Greetings… Part 3a of 3b.
Dr. Halligan, surgeon, Doctor’s Clinic Silverdale, saved my life/legs when he checked to see if the deep lesions on my left leg could be treated without surgery….and wanted a daily cleaning –debriding – and rewrapping of the leg. The doctor ultimately did it himself – everyday in the hospital.
Back home my husband, trained by Doctor’s Clinic Silverdale took over the leg lymphedema wrap.
Restless Leg Syndrome (RLS) – now called
Willis-Ekbom Disease (WED) Foundation www.willis-ekbom.org – was my biggest hindrance to healing.
“Lymphedema Tied to Obesity
By Todd Neale, Senior Staff Writer, MedPage TodayPublished: May 30, 2012
“Obesity may contribute to the development of lymphedema, a small study showed.
Among 15 obese patients with enlargement of the legs, the average body mass index was significantly greater for those with confirmed lymphedema (70.1 versus 42.0 kg/m2, P<0.001), according to Arin Greene, MD, of Children’s Hospital Boston, and colleagues.
“Our findings suggest that obesity … may be a cause of lower-extremity lymphedema,” they wrote in a letter to the editor in the New England Journal of Medicine.
“As the amount of adipose tissue increases in the lower extremity, lymphatic vessels may become dysfunctional (possibly because of compression or inflammation), thereby reducing proximal lymphatic flow,” they explained.
“Alternatively, elevated production of lymph from an enlarging limb may overwhelm the capacity of a normal lymphatic system to remove the fluid from the extremity,” they continued. “Although lymphedema is typically progressive, we speculate that
Steven Gardner, political reporter at the Kitsap Sun, will have Bariatric surgery at Swedish Hospital in Seattle probably in the April time frame. Steven tells his story here: http://fieldofsteve.com/
“Obesity is known to be a major lymphedema risk factor” Part 3a of 3b
Fitness and Exercise:
It is very important for individuals with lymphedema to be physically fit and maintain a healthy weight. A safe form of exercise is an essential part of a fitness program for people with lymphedema. Fitness and exercise are not the same. Exercise includes many different types of physical movement. The three main types of exercise are: aerobic, strength, and flexibility.
These three types of exercise, along with Lymphedema Remedial Exercises, are addressed
in this paper. There are many other types of exercise that have health benefits such as Pilates, yoga, Tai Chi, Qigong, aquatic exercise,1trampoline rebounding, breathing exercises, and relaxation exercise that have not been adequately studied in people with lymphedema. However, the person with lymphedema can use the benefits of any system of exercise if he/she follows the general safety principles of exercise with lymphedema, seeks medical guidance, and uses caution in starting any new exercise program.
Exercise and types of lymphedema:
Lymphedema has many causes. The type of exercise that is best for an individual depends upon the severity and cause of lymphedema and other co-existing medical conditions (e.g. heart disease, diabetes, arthritis, etc).
Exercise for breast cancer-related lymphedema is the most studied lymphedema condition. Many conclusions about exercise and lymphedema are based on studies of breast cancer survivors that may or may not apply to other forms of lymphedema.
Lymphedema Remedial Exercise:
Lymphedema Remedial Exercise is a part of treatment for lymphedema when reduction of size of a limb is necessary. Lymphedema Remedial Exercise involves active, repetitive, non-resistive motion of the involved body part.
Exercise in Phase I and Phase II Complete Decongestive Therapy (CDT) (see Position Paper “Diagnosis and Treatment of Lymphedema” http://www.lymphnet.org/pdfDocs/nlntreatment.pdf) is performed with compression as an essential part of the total (complete) reductive phase of lymphedema therapy.
Lymphedema exercises, used with compression, help the body’s natural muscle pump to increase venous and lymphatic fluid return to the circulatory system and out of the swollen areas. Remedial Exercises for lymphedema are similar to some movements of low impact Tai Chi and Qigong, but are different in that lymphedema Remedial Exercise is used with Phase
I treatment of lymphedema to reduce size of the body part.
Lymphedema Remedial Exercise has been studied and shown to reduce limb swelling.3-5
It is unknown whether Lymphedema Remedial Exercise alone can prevent
lymphedema in at-risk individuals, or whether they can maintain reduction of swelling without compression.
Flexibility or Stretching Exercises:
Flexibility exercises include a wide range of activities that stretch muscle and connective tissues to increase and/or preserve range of motion. Flexibility exercises can minimize skin scarring and joint contractures that may lessen lymph flow. Flexibility exercises should be performed slowly and progressed gradually. Flexibility exercises are not a treatment for lymphedema, but are a part of optimal lifestyle management for reducing the complications of lymphedema. Lymphedema has a tendency to restrict motion of muscles and joints.
