Lymphoedema and Exercise

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Lymphoedema and Exercise

Postby patoco » Wed Jun 21, 2006 12:24 am

Lymphoedema Exercises

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Lymphoedema Exercises


One thing that really bothers me is when I hear of people with lymphoedema who give up on any activity of exercise because they have this condition. You have to want more from life than just being a couch potato, exercising only your thumb as you click that TV remote.

I envision life like a football game. The doctor may say you can only go to the 10 yard line. But, you must with all endeavor try for that goal. Even if you only really the 50 yard line, you know that you gave it your best shot!

To stay as healthy as you can, exercise is absolutely necessary, this is true for lymphoedema people and non-lymphoedema people. The body simply was not designed to sit on that back side for decades. I am a very strong proponent of doing as much as you can despite lymphoedema. The key is to understand what type and how much exercise you can undertake.

Remember also, the lymphatic system does not have its own pump, like the heart. It moves through action, exercise and activity. Getting on and keeping an exercise activity will help increase that lymph flow.

I am not going to include the usual list of "exercises to avoid"
list, because, honestly, what exercise you are able to participate in depends on the stage of your lymphoedema, other medical conditions, and the advice of your doctor and therapist.

My favorite exercise is swimming. The gentle pressure of the water against the limb acts in many ways like the natural movements of our body that activates the lymphatics. In early stages of lymphoedema, swimming can actually decrease the size of your lymphoedema limb.

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Cautions and Considerations

Remember, there are only three factors that will affect what type of exercise you will be able to do with lymphoedema.

1. Accompanying medical conditions. These include, but are not limited to heart problems, diabetes, pulmonary conditions. You must
check with your physician.

2. Stage and type of lymphoedema. Obviously those with arm lymphoedema would have a problem with bowling. But those with leg lymphoedema and no arm involvement shouldn't. Stage 1 & 2 lymphoedema would present no problem with hiking and walking. At stage 3, it is more difficult. So take the type and stage of your lymphoedema into consideration.

3. Risk of injury is also a factor. At any stage you should consider the consequences of broken bones, torn ligaments and sprained muscles. These can be a serious complication with lymphoedema.

Other points to remember

1. Work with your therapist and physician to design an exercise program that is both safe and effective for you.

2. Your should always wear the appropriate lymphoedema garment when undertaking any exercise.

3. Swimming - Hot tubs, pools (especially community pools) and lakes during the summer (in warmer climates any time of the year) present an increased risk for all types of infections because of bacteria. I urge caution there.

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Exercises with Stage 1

In this stage you are able to participate in just about any and all exercises. The only ones to be concerned with are high impact ones.
Also, parachuting, hang-gliding and bungee jumping are definitely out (unless you are slightly jaded like I am, there probably is no need to warn about these).

Exercises with Stage 2

Stretch exercises - flexion, extension, abduction, rotation. The all include movements of the arms toward and away from you body, arms across your chest, behind your head and back.

Walking, Hiking, Jogging
Swimming, Canoeing, Rowing
Bowling, Archery, Bicycling
Dancing, Sailing, Scuba
Jiu Jitsu, Karate, Judo
Sailing, Frisbee, Fencing
Jogging, Skiiing, Shooting

What was that about being limited? This is only a partial list too.

Exercises with Stage 3

See the above - yes, even in stage 3 you can participate in all of the above sports. You may just have to modify how much and how long.
It wasn't until the I had the lymphomas that greatly complicated my life that I finally had to eliminate those that put a higher amount of strain on my legs.



The rationale behind doing mild exercise is that muscle contractions, especially in the calf and arm, help to promote lymph flow to veins in the neck region where it returns to the blood circulation. Exercise also helps the proteins in lymph fluid to be reabsorbed. Both result in a lesser severity of lymphoedema.

Although there is no consensus on the type of exercise regimen for people with lymphoedema, all schools of thought agree that exercise is a necessary part of healing and that it should be tailored to each patient's needs and abilities. In general, it has been suggested that a monitored, progressive exercise program, in which a person slowly builds up their stamina and strength is far better than a strenuous one, no matter what the patient's previous athletic history. High speed activities such as golf, tennis, jogging or hiking at high altitudes are not suggested as they may actually increase lymphoedema. Activities such as walking, swimming, light weights or cycling, in contrast are generally safe. For people with severe lymphoedema who have a difficult time moving, even breathing enhances the pumping of lymph in the chest region. Deep breathing exercises such as mild yoga may be especially helpful to promote both relaxation and decrease lymph load.

