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.
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“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
http://www.medpagetoday.com/Endocrinology/Obesity/32986
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.
3-5
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.
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Thanks for reading… Sharon O’Hara
Continued…in Part 3b
/p
