For a long time, it was debated whether patients with lymphedema should partake in an exercise regimen. Today, fears of overloading the lymphatic system and of causing injuries have been resolved by research findings; however, there are precautions to take, and some types of exercise are more beneficial than others. When done correctly, these exercises can improve strength, quality of life, and ability to care for oneself and others, increase range of motion, decrease pain, and even reduce edema. Lymphedema-specific programs have been developed by wonderfully creative and knowledgeable people, too. As always, patients must consult with a health care provider before embarking on a new exercise regimen. If you are managing a patient who lacks strength or full range of motion, has difficulty in daily activities, or has problems walking, therapists can help develop a safe program and improve deficits to work up to a recreational exercise program.

Precautions for Exercise in Patients with Lymphedema

Precautions should always be taken. If lymphedema is diagnosed or if the patient is at risk for lymphedema, then use of compression garments and pre- and post-exercise manual lymphatic drainage would be advised. It is always easier to develop a routine exercise program that you enjoy, so continuing an activity you love with lymphedema precautions is great. Encourage patients to stay well hydrated so that the lymphatic system and the rest of their organ systems function well. Precaution for sunburn, bug bites, and accidental skin injuries should be observed because these injuries could exacerbate lymphedema.

Exercise Programs for Patients with Lymphedema

Sherry LeBed Davis has developed a wonderful exercise program for cancer patients that has been adapted into wellness for adults and children (see the Healthy Steps link at the end of this blog). It uses music to create a fun movement and exercise program. In addition to being available at hundreds of locations worldwide, it can be obtained at online resources. Deep breathing, sequence of movements, and complete use of all extremities make this an exceptional exercise program for patients with lymphedema.

Although there hasn’t been research to prove that aquatic therapy is better than standard care, a systematic review of current research shows that standard land-based care versus aquatic exercise indicates no significant difference in outcomes. So, pending further research, a water regimen can be great exercise, with at least one meter depth for the legs. There is benefit as well for the arms. Again, if preparatory manual lymphatic drainage and sequential exercises are done, get patients in the pool! Check out the Internet for a multitude of videos.

Yoga offers benefits with its deep breathing, gentle approach, and meditation incorporated into the program. Decreasing stress increases lymphatic flow, and the benefits of increasing range of motion, flexibility, and muscle strength are desirable outcomes, too. Hatha and Iyengar methods are gentle and slow. Advise patients to request adapted poses to fit their abilities and lymphedema. Some poses that offer elevation of your involved extremities are even better. (See the Lymphedema blog link below.)

For individuals with lymphedema reading this post, if you have a exercise routine already, consult your health care provider to determine any necessary modifications. What are you waiting for? Put your garment on and get out and exercise!

Suggested Resources and Reading
Healthy Steps: www.gohealthysteps.com
Morris C, Wonders KY. Concise review on the safety of exercise on symptoms of lymphedema. World J Clin Oncol. 2015;6(4):43–4. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26266100/
Stewardson M. Lymphedema relief through yoga. Yoga J. August 28, 2007. Available at: https://www.yogajournal.com/lifestyle/calm-cure
Yeung W, Semciw AI. Aquatic therapy for people with lymphedema: a systematic review and meta-analysis. Lymphat Res Biol. 2018;16(1):9–19. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28346851
Yoga for Lymphedema: www.lymphedemablog.com

About the Author
Janet Wolfson is a wound care and lymphedema educator with ILWTI, and Lymphedema and Wound Care Coordinator at Health South of Ocala with over 30 years of field experience.