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Exercise And Lymphoedema

Exercise And Lymphedema by Sabrina S. Selim, MD, Francine Manuel, RPT, Cheryl Ewing, MD, Ernest H. Rosenbaum, MD

The rationale behind doing mild exercise is that muscle contractions, especially in the calf and arm, help to promote lymph flow to veins in the neck region where it returns to the blood circulation. Exercise also helps the proteins in lymph fluid to be reabsorbed. Both result in a lesser severity of lymphedema.

Although there is no consensus on the type of exercise regimen for people with lymphedema, all schools of thought agree that exercise is a necessary part of healing and that it should be tailored to each patient's needs and abilities. In general, it has been suggested that a monitored, progressive exercise program, in which a person slowly builds up their stamina and strength is far better than a strenuous one, no matter what the patient's previous athletic history. High speed activities such as golf, tennis, jogging or hiking at high altitudes are not suggested as they may actually increase lymphedema. Activities such as walking, swimming, light weights or cycling, in contrast are generally safe. For people with severe lymphedema who have a difficult time moving, even breathing enhances the pumping of lymph in the chest region. Deep breathing exercises such as mild yoga may be especially helpful to promote both relaxation and decrease lymph load.

Several rules about exercising with lymphedema should be observed:

1. Always start an exercise program gradually to avoid sprains and injury to muscles. It will also allow the person to observe how the edematous extremity responds to exercise. This will differ for each person.

2. A compression garment or bandages should always be worn during exercise. This provides pressure on the limb and assists in pumping lymph from the extremity.

3. For women with post breast cancer treatment lymphedema in the arm, arm exercises should begin as soon as the doctor okays it. If the shoulder or wounds are sore, begin with mild pendulum exercises. Lean forward and let your arms hang down, then make circles. You can also swing them forward, backward and sideways. Once you can lift the arm over your head, you can begin active exercises.

4. An exercise program should involve all of the following movements:

  • Flexion (arms over the head close to the ear, palms toward the head)
  • Extension (move straight arms toward your back)
  • Abduction (arms away from the body, palms down)
  • Horizontal abduction (move arms across the chest)
  • External rotation (put hands behind your head)
  • Internal rotation (put hands behind your back)

Once you can do these movements 30 times without weights, add one pound per week. Take your time. Begin with 10 and add 5 repetitions each day. If weight lifting adds to increased lymphedema, just do the exercise without the weight.

5. Daily exercise should be done as long as motion is limited. Once you have full movement, you can exercise 3x per week.

A Sample Progressive Exercise Program For Lymphedema

This exercise program has been devised to increase your strength and endurance. The program, which takes you from your bed to being up and around in three stages, can be started as soon as your physician says its ok. You can refer to the healthlibrary.stanford.edu/resources/videos.html website for videotapes of appropriate exercises.

Stage I is on one tape and Stages II and III are together on another tape. The demonstrations include warm-up and full-exercise programs with relaxation sessions at the end.

Stage I exercises are simple and help you to maintain and increase your range of motion. They require little exertion and can be done in bed.

Stage II exercises use a small added weight to increase resistance and can be done when you are spending part of the day out of bed. Once you have gotten back to your normal activities, you will need to establish an exercise routine that includes exercises like these to build up your body's reserves so that temporary bouts with bed rest will not deplete your energy stores.

Stage III exercises provide you with a strengthening and maintenance program for when you are able to spend the whole day out of bed. This series of exercises is a progressive and comprehensive physical rehabilitation program for people with acute or chronic illness. With your doctor's permission, you can begin these exercises even while you are recovering from surgery or undergoing cancer therapy.

an excerpt from Living with Lymphedema by Sabrina S. Selim, MD, Francine Manuel, RPT, Cheryl Ewing, MD, Ernest H. Rosenbaum, MD. To find out more visit www.cancersupportivecare.com.

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