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Exercise as Treatment for Lymphedema

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Whether or not you regularly exercised your arm and upper body before developing lymphedema, exercise is likely to be an important part of your treatment plan. In the past, women often were advised to avoid exercising the arm, for fear this could worsen lymphedema. Now research shows that if women start exercising slowly under the supervision of a lymphedema therapist, taking care not to overstress the arm, exercise is not likely to make lymphedema worse. Some studies suggest that it can play a role in reducing lymphedema flare-ups.

For example, one study has received a great deal of attention: the Physical Activity and Lymphedema Trial, or PAL Trial. PAL found that strength training was safe for most women at risk for, or already diagnosed with, lymphedema — and that it could even reduce the number of symptom flare-ups for some people. One portion of the PAL Trial enrolled more than 140 breast cancer survivors with stable lymphedema and assigned them either to (a) usual care without a change in exercise level, or (b) twice-weekly, whole-body resistance training with gradually increasing weight and repetitions done initially under supervision in group classes, then on their own. Women in the weight training group were found not to be at any higher risk of developing arm swelling. They also had a lower incidence of lymphedema flare-ups — 14% in the exercise group, versus 29% in the control group — as assessed by a certified lymphedema therapist.

According to the National Lymphedema Network’s Position Statement on Exercise, most women with lymphedema can exercise the affected arm or other body part safely as long as they:

  • wear compression garments
  • do not exercise the arm or other affected body part to the point of fatigue
  • make appropriate modifications to prevent trauma and overuse

Designing your exercise plan

Work with your therapist to customize a plan that meets your needs and current fitness level. The general rule is to start slowly, build your strength gradually, and use the response of your arm or upper body to judge if you’re doing too much. Keep in mind that no two bodies respond to exercise in exactly the same way. An exercise that is fine for another woman could aggravate your symptoms — just as something that helps you could hurt someone else.

Initially, your lymphedema therapist is likely to have you do gentle stretching and range-of-motion exercises that help the muscles contract and relax — which is thought to help push the lymph along — and also strengthen the lymphatic system. “Some examples could include making a fist and extending the fingers; doing wrist curls; or gentle punching motions to extend and flex the elbow,” says Dr. Andrea Cheville of Mayo Clinic.

Once your symptoms improve and your lymphedema is stable, your exercise plan might expand to include gentle yoga (excluding positions that put weight on the upper body, at least at first), swimming, and/or lifting light weights, depending on the advice of your certified lymphedema therapist. Generally, a combination of stretching, flexibility, and aerobic activities is recommended, but again, your plan has to be individualized. If you have more ambitious fitness goals, your therapist can help you make a plan for reaching them. Bandages, a compression sleeve, or other compression garments would be worn while exercising.

Other tips:

  • Watch your arm, hand, and upper body during and after activity for any change in size, shape, tissue, texture, soreness, heaviness, or firmness. Any changes could be a sign that you need to ease up on a particular activity, take a break, or stop it all together. If a change persists for more than a few days, see your doctor or therapist.
  • Be aware that not all exercise programs for cancer survivors will meet your needs and could even be risky. Many health clubs, gyms, and hospitals offer exercise programs targeted at cancer survivors. Check out any program you’re considering in advance or run it by your therapist. Even if it’s billed as “cancer rehabilitation,” it may not be designed to meet the needs of people at risk for lymphedema.
  • If you don’t have access to a doctor or therapist with expertise in lymphedema, whether because of location or cost, ask another physical therapist or health care provider to consult with you. Talk to this person about your lymphedema concerns and your plans to engage in exercise. You may want to share the National Lymphedema Network’s Position Statement on Exercise as a starting point.

For more information about what goes into making an exercise plan, see the Lymphedema and Exercise section.

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