Exercise therapy is considered one of the pillars of Combined (or Complex) Decongestive Therapy, the gold-standard therapy for treating the chronic swelling condition known as lymphedema. The working assumption among therapists has been that exercise therapy can act to decrease limb volume in combination with a decongestive therapy program. Therapists including ourselves have good anecdotal evidence in support of this practice, and this also makes good physiological sense: active exercise involving muscular contraction promotes a mechanical pumping of limb fluids, promoting lymphatic and venous return. However, exercise that is too vigorous could potentially promote excess blood flow to the area and thus overwhelm the drainage capacity of the lymphatic vessels. So does the positive anecdotal evidence and rational physiological underpinning of this practice also have the support of clinical research studies?
Interestingly, there is not much published research regarding the use of an exercise therapy program to help manage limb volume. The majority of studies to date that have examined the effects of exercise have been designed to examine the safety of exercise for people at risk of breast cancer related lymphedema (it has been found to be safe), rather than any potential benefit, or lack thereof, on limb volume. The studies that did investigate potential benefits of exercise therapy did not have sufficient statistical power to prove a reduction in limb volume, although statistically significant improvements in patient-reported symptoms were shown. Thankfully, a new study sheds further light on this topic.
A small randomized controlled trial was recently undertaken to examine the efficacy of exercise therapy for limb volume reduction in people with breast cancer related lymphedema (Jeffs, E., Wiseman, T. Randomised controlled trial to determine the benefit of daily home-based exercise in addition to self-care in the management of breast cancer-related lymphedema: a feasibility study. Support Care Cancer. 2012 Oct17). This study compared lymphedema self-care with or without a daily home-based exercise therapy program over a 6 month period. Participants in the exercise group wore compression hosiery while exercising. The results published this month show a statistically significant reduction in limb volume when exercise therapy is performed. Although the study was a small feasibility study for a potential larger follow-up trial, it is encouraging to finally see good academic data in support of our standard practice. I’m looking forward to seeing larger studies further confirming the utility of this practice, and ideally, exploring the differential utility of individual exercise regimes.
This study is a helpful reminder that while gold standard medical practices represent state-of-the-art knowledge, the scientific data supporting these practices sometimes lags behind their implementation. This study provides further validation to individuals with lymphedema that Combined Decongestive Therapy which includes exercise therapy continues to represent the most current and scientifically supported practice for the management of this condition.