainer.

This provides the extra support that helps the muscles function more effectively.  It also prevents added fluid from pooling in the affected limb.

Basic Exercise Precautions

  • Before beginning any exercise program, check with your therapist or physician.
  • Exercise moderately and avoid overuse of your affected limb.  Gradually build-up your strength and ability.
  • Carefully follow the “warm up” and “cool down” steps of your exercise program.
  • Wear your compression garment during exercise.  If you have questions about this, check with your therapist.
  • Try not to get overheated and be sure to drink plenty of water to keep your body hydrated.
  • top exercising if you encounter any sign of trouble, such as increased swelling or pain.  Check with your therapist or physician before restarting your exercise program. 

Endurance Exercises and Resistance Training

Endurance exercises, which are also known as aerobic exercises, increase your heart rate and breathing for an extended period of time. Examples of these types of exercises, including bicycling, jogging, step aerobics, and walking.  These activities are an important part of any exercise regimen because they:
  • improve the circulation of both blood and lymph;
  • aid in the flow of fluid away from affected areas;
  • combat fatigue;
  • increase your sense of well-being.

Resistance-training, also known as strength training exercises, require the muscles to exert a force against some form of resistance.  Research is underway to determine if activities such as bench pressing are beneficial and early results are promising.  It is believed that this type of exercise is beneficial for those with lymphedema because:

  • the contraction of the muscles causes a pumping action that helps to move lymphatic fluid away from the affected area and back toward the chest.
  • strength training encourages deep breathing to ensure an adequate supply of oxygen to the tissues.  This exercises the chest and abdomen in a manner that stimulates lymphatic drainage. 

Varieties of Activities

Exercise classes - Some lymphedema treatment facilities provide exercise classes as part of their treatment program.  Traditionally, these have been mild to moderate exercises with movement, stretch bands, and activities with exercise balls.

Walking - An ideal exercise that does not require major equipment, except appropriate shoes, and can be done almost anywhere.

Water exercises - Another ideal exercise because the water provides total body compression and it cushions tender joints and makes movement easier.  Because of the pressure of the water, it is not necessary to wear compression when doing exercises with the affected limb in the water. [3]  See also Aquatics

Dancing - Dance exercise programs encourage healthy movements while having fun.  Exercising together as a dance group, such as Healthy-Steps (aka The Lebed Method), provides the added motivation and pleasure of being part of a group.

Pilates - Naomi Aaronson recommends Pilates exercises because these exercises are gentle to the body while giving it a thorough workout.  If Pilates interest you, be aware that these exercises are not recommended after TRAM flap reconstruction until you have clearance from your surgeon. [4]

Golf - Linda T. Miller, a Philadelphia-based physical therapist specializing in the treatment of lymphedema after breast cancer, actively encourages her patients to return to playing golf.  Their enthusiasm has been contagious and she often joins them in playing. [5] To learn more about her treatment philosophy, visit the Breast Cancer Physical Therapy Center.

Yoga and other stretching exercises - These are activities that move the skin, muscle, and other tissues in the affected area and help to relieve the feeling of tightness that often accompanies lymphedema.  They also help regain a range of motion in an affected area, increase flexibility, and increase freedom of movement.  Stretching exercises are also relaxing; however, because they do not improve endurance or strength, these activities need to be part of a balanced exercising program.

Tennis - If you were an avid tennis player before developing, or becoming at risk for lymphedema, you will want to go back to this sport.  Again training and a gradual return, is important.  If you were accustomed to playing singles, you might start back by playing doubles.

Triathlons - Those with, or at risk of developing lymphedema are not letting this stop them from taking part in triathlons in which they bike, swim, and run.  Again, adequate and appropriate training are important.

Other activities not included in this article include Dragon Boating and Healthy-Steps (aka Lebed Method).

References
[1] The Human Body Explained by P. Whitfield. Henry Holt and Company, 1995, page 128.

[2] “Exercise for Women With or at Risk for Breast Cancer–Related Lymphedema.” D. Bicego, K. Brown, M.Ruddick, et al. Physical Therapy, Vol. 86, No. 10, October 2006, pp. 1398-1405.

[3] “Aquatic Therapy” in Living Well with Lymphedema. A. Ehrlich, A.Vinjé-Harrewijn, PT, CLT-LANA and E. McMahon PhD. Lymph Notes, 2005, pages 185-194.

[4] “Pilates Exercises” by Naomi Aaronson (Recovercises For Wellness) Voices of lymphedema.  Edited by A. Ehrlich and E. McMahon PhD. Lymph Notes. 2007, pages 91-93.

[5] “When can I Play Golf Again” by Jeanette, no longer a former golfer.  Voices of Lymphedema. Edited by A. Ehrlich and E. McMahon PhD. Lymph Notes. 2007, pages 97-98.

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