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Management

    continued...

    Treatment

    The goal of lymphedema treatment centers on controlling limb swelling and minimizing complications; the underlying lymphatic vessel interruption cannot be corrected. Because clinical trials evaluating pharmacologic measures are generally not found to be effective, nonpharmacologic measures are the mainstay of treatment, with the goal of maximizing the activities of daily living, decreasing pain, increasing range of motion, and improving function.

    Exercise

    Nonfatiguing exercises may induce sufficient muscle contraction to move lymph into terminal lymphangioles and reduce swelling. Aerobic exercise may also increase the tone of the sympathetic nervous system, which causes the lymph collector vessels to pump more vigorously.[3] Multiple studies indicate that exercise, including upper-body exercise, is safe for women with breast cancer–related lymphedema.[4]

    There is also evidence that slowly progressive weight lifting among women with previously diagnosed breast cancer–related lymphedema leads to a reduction by half of the likelihood of a clinically meaningful exacerbation of lymphedema (a flare-up) that requires treatment by a physical therapist.[5][Level of evidence: I] A group of 141 breast cancer survivors with lymphedema were randomly assigned to a twice-weekly, year-long weight-lifting intervention (N = 71) or to a wait-list comparison group (N = 70). The intervention started with 13 weeks of supervised training with little to no resistance; the amount of weight lifted was increased very gradually and only if there was no change in lymphedema symptoms or swelling. The participants all wore well-fitting, custom-made compression garments that were replaced 6 months into the intervention period. Women with breast cancer–related lymphedema should be guided to work with a certified fitness professional or physical therapist to learn the proper biomechanical form for upper-body weight-lifting exercises before undertaking this program on their own. (The specifics of the intervention are available to certified fitness professionals and physical therapists through the National Lymphedema Network.) Further research is needed to develop a version of this intervention that can be broadly disseminated.

    One small pilot study has examined the safety of an intervention similar to that described above in cancer survivors with lower-extremity lymphedema secondary to melanoma or gynecologic or urological cancers. In this uncontrolled pilot study, 20% of participants developed a cellulitic infection within the first 2 months after starting a slowly progressive weight-lifting regimen.[6] Further research is needed to determine whether weight-lifting is a safe exercise modality for cancer survivors with lower-extremity lymphedema.

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