Several rules about exercising with lymphedema should be observed:

Always start an exercise program gradually to avoid sprains and injury to muscles. It will also allow the person to observe how the edematous extremity responds to exercise. This will differ for each person.

A compression garment or bandages should always be worn during exercise. This provides pressure on the limb and assists in pumping lymph from the extremity.

For women with post breast cancer treatment lymphoedema in the arm, arm exercises should begin as soon as the doctor okays it. If the shoulder or wounds are sore, begin with mild pendulum exercises. Lean forward and let your arms hang down, then make circles. You can also swing them forward, backward and sideways. Once you can lift the arm over your head, you can begin active exercises.

An exercise program should involve all of the following movements:

a.Flexion (arms over the head close to the ear, palms toward the head)
b.Extension (move straight arms toward your back)
c.Abduction (arms away from the body, palms down)
d.Horizontal abduction (move arms across the chest)
e.External rotation (put hands behind your head)
f.Internal rotation (put hands behind your back)

Once you can do these movements 30 times without weights, add one pound per week. Take your time. Begin with 10 and add 5 repetitions each day. If weight lifting adds to increased lymphedema, just do the exercise without the weight.

Daily exercise should be done as long as motion is limited. Once you have full movement, you can exercise 3x per week.

A Sample Progressive Exercise Program

This exercise program has been devised to increase your strength and endurance. The program, which takes you from your bed to being up and around in three stages, can be started as soon as your physician says its ok. You can refer to the
website for videotapes of appropriate exercises.

Stage I is on one tape and Stages II and III are together on another tape. The demonstrations include warm-up and full-exercise programs with relaxation sessions at the end.

Stage I exercises are simple and help you to maintain and increase your range of motion. They require little exertion and can be done in bed.

Stage II exercises use a small added weight to increase resistance and can be done when you are spending part of the day out of bed. Once you have gotten back to your normal activities, you will need to establish an exercise routine that includes exercises like these to build up your body's reserves so that temporary bouts with bed rest will not deplete your energy stores.

Stage III exercises provide you with a strengthening and maintenance program for when you are able to spend the whole day out of bed. This series of exercises is a progressive and comprehensive physical rehabilitation program for people with acute or chronic illness. With your doctor's permission, you can begin these exercises even while you are recovering from surgery or undergoing cancer therapy.

Cancer Supportive Care Programs


Jogging and Lower extremity Lymphedema

Q. I have primary LE in both feet. I am currently trying to lose weight and a friend suggested that I try jogging instead of walking (I've been walking on a treadmill at home for 30 min/three times a week). I told him that I am not supposed to run because I have LE (I read in a book that if you run or jump it can cause the LE to worsen). He thought that the circulation would actually help my legs. Which is true?

A. First of all, congratulations on being proactive in your personal weight loss program. In terms of aerobic activity to burn calories, walking at a pace of 4 miles per hour (fifteen minute miles) for at least 45 minutes daily will help you lose weight safely, while tightening and toning your body. Daily, brisk walking will burn calories nicely. Exercising 3x/week for only 30 minutes may not be enough for you to lose weight. It is not necessary to jog, although jogging is not "contraindicated" if you have LE. Each individual reacts differently to different activity levels. I have had some patients who did well jogging, despite their lower extremity lymphedema, although I must say that none of them was overweight and they were runners before they developed lymphedema.

The idea that better circulation will help the LE in your legs is not entirely true. Remember, the problem with LE is that there is not enough lymph transport capacity for the normal amount of lymph fluid that is produced. When you exercise, the muscles need more blood to supply them with oxygen. With the extra blood, comes the extra lymph fluid. That is the problem with LE and "too much exercise": there is extra lymph to transport in a system that is already overloaded.

Only you can discover where your "overload" point is in relation to exercise. My suggestion would be to increase your activity level slowly so that you can monitor its effect on your legs/feet. I hope that you have properly fitted compression garments to wear, which will assist your "muscle pump" to move the extra lymph fluid that is produced during the exercise. Good luck and here's to a healthier, trimmer you in 2000!

