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Joachim Zuther, Lymphedema Specialist. Read more
Lohmann Rauscher
MediUSA

Tactile Medical

Aerobic Exercises for Lymphedema

 

This is the first part in a three-part series covering exercises for patients affected by lymphedema. Part two will cover resistive exercises; part three will discuss decongestive and breathing exercises – so stay tuned.

Patients affected by lymphedema can and should be active, and those who never exercised before should consider starting that daily walk, swim or spending twenty minutes on a stationary bicycle. The right type of physical activity helps to reduce the swelling by improving the flow of lymph, and presents a vital tool for patients to stay in shape and continue with normal activities of daily living.

So what is the right type of exercise for lymphedema?
Many patients ask if they can continue their pre-lymphedema activities, or if they should adjust, or replace them. The answer to that question depends on the kind of activity. Tennis or golf for example does not rank very high on the list of beneficial activities for individuals with upper extremity lymphedema. For patients with lymphedema of the leg, kick-boxing and step-aerobics are activities that bear a great risk of injury and therefore should be avoided.

However, the reality is that for some individuals exercise plays such a vital role in their daily routine, and is so ingrained in their personality, that giving up these so called “high-risk activities” would have a serious impact on their well-being.

These individuals should continue with their exercise regimen, even if it is tennis for patients with lymphedema of the arm, or running for those affected by lower extremity lymphedema. The fact is that nobody knows better than the lymphedema patient her-or himself what is good for their body and spirit. As long as the patients are under the care of a trained lymphedema therapist, wear their compression garment during these physical activities, and the exercise regimen does not cause discomfort or pain, it is fine to continue with these activities. However, if the affected limb hurts, feels strained, or increases in volume during and after the activity, the patient should adjust as necessary and consult with their lymphedema therapist or physician. The keywords here are caution and moderation; gradual progression is imperative while trying to accomplish an improved return of lymphatic fluid without adding further stress to an impaired lymphatic system.

What are aerobic exercises?
Aerobic conditioning is generally performed in a repetitive fashion using large muscle groups. Some long-term benefits include 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, or contain higher risks of injury. Ideally, such high-risk activities should be avoided by patients suffering from lymphedema. Examples of these high-risk activities include soccer, kick-boxing or step-aerobics for lower extremity lymphedema, and tennis/racquet or golf for lymphedema affecting the arms.

Beneficial activities for upper and lower extremity lymphedema include (but are not limited to):

  • Swimming/water aerobics – with the body weight reduced by about 90% in chest-deep water, exercises performed in the water improves mobility and enhances strength and muscle tone. In addition, the pressure exerted by the water on the body surface contributes to lymphatic and venous return. Hot water (temperature above 94 degrees F) usually found in hot tubs and Jacuzzis must be avoided. High water temperature definitely has a negative impact on lymphedema
  • Walking – a 20-minute walk outdoors, or on a treadmill (10-15 minutes, slow walking speed) while wearing the compression garment, will stimulate the circulatory system and contribute greatly to the individual’s general well-being. Key points: walk with a normal gait; do not drag the affected leg and avoid limping
  • Easy Biking – 25-20 minutes either outdoors or at the gym, using a comfortable and wide saddle. Legs are placed in a higher position on recumbent bikes, which makes them a better choice for individuals affected by lower extremity lymphedema
  • Yoga – the combination of stretching, deep breathing, relaxation and the positive impact on the venous and lymphatic return, makes yoga a perfect choice of exercise. Strenuous yoga practices should be avoided, and if certain poses seem uncomfortable, they should be altered, or skipped. Many cancer centers and support groups have contacts for yoga classes specifically tailored to cancer survivors and lymphedema patients
  • Lebed-Method – this relatively new exercise and movement program is designed for people with lymphedema and cancer survivors. More information can be found here: Lebed Method
  • Decongestive Exercises – the exercise program practiced with the lymphedema therapist during the intensive phase of complete decongestive therapy is tailored to each individual patient’s needs, abilities and restrictions. This exercise regimen, which should be performed twice daily, improves circulation, mobility and well-being

In general, exercises and activities should always be performed with the compression garment in place; intensity and duration of any exercise should be gradually increased; movements that over-strain, cause discomfort or pain should be avoided, and the extremity should be carefully monitored for any changes in size or shape.

