Is exercise for lymphedema patients safe? Is it beneficial?

The evidence supporting the safety of exercise for lymphedema patients continues to grow, as does the number of clinicians recommending it to their patients. There is even some early data suggesting that some exercise may benefit lymphedema directly. But there are important caveats to this body of research that need to be considered.

Current clinical data supports exercise for lymphedema

It wasn’t long ago that individuals with lymphedema were widely advised against participating in strenuous activities.

The old thinking was that strenuous activities including exercise would increase interstitial fluid levels and thereby exacerbate swelling. Even though clinical recommendations are changing in support of exercise, there are still many health practitioners operating according to outdated thinking, and there are definitely many lymphedema patients who still avoid exercise for fear that it will worsen their lymphedema.

Compelling studies now support the safety of exercise for lymphedema patients (ref1,2,3), even including heavy resistance training (see: “Is it safe for patients with lymphedema to lift HEAVY weights during exercise?“). In general, exercise is very beneficial for individuals who have gone through cancer treatment. As such, many cancer patients maintain or even increase their physical activity levels after cancer treatment compared with their activity levels prior to diagnosis.  Exercise in cancer survivors appears to offer sizable benefits, from improving fitness levels and quality of life, to even increasing survival rates (ref4).

In contrast, cancer patients with lymphedema appear to actually be at risk of decreasing their physical activity levels after cancer treatment (ref5). This is unfortunate, because in addition to the numerous other benefits that exercise offers, exercise may also benefit lymphedema directly:

1. In a handful of studies of breast cancer patients exercise has been found to be associated with a decreased risk of developing lymphedema (ref1,6).
2. There is also some evidence to suggest that in individuals with breast cancer-related lymphedema, exercise may decrease the incidence of lymphedema flare-ups and symptom severity (ref1,3,7).

Wearing lymphedema compression garments during exercise may further reduce any risk of swelling, and in fact, may promote additional limb volume reduction (see our review of this research: “Should I wear lymphedema compression garments while exercising?”).

But there are caveats

It is important to note that the studies on exercise for lymphedema patients are almost exclusively small and focused on breast cancer-related lymphedema. So it is plausible that individuals with other forms of lymphedema may be more susceptible to exercise-induced swelling, and also that some breast cancer patients may at times experience a worsening of their lymphedema symptoms with exercise. Indeed, most of these studies describe their study population as having “stable” breast cancer-related lymphedema – and therefore conclusions from these studies should only be applied to patients who are similar to those studied.

Tips for exercising with lymphedema

1. Consult with your health care providers. This consultation should take into consideration the current stability of your lymphedema, your history and past experiences with exercise, and any other current lymphedema risk factors.
2. Consider wearing compression garments while exercising. This may further decrease your risk of swelling, and aid in volume reduction of the affected tissue.
3. Consider a supervised exercise program. Expert advice can help you in setting up a safe program, with suitable starting points and progression. It can also help you monitor symptoms, and treat them early (or conversely, provide reassurance that your changing symptoms are ok).
4. Self-monitor for any aggravation of symptoms.
5. Choose the best type of exercise for your lymphedema. For help, see our upcoming post on the best type of exercise for lymphedema patients.

References:

1. 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].
2. Keilani M., Hasenoehrl T., Neubauer M., et al. Resistance exercise and secondary lymphedema in breast cancer survivors – a systematic review. Support Care Cancer. 2015 Dec 30 [Epub ahead of print].
3. Stuiver M.M., ten Tusscher M.R., Agasi-Idenburg C.S., et al. Conservative interventions for preventing clinically detectable upper-limb lymphoedema in patients who are at risk of developing lymphoedema after breast cancer therapy. Cochrane Database Syst Rev. 2015 Feb 13;2.
4. Spence R.R., Heesch K.C., and Brown W.J. Exercise and cancer rehabilitation: a systematic review. Cancer Treat Rev. 2010 Apr;36(2): 185-94.
5. Sander A.P., Wilson J., Izzo N., et al. Factors that affect decisions about physical activity and exercise in survivors of breast cancer: a qualitative study. Phys Ther. 2012 Apr;92(4):525-36.
6. Gho S.A., Steele J.R., Jones S.C., et al. Self-reported side effects of breast cancer treatment: a cross-sectional study of incidence, associations, and the influence of exercise. Cancer Causes Control 2013 Mar; 24(3):517-28.
7. 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.