Mastectomy, Exercise and Lymphedema

Q: I had a Modified radical mastectomy in August 1994 and about 6 month ago developed mild lymphedema of my right arm. I want to resume exercising and need to know if push-ups and other arm exercises are precluded by the lymphedema.

A: Anybody who has had breast cancer, with or without lymphedema, needs to exercise. However, it is important to know the proper type of exercise, as well as proper weight (not more then 15 lbs). The motion of lymph fluid through lymph vessels is supported by skeletal muscles. Deep breathing exercises also help by dropping the intrathoracic pressure which facilitates drainage in the thoracic duct. Also be sure to wear a compression sleeve/glove while in the gym to support the limb while exercising. Of course if you notice an increase of swelling, discontinue that particular exercise. (Note: An excellent exercise videotape is available for arms as well as for legs through Lymphedema Services in New Jersey - see the Resource Guide for contact information




Please read carefully before beginning

Exercise only while the arm or leg is wrapped or while wearing an elastic sleeve or stocking.

Do not wear tight or restricting clothing (eg. Breast straps, heavy breast prostheses, tight underwear, etc.)

Increase length of exercise session slowly over a comfortable period of time. Try to do exercises twice a day for 10-15 minutes.

Perform each exercise in a slow and controlled manner. After muscle contraction, be sure to relax adequately before beginning again. The time spent relaxing should be at least as long as the time spent working the muscle.

Alternate tensing and relaxing muscle groups. Be sure that muscles not involved in the exercise are relaxed. Still, if sitting on a chair, be sure to maintain good posture.

Include breathing exercises in every exercise session. Begin and end each session with them.

Patients with lympoedema of the arm may sit on a kitchen chair without leaning back. Many of the exercises, however, may be performed by lying on the floor.

Patients with lymphoedema of the leg may perform exercises while lying on the floor, preferably on some kind of cushioned mat or other surface that maintains some firmness.

Patients who have just had an MLD treatment session should rest 20-30 minutes before beginning to exercise.

After the exercise session, it is recommended to rest with the affected limb elevated for 15-20 minutes.






I. Abdominal breathing

inhale deeply through nose

exhale through mouth

relax 3x

II. Head Turns/Stretches

turn and angle head in different directions

eg. Turn head and look right, return to normal

position; repeat for left side

eg. Angle head to right, try to touch ear to

shoulder, return to normal position;

repeat for left side 2x (each)


III. Shoulder Exercises

A. Shoulder shrug

-shrug both shoulders and inhale

-lower shoulders slowly and exhale

-relax 3x

B. Shoulder Rotation

-rotate shoulders, alternating left

and right sides

-perform both forwards and backwards

-do the same motion moving both shoulders

at the same time 5x

IV. Hand and Arm Exercises

A. Fist Clenches

-squeeze fist 2 seconds

-relax hand for 2 seconds

-alternate with other hand 5x

B. Wrist Rotations

-make a fist and rotate clockwise

-rotate same fist counter-clockwise

-alternate hands 5x

C. Shoulder Touch

-make a fist and touch it to

opposite shoulder

-return hand to leg


-alternate hands 5x

D. Apple Picking

-stretch out arm and lean forward

-clench fist

-bring fist to opposite shoulder

-return hand to leg


-alternate arms 5x

E. Climb to the Sky

-hold arms above head

-grasp rungs of imaginary ladder

-alternate use of both arms .5 minutes

F. Hand/Knee Squeeze

-place hand on opposite knee

-push down with hand and upward with knee

-hold for 2 seconds

-relax for 2 seconds

-alternate sides 5x

G. Breast Stroke

-self explanatory 5x

H. Light Bulb Change

-elevate arm above head

-rotate hand as if screwing in a

light bulb

-alternate sides 5x

I. Finger Dexterity

1. place palms and fingers together

-separate thumbs, return

-separate index fingers, return .5 minutes

2. hold hands out in front of trunk,

palms up

-touch thumb to index finger,

return to open hand

-touch thumb to middle finger,

return to open hand .5 minutes

V. Stick Exercises

A. Hand Walk

-hold stick vertically between legs

with hands

-grasp stick at bottom with one hand

-walk up and down stick by alternating

hands 5x

B. Biceps Curl

-grasp stick with both hands,palms up

-curl stick upwards

-return to original position

-relax 5x

C. Kayak Paddles

-grasp stick with both hands, palms down

-start paddling to either side 5x


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