Clinical Perspectives
Exercise
and Lymphedema By Dorit Tidhar and DeCourcy Squire
P
eople need to exercise. Exercise is beneficial for overall health and well-being, and for many illnesses. Exercise reduces sugar levels in people with diabetes, improves cardiac function in people who suffer from heart disease, and reduces the risk for cancer and its recurrence. Yet many people with lymphedema are afraid of exercise, perhaps
Decongestive exercises are an integral part of lymphedema treatment.
because for years they were told to avoid lifting heavy objects and over-exertion (which may be valid post-op precautions, but not life-time restrictions), or because they found that exercise exacerbated lymphedema. In this article, we discuss the role of exercise in the treatment for lymphedema—exercise for lymphedema— and guidelines for a safe return to more vigorous activity—exercise with lymphedema.
Exercise for lymphedema Decongestive exercises are an integral part of lymphedema treatment. Muscle contractions improve lymph flow in the muscles, and walking or moving the arms improves lymph flow in the lymphatic vessels1,2. However in lymphedema, lymph flow will not necessarily drain centrally as it should but may instead be pushed to low resistance areas such as the skin (dermal backflow) making swelling worse3. Therefore, individual tailoring of an exercise program is needed. Casley-Smith demonstrated an improvement in lower and upper extremity lymphedema when a sequence of decongestive exercises that started with the neck and trunk and progressed to the limbs, combined with deep breathing and some self-MLD, was done
Dorit Tidhar PT was certified by Prof. Judith Casley-Smith as a teacher in Self Management and Exercise for Lymphedema in 2003. Dorit designed an Aqua Lymphatic Therapy program to help people who suffer from lymphedema maintain and improve the results of conventional treatment and conducted a randomized controlled trial as part of her Master’s degree in Tel Aviv University in Israel to examine this method. Currently, Dorit is working in Maccabi health care services as a clinician and the national director of the lymphatic therapy services. DeCourcy Squire PT, CLT-LANA, ALT, CI-CS has been treating lymphedema for 20 years and has been an instructor in the Casley-Smith method of Complex Lymphatic Therapy since 1999. She currently works in the Lymphedema Specialty Treatment Service at Hennepin County Medical Centre, Minneapolis.
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for a year4. Boris et al. found this sequence also led to continued reductions after a course of intensive treatment5. Katz-Leurer et al. found that contracting muscles near the trunk was more beneficial in reducing volume than contracting muscles near the hands and feet6. In these studies, people performed the exercises wearing bandages or garments. Wearing compression during exercise helped prevent fluid accumulating under the skin by moving it up the limb and assisted in the reduction of the limb volume7. In studies of women with breast cancer related lymphedema (BCRL), simple exercises with deep breathing and relaxation performed for short periods (10 and 15 minutes) and Aqua Lymphatic Therapy (ALT) led to reduced volume and improved symptoms8,9,10. In ALT, the hydrostatic pressure provides a gradient compression that increases with the depth of the water. When the goal is to improve or maintain control of lymphedema: • Gentle slow rhythmic shoulder exercises with deep breathing (for arms) • Aqua Lymphatic Therapy (for arms or legs) • Remedial/decongestive exercises (such as the Casley/Smith sequence) (for arms or legs) These have all been found to improve lymphedema and should be performed as part of lymphedema therapy in the intensive, transitional or long-term phase. Wi n t e r 2 0 1 4