Joachim Zuther, Lymphedema Specialist. 
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.
Lymphedema patients 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 the should adjust, or replace them. The answer to that question really 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.
But the reality is that for some individuals exercise plays such a vital role in their daily routine, and is so engrained in their personality, that giving up these so called “high-risk activities” would have a serious impact on their well-being.
My advice to these individuals always was to 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 simple 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 perfectly 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 on their website: www.lebedmethod.com
- 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 overstrain, cause discomfort or pain should be avoided, and the extremity should be carefully monitored for any changes in size or shape.
I would like to wish all of my readers a Merry Christmas!
Additional Resources:
Lymphedema People – Lymphedema and Exercise
National Cancer Institute: Exercises for Lymphedema
Join Lymphedema Guru, a Facebook page solely dedicated to inform about all things related to lymphedema – news, support groups, treatment centers, and much more
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!
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.
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
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.
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!
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.
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.
i cannot afford the lower leg garment s do you know who can help
Please contact the National Lymphedema Network for the Marilyn Westbrook Garment Fund at http://lymphnet.org/patients/westbrookFund.htm
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.
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. [...]
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
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
Can you please help me out with a trained Lymphoedema therapist in Bangalore,India
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