Best types of exercise for lymphedema patients

Current research supports exercise in patients with lymphedema. But some types of exercises for lymphedema patients may be more beneficial than others.

The latest research supports exercise for individuals with lymphedema

Although the body of research is still relatively small, there is considerable and growing evidence to suggest that exercise is safe in patients with lymphedema. In fact, it may even help prevent the development of lymphedema, as well as decrease the incidence and severity of lymphedema in patients who already have the condition (see our post “Is exercise for lymphedema patients safe? Is it beneficial?“).

However, the studies to date focus almost exclusively on breast cancer-related lymphedema, and in patients with “stable” lymphedema symptoms. So it is important to keep in mind that these observations may not be true for all forms of lymphedema, nor true for all individuals with lymphedema, at all times.

So what are the best types of exercises for lymphedema patients to do?

The clinical data is admittedly small, and focused exclusively on breast cancer-related lymphedema, but it still offers some meaningful insights.

In short, the best form of exercise for lymphedema varies depending on the individual – there is no single prescription for what works best. Below is a summary of the current clinical data, which you can use to help chart your own optimal path:

1. If you have a high BMI (body mass index) it’s ideal to include forms of exercise (and nutrition) that will help you reduce your body weight. For patients with a high BMI, any exercise that reduces body mass could potentially benefit their lymphedema symptoms.
   • High BMI is a well-known risk factor for lymphedema and above a certain threshold BMI, lymphedema appears all but guaranteed (ref1). High BMI has also been shown to increase the risk of lymphedema in breast cancer patients (ref2). For more information on the relationship between BMI and lymphedema, see “Lymphedema is a common but little-known health hazard of obesity“, and “Lymphedema caused by obesity may (not) be reversible“.
   • Reducing body weight can help in two major ways: first it could relieve the compression of lymphatic vessels caused by excessive fat deposition and reduce long-term damage. Second, it could reduce total limb fluid volume by decreasing lymph fluid production and relieve body weight-related venous insufficiency.
   • So what should I do to help decrease my weight? First, proper nutrition. Second, regular exercise. You will burn many more calories with cardiovascular exercises such as walking, running, swimming, and cycling than with low-intensity cardiovascular activities such as yoga, tai-chi or resistance training.
2. Resistance training may be the best choice of exercise for reducing lymphedema. Resistance training is the most frequently investigated form of exercise for lymphedema patients, and appears to show the greatest lymphedema-specific benefit.
   • The highest quality lymphedema exercise study to date examined the effects of a 12 month resistance training program (ref3). Compared to control subjects who did not exercise, patients who stuck with the training program in this study exhibited a lower incidence of lymphedema flare ups and decreased symptom severity.
   • Physiologically speaking, resistance exercises for lymphedema make a lot of sense. Resistance training improves muscle tone and strength, and muscle contraction can help stimulate both venous flow and lymph flow.
3. Yoga. There has been growing interest in using yoga for lymphedema management. Yoga is a holistic form of exercise, and early evidence suggests that specialized yoga routines may help improve lymphatic flow and reduce the symptoms of lymphedema  including physical (e.g. swelling and skin changes) and psychosocial (e.g. body-image and feelings of marginalization) (ref4).
4. Supervised exercise programs appear to be more beneficial to lymphedema patients than you might expect.
   • Expert supervision, as demonstrated in clinical studies, can: improve patient adherence, provide patient-specific programs with an appropriate starting point and progressions based on symptom response, minimize injury risk (particularly important in the affected limb or body region), allow for early detection of symptoms and allay patient concerns (ref5).
   • Some level of expert supervision is considered to be an important factor in predicting the success of exercise programs for lymphedema (ref6).
5. Choose an exercise program that you can stick with, and change it when you can’t. If we put the sparse clinical data aside for a moment, it is self-evident that the best exercises for lymphedema are the ones that people will actually do on a regular basis.
   • Exercising on a regular basis is paramount, so we encourage patients do the form of exercise that suits them best.
   • Giving individuals the choice of different exercise options promotes long term adherence. So feel free to mix it up and switch to other forms of exercise if you are having trouble sticking with it.
6. Just exercise, it doesn’t matter which type.
   • Exercise, irrespective of which type (cardiovascular, resistance, or other), appears not to be a risk factor for lymphedema (ref5).
   • Exercise, irrespective of which type, benefits overall health and well being, and improves the quality of life and survival of cancer patients.

Please consult with your health providers before starting an exercise program. Seek out guidance to do it safely and effectively, consider wearing compression while exercising (see our upcoming post: “Should I wear lymphedema compression garments while exercising?”), pick something you enjoy and can stick with, and mix it up when you can’t! :)

Need a bit more motivation to exercise? Check out this insightful and highly entertaining video about the benefits of exercise, created by our internationally renowned colleague and health activist, Toronto’s own Dr. Mike Evans.

References

1. Greene, A.K., et al. Obesity-Induced Lymphedema: Clinical and Lymphoscintigraphic Features. Plast Reconstr Surg. 2015; Feb 20 Epub ahead of print.
2. Helyer, L.K., et al. Obesity is a risk factor for developing postoperative lymphedema in breast cancer patients. Breast J. 2012 Jan-Feb; 16(1):48-54.
3. Schmitz K.H., Ahmed R.L., Troxel A., et al. Weight lifting in women with breast-cancer-related lymphedema. N Engl J Med. 2009 361:664–673.
4. Loudon A., Barnett T., Williams A.D., et al. Guidelines for teaching yoga to women with breast cancer-related lymphoedema: an evidence-based approach. Int J Yoga Therap. 2017 Nov;27(1):95-112.
5. Hayes S.C., Reul-Hirche H., Turner J. Exercise and secondary lymphedema: safety, potential benefits, and research issues. Med Sci Sports Exerc. 2009 Mar;41(3):483-9.
6. Singh B., Disipio T., Peake J., et al. Systematic review and meta-analysis of the effects of exercise for those with cancer-related lymphedema. Arch Phys Med Rehabil. 2015 Oct 9. [Epub ahead of print].