 

Additional Resources:
Lymphedema People – Lymphedema and Exercise
National Cancer Institute: Exercises for Lymphedema

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42 comments to Aerobic Exercises for Lymphedema

  • jennifer

    Thank you for posting this information. I have lymphedema in my abdomen, hip and right thigh to right around the knee. I used to go to the gym 4 days a week and I do not do any exercise anymore for fear of blowing up with more fluid. I do have lymphatic drainage massage 2x a week. I wish there was a gym class or instructional video for aerobic and weight training for those with lymphedema in leg and abdominal areas. Any further info would be greatly appreciated!!!! Cancer stinks but lymphedema has changed my life drastically. HELP!

  • sandy

    I exercise a lot, one of the classes I enjoy the most is Aqua aerobics however if I use my standard leg compression garment in the pool the pool chlorine destroys it in a very short time. They are too expensive to replace each month as they are custom fit.
    Is there something I can use that would help with compression but standup to the pool chlorine.

    • Joachim Zuther

      Dear Sandy:
      I would suggest a waterproofed cast guard, which would protect your garment from the water and chlorine and still allows ample movement for exercises. They are around $20-$30 – here is a link: http://www.xerosox.com/?gclid=CNLx8bT-86UCFRRg2godkStHVw

      • Liz Franco

        My therapist advised me to go into the pool without compression since the water gives you the most compression. I did this all summer and my legs did wonderful I am looking forward to getting back to the pool asap possibly at a gym. I saw a big difference in my legs and it was no effort in the water.

  • I am very happy to see so many articles for patients who want to continue their exercise regime and are so confused by sound-bite articles that don’t give the full story. As an oncology massage therapist in a large outpatient cancer center, there is so much confusion for patients. I will definitely add this information to my web-site.

  • janice

    I am so glad that i have this information because I was a fraid to do exercise. I like to swim, walk and biking and I rarely did due to my right leg lymphedema. No0w with this source i am able to know how to do the correct exercise for my self thank you!

  • Carol

    Thank you for this information. I was diagnosed with Lymphadema in the legs last year. I use a compression pump and have just recently started at the gym and using the pool. I also use the hot tub but will not any more. I didn’t know it was not a good idea. I will start reading this news letter religiously when I receive it. Thank you for taking the time to put this all together and sharing it with everyone.

  • Helena Janlov Remnerud

    Golf CAN be beneficial for lymphedema in upper extremity lymphedema. Don´t let lymphedema take over your interest in golf – find out a way to coop. Feeling too restricted is bad for the lymphflow. If you take certain precautions golf can also be beneficial. The shouldermovement in the golfswing is certainly helping the lymphflow. The bending and stretching and walking is also good for the lymphflow. A 4 hr walk on a golfcourse in hot (Florida)weather is a precaution. Wheras in cooler weather it may be allright. Otherwise try a golfcart. Maybe 18 holes is too much – then choose 9. Maybe you have to put in some deepbreathing and x-tra shouldermovements. My experience as a lymphtherapist in Sweden is that my patients that play golf are in a better condition with their lymphedema in the summer than in the wintertime when they don´t play golf.

  • arnetta

    i cannot afford the lower leg garment s do you know who can help

  • Thanks for posting this. I wasn’t sure what type of exercises I could do with lymphedema. Now I know what I can do without being afraid hurting myself.

  • Amanda

    So helpful! I am 30 years old and recently had a lymph node dissection for cervical cancer. Four months after my surgery I noticed I was getting lymphedema in my left leg. Thank you for the info!

  • […] Exercises: Trunkal lymphedema is often associated with restrictions in thorax and shoulder movements, which should be evaluated by a Physical or Occupational Therapist. Specific exercises addressing these issues and to increase range of motion and function with daily activities should be performed. […]

  • pandagirl

    Your article gives me hope, Joachim. I used to be very keen on doing boxercise/ cardioboxing, which is a high intensity workout. I have lymphedema in my left (non-dominant) arm and have previosuly been cautioned against this activity. I have since taken up qi gong which I find enormously beneficial, and I have done a lot of supervised cardio and weight training, but I miss the boxercise and would love to do it again. I am wondering if you think it is risky or perhaps recent research supports the notion that it might be a good thing for me?
    Pandagirl67

    • Joachim Zuther

      Because of the high intensity of boxercising, I would caution against this activity. However, with proper precautions (wearing of your compression garment or bandage, avoiding injury) you should be able to avoid increase in swelling

  • Shalu

    Can you please help me out with a trained Lymphoedema therapist in Bangalore,India

    • Joachim Zuther

      We do not have any direct contacts with therapists in India. I would suggest contacting the National Lymphedema Network (NLN); I am sure they will be able to help

  • Great article Joachim. Very helpful for Lymphedema patients.

