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 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 over-strain, cause discomfort or pain should be avoided, and the extremity should be carefully monitored for any changes in size or shape.
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