Optimal lymphatic function requires full mobility of muscles and joints. Lymphedema from cancer treatment can be associated with tight muscles and connective tissues due to fibrous adhesions from surgery or radiation. Tight muscles and scars from surgery or radiation may require Physical or Occupational Therapy to treat before attempting to do self-stretching.
Specific stretching exercises for cancer treatment-related scars and joint restrictions in an area at risk of lymphedema should be prescribed by a provider familiar with the management of lymphedema. A specialized form of stretching exercise may be required for Axillary Web Syndrome (AWS) or axillary cording, a condition that can occur in cancer survivors who have had axillary (armpit) lymph nodes removed.6
AWS may benefit from treatment by a certified lymphedema therapist and specific home stretches taught by a therapist.7
Resistance or Weight-Lifting Exercise:
Resistance exercises are usually thought of as weight-lifting. Resistance exercises may involve lifting body weight (such as push-ups) or lifting objects (such as dumbbells, weight machines, etc).
Resistance exercises can be performed without moving a joint (isometric) or by moving the joint through a range of motion (isotonic). All of these types of resistance exercise may be utilized by individuals with lymphedema, but should be done cautiously, starting with low weights, low repetitions, and gradual progression. Resistance exercises are performed against an opposing load to enhance muscle power, stamina, and tone. Resistance exercise may reduce limb volume when used as an adjunct to compression therapy8
One study showed that guided participation in resistance exercise, as a part of a total fitness program, did not increase the risk of developing lymphedema in breast cancer patients at risk over the group who did not exercise.9
Lymphedema did occur in both groups. No increase in lymphedema development was noted between the exercise and the non-exercise group. There have been many studies on resistance exercise in breast cancer-related lymphedema that show no harmful effect on lymphedema and beneficial effects for overall health.10-20
Aerobic Conditioning or Cardiopulmonary Exercise:
Aerobic conditioning exercise is often referred to as “cardio” exercise. Aerobic exercise involves activity that uses large muscle groups to increase the heart rate to 60-70% of an individual’s maximum heart rate. This type of exercise, when progressed gradually, increases the heart and lung capacity while also improving muscle conditioning.
Aerobic conditioning enhances cardiovascular fitness, effective weight management, and overall health and well-being, all of which are very beneficial to people with lymphedema from all causes.10-21
Walking, jogging, cycling, and swimming are examples of aerobic conditioning exercise. Aerobic conditioning has not been studied formally as a treatment for lymphedema. One study showed no adverse effect on lymphedema from aerobic exercise.17
Resistance Exercise plus Aerobic Exercise:
Studies of combined resistance and aerobic exercise have shown no adverse effects on lymphedema.21
No studies have specifically evaluated resistance plus aerobic exercise as a stand-alone treatment for lymphedema. One study in breast cancer-related lymphedema showed that the individuals who performed aerobic conditioning and weight lifting had better control of their lymphedema and had fewer flares of lymphedema than those who did not exercise. However, individuals with lymphedema still had to utilize standard lymphedema therapy techniques for flares.
Another study about women at risk for breast cancer-related lymphedema showed that aerobic conditioning and weight-lifting reduced the risk of developing lymphedema.
Considerations for Designing an Exercise Program:
A number of studies have shown that aerobic and resistance exercises are safe and beneficial for people with lymphedema or at risk of lymphedema if they follow the guidelines for progressing slowly, use recommended compression, and report any adverse effects to a professional who can help them adapt their exercise regimen.9,16-21
Most studies on lymphedema and exercise have been done on breast cancer survivors, but the principles may guide exercise in other forms of lymphedema. Individuals with or at risk of lymphedema must report other health conditions that need to be considered in developing a personal exercise regimen (diabetes, heart disease, neuropathy, arthritis, etc).
Modifications of aerobic and resistance exercise that are commonly recommended for individuals with lymphedema are:
1) Allowing adequate rest intervals between sets; 2) Avoiding weights that wrap tightly around an extremity or clothing that cause constriction; 3) Wearing compression sleeves or bandages during exercise; 4) Maintaining hydration; 5) Avoiding extreme heat or overheating; 6) Exercising in a circuit that alters the type of exercise and body part within the exercise session.
Exercise and Compression Garments:
Lymphedema Remedial Exercise as a part of CDT requires compression garments or bandages.3-5 There are no studies on the use of compression garments when performing stretching or flexibility exercise alone.
Thanks for reading… Sharon O’Hara
Continued…in Part 3b