  • Mose Elmes

    aerobic exercises are quite nice since it can build your heart strength and it can reduce body fat too.,

    Remember to look into our favorite blog
    http://www.healthmedicinecentral.com/tongue-cancer-pictures/

  • tiffany

    I have been dealing with this since I was 14. I am now 27. Nobody knew what it was and even now I have not been officially diagnosed with lymphedema. I have been doing so much research on this and different conditions that give me my symptoms. I keel coming back to lymphedema. I have pushed the issue with my Dr and am having something done about it. Thank you for this information because when we don’t know we may cause more harm than good. I’m thankful for the drs who do continuous research on this condition. I hate it bc I feel disfigured even though my legs aren’t as bad as they could be. I see there is more hope now then there was a few yrs ago when I was researching.

  • Karen

    Please help if you can.
    I had BC and had 23 nodes removed, right (dominant) arm. Got LE about two months later.
    I was a runner prior to LE and I miss it so much!
    My arm swells when I walk while wearing a sleeve+glove.
    It swells when the barometer drops, too, like when we get rainstorms. It swells just doing day-to-day stuff, like housework and laundry.
    If my arm swells when walking moderately, how will I be able to do more strenuous exercise? What do I need to do differently?

    • Joachim Zuther

      It seems you need another sleeve – either you need to be remeasured for the same compression class, or you may need a higher compression (maximum class III) while performing ev=xercises

      • Karen Rosenkilde-Bayne

        I got a higher compression sleeve (class 3), and some of the day to day things have improved (like being able to do laundry). So you were right!

        But today I went for a VERY SLOW jog/walk around the block and my arm felt like I was dragging a bowling ball. It was very uncomfortable. I didn’t notice any visible swelling (but then, I stopped jogging also). Is this how it’s supposed to feel now that I have lymphedema?

        How are people with lymphedema supposed to do cardio?

      • Karen

        You were right. I got a higher compression sleeve (custom, class 3), and I can do more of the day to day household stuff.

        I tried a very slow jog/walk around the block today and it felt like my arm was as heavy as a bowling ball. It was very uncomfortable. Is that how it’s supposed to feel now that I have lymphedema?

        How do people with lymphedema do cardio?

  • Jackie

    I want to go swimming. What can I do to hide the fact that my leg in rather large due to lymphadema?

  • debbie CB

    I have been taught that the most effective way to exercise with my post cancer surgery lymphedema of the left leg is to work with the leg wrapped in compression bandages. I do this two times a week(for 6 yrs now), and my exercise not only includes specific leg exercises, but exercises for the upper body as well, which enhance the overall circulation and fluid return in my body. After exercise I always rest by lying flat, because no matter what I do with my leg lymphedema, there is always congestion and discomfort in my thigh, that is greatly improved with relieving the effect of gravity on the leg and compression wrapping. Other times of the week I ride my bicycle, and I wear a compression garment on my leg every single day except at night when I wear a solaris garment to bed. My lymphedema care is tedious, but I believe the wrapping and exercising and lying flat goes a very long way to helping me control it. I definitely have congestion and swelling issues, but these daily and rather tedious interventions have kept that to a reasonable minimum in terms of visible swelling. Coming out of this routine, even for 1-2 weeks of vacation away from my home creates a noticeable increase in the swelling…so this is how I know it all works for me.

  • barbara corn

    With my understanding of lipo lymphedema I find it reviving if I do a step class or kick boxing I understand with the pressure of the lymphatic muscles and all cause it can do more harm than good but with graduated compression shouldn’t the exercise be slightly intensified with upgraded compression with the help of a lymphedema therapist

  • I live in Italy and have lymphedema in my arm. I had all my lymph nodes removed due to breast cancer. I have been going to a kinectic center for therapy. I am treated with the arm pump and water aerobic excerise. I have seen very little improvement. They do not think I need a sleeve. When is a sleeve needed?

