• #14-1. Lymphedema and Exercise


    Exercise is just as important to lymph circulation as weight control. Regardless of whether you have lymphedema or not, exercise makes a key component of healthy life and patients, in particular, would gain a lot of benefit from correct exercise regimens. I feel frustrated when I see patients with lymphedema give up exercise. The human body was not built just for lounging around on the sofa. Exercise is important but one should think about what type of exercise should be done for how long. The lymphatic system lack pump function and depend on the physical activity to increase the lymphatic flow. Swimming helps patients with early lymphedema as water applies soft pressure and promotes circulation.


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    Exercise increases absorption by peripheral lymph nodes and collecting lymphatics promotes pumping action. Exercise also helps avoid muscle atrophy from lymphedema and promotes recovery. Wearing appropriate compression bandages and stockings enhances the benefits of exercise. I recommend walking for 30 minutes twice daily.

    Exercise should be carefully planned. The right type and amount of physical activity has largely four functions. First, the initial objective of exercise is to drain the proximal the lymphatic system. Second, exercise helps the function of active lymph. Third, it reduces swelling and makes the joints more flexible. Fourth, it increases muscle strength and avoid muscle atrophy, common in lymphedema.

    Stillwell (1969) educated his patients to perform strong muscle contraction to minimize joint movement. Minimal muscle movement is more effective as it is less strenuous and prevents unnecessary energy consumption. I recommend 1-2 seconds of muscle contraction followed by 2-3 seconds of relaxation repeated 20 times and resting for 5 minutes.


    Things to consider when exercising

    The doctor should consider presence of other underlying diseases such as diabetes, heart or respiratory diseases. If an underlying disease is present, consult the attending physician before starting exercise. The type of beneficial exercise differs depending on the stage and type of lymphedema. For example, bowling may be appropriate for a patient with lower limb lymphedema but not for those with upper limb lymphedema. Stage 1 and 2 lymphedema may benefit from hiking and walking. However, patients with Stage 3 disease should abstain from walking. Caution should be given to the risk of damage, such as fracture, ligament rupture, and sprain in all stages of lymphedema. Such damage can cause serious complications.


    Important things to remember

    1. The exercise program should be devised by a therapist or doctor to be safe and effective.

    2. Always wear compression clothing regardless of the exercise type.

    3. One should be aware about the risk of bacterial infection when doing exercise in the pool or sauna, etc.


    Appropriate exercise for lymphedema stage

    Exercise for Stage 1 lymphedema: Any type of exercise is fine except for overly strenuous types such as sky-diving, hang gliding, bungee jumping, etc.

    Exercise for Stage 2 lymphedema: All stretching movements such as bending and straightening joints, rotating and turning, etc. are possible. Walking, hiking, jogging, swimming, canoeing, bowling, archery, cycling, dance, sailing, scuba diving, karate, judo, fencing, skiing, and shooting are all beneficial at this stage.

    Exercise for Stage 3 lymphedema: Most exercises are possible at Stage 3, however, one should be careful to adjust the intensity and duration.

    The most important purpose of exercise is muscle contraction. Movement of thigh or arm muscles increases lymph circulation to help drain the lymph and protein into the veins. Patients with lymphedema need to program their exercise routine according to their physical needs and abilities. It is advisable to gradually increase the amount of exercise along with their level of strength. Performing high-speed exercises such as golf, tennis, jogging, or hiking in a high altitude can exacerbate lymphedema and should be avoided. On the other hand, walking, swimming, light weight lifting, and cycling are safe. Patients with lymphedema who have limited mobility should perform breathing exercises to promote lymph circulation of the chest. Deep breath exercise and yoga are not strenuous and has a stabilizing and calming effect.


    -To be continued-

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