Should I wear lymphedema compression garments while exercising?

Compression bandaging and garments can help reduce swelling due to lymphedema, but should patients wear lymphedema compression garments while exercising?

People with lymphedema suffer from lymphatic insufficiency, an inability to effectively clear extravascular fluid from affected tissues. Consequently, anything that increases fluid volume in an affected area could cause symptom flare-up. Fear of inciting swelling prompts many with lymphedema to avoid strenuous activities that involve the affected area, whereas others may overly rely on compression garments. So what does the current research say?

First off, the best advice is to not avoid exercise, even heavy resistance training

Many individuals with lymphedema avoid exercise. In fact, lymphedema management guidelines historically recommended against exercise and other strenuous activity. Thankfully, these recommendations are changing as clinical studies continue to accumulate, showing that exercise is well tolerated by people living with lymphedema, and may even be beneficial for their symptoms (see: “Is exercise for lymphedema patients safe? Is it beneficial?”). Briefly, a handful of studies indicate that exercise does not exacerbate lymphedema; that cancer survivors who are physically active appear to have a reduced risk of developing lymphedema; and that exercise may decrease the incidence and severity of swelling in patients with lymphedema.

Even heavy resistance training (weight lifting) does not appear to be a significant risk factor for symptom flare-up (ref2) (see: “Is it safe for patients with lymphedema to lift HEAVY weights during exercise?“). Another recent study included a biochemical component to the question, evaluating the relationship between intensity of exercise and blood indicators of muscle damage and inflammation in patients with breast cancer-related lymphedema. The study showed no difference between low, moderate, and high intensity exercise on biochemical markers of muscle damage and inflammation, or physical measures of swelling (ref3). This appears to lend further support the safety of even high intensity exercise for this population.

However, there is one important caveat to the recommendation that individuals with lymphedema should exercise: the overwhelming majority of studies to date have been focused on a relatively homogeneous population of female breast cancer survivors with “stable” secondary lymphedema.

It is possible that other lymphedema populations may have their symptoms exacerbated by exercise, and the same may be true for certain individuals with breast cancer-related lymphedema, at certain times.

Your personal history of exercise and symptom sensitivity, and a consultation with your health care team is your best guide as to how you should proceed with your exercise plans. More on this below.

Clinical data doesn’t appear to support wearing compression garments while exercising

There isn’t strong clinical data that I am aware of that shows that wearing compression garments during exercise decreases the risk of lymphedema, be it an initial occurrence of swelling or a subsequent flare-up.

A recent 2015 study examined the usefulness of compression garments during exercise (ref3). They measured arm volume in 21 women with “stable” breast cancer-related lymphedema before, immediately after, and 24 hrs after upper body resistance training with and without compression garments. They concluded that:

“An acute bout of moderate-load, upper-body resistance exercise performed in the absence of compression does not exacerbate lymphedema in women with BCRL [breast cancer-related lymphedema]”

In support of this, a nice 2015 review paper (produced by the same group) examined the other available clinical studies to date on the subject and drew the same conclusion: that performing exercise without using compression garments appears not to exacerbate lymphedema (ref1).

So does this mean that it would be advisable for all individuals not to wear lymphedema compression garments while exercising at all times? Certainly not.

Since exercise does not appear to worsen lymphedema in the population that tends to be studied, then we should expect that studies of this same population would in turn show that compression garments are unnecessary. So perhaps it is more accurate to conclude from the above study that the absence of compression is insufficient to exacerbate lymphedema in a small cohort of women with stable BCRL undergoing a single bout of exercise. In other words, removing compression during exercise is, in most instances, simply not enough to induce lymphedema on its own in this population.

So while this research adds to our understanding of lymphedema, it is not directly translatable to the real world, at least not yet. Indeed, the 2015 review qualified their conclusions, stating that there are simply too few studies and insufficient evidence to draw definitive recommendations for or against the use of compression during exercise.

Current best advice is that you should still wear compression garments while exercising

Individuals in the real world can differ greatly from the small cohorts of patients used in clinical studies, for example, not everyone is a woman with “stable” breast cancer related lymphedema. Hence, we feel that the recommendation to wear compression during exercise should remain, and here’s why:

The ‘cost’ of wearing a compression garments while exercising is small, but the benefit may be substantial and two-fold:

1. Compression during exercise is likely to be necessary in some patients under some circumstances to prevent a lymphedema flare-up.
2. Exercise while wearing compression will act to help further drain the affected tissue. Time spent wearing a compression garment, in particular while exercising, will increase pressure in the tissue and help reduce tissue fluid volume. In fact, in the same studies discussed above, limb size immediately post-exercise tended to be reduced in the compression group compared to pre-exercise levels, but were unchanged in the no-compression group (although with short study durations the net benefit of this potentially temporary arm volume reduction is unknown).

Summary:

The best general advice is to exercise, and to wear your compression garment while you do it. The huge benefit of exercise, especially for cancer survivors, is much greater for your health than the small and still unproven risk that it may exacerbate lymphedema, and wearing a compression garment will likely further reduce this risk. Plus, emerging evidence suggests that exercise may even help your lymphedema.

According to our clinical director Lindsay Davey, PT, CDT, a good rule of thumb is to recommend that patients wear compression garments while exercising, unless this means that they will exercise less. But she cautions against applying general guidelines to all individuals:

“Remember, health guidelines and recommendations are designed to apply to the general population, not specifically to individuals. Use of compression during exercise is a personal choice, one that should take into consideration patient history, the stability of their lymphedema, past experiences with activity and exercise tolerance, coincident risk factors for lymphedema, and patient adherence. Patients should discuss it with their health team to determine what is best for them.”

Need help deciding on an exercise program? Check out Lindsay’s 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. Cormie P., Singh B., Hayes S., et al. Acute inflammatory response to low-, moderate-, and high-load resistance exercise in women with breast cancer-related lymphedema. Integr Cancer Ther. 2015 Nov 17 [Epub ahead of print].
3. Singh B., Newton R.U., Cormie P., et al. Effects of compression on lymphedema during resistance exercise in women with breat cancer-related lymphedema: a randomized cross-over trial. Lymphology. 2015 Jun;48(2):80-92.