    • Joachim Zuther

      In order to manage lymphedema efficiently, a sleeve is always needed. Proper treatment for lymphedema does not include the sole use of pneumatic compression pumps; lymphedema should be treated with Complete Decongestive Therapy. I would suggest seeking the services of a trained lymphedema therapist in Italy.

  • Beverly

    Thanks for you reply. Finding a therapist is Italy has been a challenge. They all say lets wait till September to consider a sleeve. Nothing much happens here in the summer. Meanwhile the heat isn’t making it any better. No air condition here. Even the hospitals don’t turn it on.

  • Karen Y

    I had inflammatory breast cancer about 8 years ago and they removed all my lymph nodes on my right (dominant) side. I did not notice that I had lymphedema until about 1 1/2 year ago. I started wrapping and wearing sleeves. I thought my condition was under control because even when I quit wrapping at night and wearing sleeves, the size was not changing. That was in the spring. About that time, I had had rotator cuff impingement in the lymphedema arm. I did PT all summer, and then the pain seemed to get worse so I started swimming about a month ago, which I love to do. I have been swimming a mile 5 times a week and my shoulder pain is much better but I have gained about 1 cm in the circumference of my upper arm. Should I quit swimming? Is there something I should wear while swimming?

    Then

    • Joachim Zuther

      Dear Karen: Swimming is considered to be a beneficial activity for individuals affected by lymphedema, so I would definitely recommend to continue. Some individuals do wear one of their older compression garments in the pool, which seems to help.

  • Fiona Dyson

    Hi Joachim and a nello to Beverly in Italy,

    I am Australian and was living in Italy too. Am now back in Australia because there was so little help available in Rome. I went to two of the top Vascular surgeons and they both poo-poo sleeves and gloves. Their attitude is disinterested, and their learning way behind. Sleeves are difficult to get fitted for, if there is no professional willing or able to help with it. As I found. Hospitals are poorly run and little if any aircon. Medical help is extremely expensive. Public transport is rarely aircon, it’s hellish in summer. I have a very small income, so I basically ran out of money and hope and faith and left my beautiful boyfriend to run back to Australia. Even if here too of course is so hot in summer. I’m still trying to figure something out that can work for me, so I can return to Rome and get the help I need to survive there with my arm. Mind you, don’t be fooled, treatment here in Australia is also very very expensive and not easy to get any government assistance with treatment. I thought it was going to be so easy here, but it never is, no where in the world. But it’s easier than Italy!

  • Han SL

    Your article gas been very helpful. Tks so much
    I am not aware that I need to wear compression if I want to exercise as the physiotherapist did not mention it at all

    What kind of compression sock is needed if I want to do Zumba or light logging ?

    I love hiking n am not sure if it is safe n ok for me to continue with this ? Is hiking for 6-7 hours ?

    • Joachim Zuther

      The type and class of compression garment depends on your personal situation. You should wear your garment during exercise. As long as you are wearing compression, it is perfectly fine to go hiking.

  • Jean LaBarr

    I was told that I have lymphedema in my legs foot and toes. They didn’t perform a test that confirms this diagnosis. I’ve only had tests to see if I had a heart problem, venous insufficiency, which showed a minor problem. I have been wearing compression stockings during the day and I wrap my left foot and toes every night. They look ok in the morning, but at night my toe swells up, which looks like it is being strangled by the fluid buildup. Is this lymphedema or is it something else?
    There are no doctors around that I know of, that know anything about lymphedema. Can you help me?

  • Carmen

    If I exercise on a stationary bicycle for 1/2 an hour with my compeession thigh high stockings I presume I have to wait before taking them off ?
    How much time should I wait ? and if it is proper to raise my legs in the meantime
    Much appreciated !

    • Joachim Zuther

      In general, compression garments should be worn during the day and not be taken off until going to bed

  • Carmen

    Thanks !
    Should I raise my legs afterwards ?
    I was thinking after the exercise to take them off to take a shower and putting them on again