Lymphoedema and exercise management
It is safe to exercise throughout your cancer experience, and a guided and individualised rehabilitation program can ultimately reduce the severity of adverse effects such as Lymphoedema during and post treatment.
What is secondary Lymphoedema and why do I have it?
Lymphoedema is a secondary effect of Oncology treatment following lymph node damage and/or removal due to physical disruption or compression of lymphatic channels (surgical resection, and/or radiation-induced fibrosis of vessels or nodes). Swelling then develops on the affected limb whereby the lymph volume is exceeding the transport capacity, leading to abnormal accumulation of tissue protein, oedema, and chronic inflammation.
There are variable levels of severity, pain intensity, and disability related to Lymphoedema. Specifically, physiological and psychological changes can result in decreased function, mobility, and altered daily living such as clothing, sleep, social engagement and physical activity.
Approximately 20% of survivors from breast, gynaecological and prostate cancer, or melanoma will experience secondary lymphoedema.
It is highly important that you and your medical treatment team create a collaborative plan to assist in your Lymphoedema management. Evidence-based practice and recommendations include following a combined regimen which includes:
Manual lymphatic drainage combined with compression bandaging and/or garments
Exercise and Education
Skin Care and Infection Control
Psychosocial Care Strategies; Psychological and emotional wellbeing support
Most importantly, you need to be able to undertake self-management on a daily basis, and this should be guided by a qualified Allied Health Professional who can ensure it is tailored to your specific condition and abilities (everyone’s experience is different!)
Benefits of Exercise:
Early detection and exercise intervention remain one of the primary strategies for reducing the incidence and severity of Lymphoedema. Exercise benefits include:
- Enhancing the efficiency of the lymphatic system; activating the musculoskeletal pumping mechanism that increases both venous and lymphatic return.
- Reduce swelling, and return full range of movement
- Assist in ultimately ‘resetting’ the sympathetic drive to lymph vessels, resulting in positive long-term management of lymphedema·
- Reducing the psychosocial impacts on daily life including functional impairment, social and emotional distress, and poor quality of life
- Undertake a guided exercise regimen with a combination of aerobic and resistance exercises consistently (3-5 days per week dependent on your level of fatigue and functioning).
- Continue regular muscle movements on a daily basis to reduce lymph accumulation. This means avoiding prolonged postures or sedentary behaviours.
- Gradually expose yourself to loaded exercises, and usual daily activity – start using your affected limb normally, however, try to avoid one-off heavy lifting.
- Practice Diaphragmatic Breathing; it changes abdomen and chest pressure to encourage lymph flow into the blood system, and increasing drainage away from the effected region.
- Avoid exercising in extreme temperatures (hot or cold); ensure the weather is moderate and comfortable.
- Ensure longer warm up and cool downs with exercise sessions to allow for the slow draining Lymphatic system.
More information & Access to support groups:
Australiasian Lymphology Association: https://www.lymphoedema.org.au/education-&-resources/links/
Download Health Information Sheet
Kwan, Cohn, Armer, Stewart, and Cormier. (2011). Exercise in patients with lymphedema: a systematic review of the contemporary literature. J Cancer Surviv 5:320–336
Schmitz, K. H., Troxel, A. B., Cheville, A., Grant, L. L., Bryan, C. J., Gross, C. R., Lytle, L. A., & Ahmed, R. L. (2009). Physical Activity and Lymphedema (the PAL trial): assessing the safety of progressive strength training in breast cancer survivors. Contemporary clinical trials, 30(3), 233–245
Armer, J. M., Hulett, J. M., Bernas, M., Ostby, P., Stewart, B. R., & Cormier, J. N. (2013). Best Practice Guidelines in Assessment, Risk Reduction, Management, and Surveillance for Post-Breast Cancer Lymphedema. Current breast cancer reports, 5(2)