This is part two of a three-part series covering exercises for patients affected by lymphedema. Part one covered aerobic exercises; part three will discuss decongestive and breathing exercises.
Strength exercises improve muscular power, increase the strength in ligaments, tendons and bones, and positively contribute to weight control. Resistive exercises are typically performed in a repetitive fashion against an opposing load. Gradual progression is imperative and exercise programs should be comparable to the patient’s fitness level, while trying to accomplish an improved return of lymphatic fluid without adding further stress to an impaired lymphatic system. Certain strength exercises are beneficial for lymphedema patients and should always be performed with the compression garment or bandage in place. Resistive exercises using weights present possible problems in regard to injury or overuse. However, with appropriate precautions resistive exercises using weights can be very beneficial.
An improved baseline of strength will allow daily tasks to be performed with less effort and possibly prevent muscular or ligament sprain or strain. Improved strength can prevent against overuse syndrome and restore intramuscular balance and normal biomechanics to the involved limb and surrounding joints. When beginning a resistance program, weights should be light, with higher repetitions, as opposed to choosing the heaviest weight the patient can only lift 1-3 times. Negative effects in terms of accumulation of fluid in the affected limb (or the limb at risk) are unlikely if exercises are performed with compression in place on the involved extremity.
As some of you may know, an article published August 13, 2009 in the New England Journal of Medicine addressed the topic of weight lifting in women with breast cancer-related lymphedema. The article summarized an 18-month study performed by Dr. Kathryn Schmitz and colleagues in a controlled trial of twice weekly progressive weight lifting involving 141 breast cancer survivors with stable upper extremity lymphedema.
Shortly after this article was published, I received a large number of phone calls and email messages from patients and graduates of our lymphedema management certification courses asking us for clarification on some misleading and inaccurate statements that were made on the results of this study.
One of the more frequent questions I received from patients was: “If it is okay and safe for me to lift weights as this study suggests, is it okay then to lift heavy items at home or at work as well?”
The obvious answer to this question is “NO!”
This is not what this study suggested either, there was clearly some misunderstanding. As a result of these misconceptions, the National Lymphedema Network’s Medical Advisory Board asked Dr. Schmitz to address the many misleading statements that were made in the media about the results of her study. Fortunately, Dr. Schmitz answered the NLN’s call and her response was published in the April/June 2010 issue of the LymphLink. This response was necessary to clarify the results of this important study, and what they mean to patients living with lymphedema, or those individuals at risk of developing this condition. Click here to read Dr. Schmitz’ response.
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