Lymphedema (PDQ®): Supportive care - Health Professional Information [NCI] - Management
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. Multiple studies indicate that exercise, including upper-body exercise, is safe for women with breast cancer–related lymphedema.
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.[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. Further research is needed to determine whether weight-lifting is a safe exercise modality for cancer survivors with lower-extremity lymphedema.
Gradient pressure garments
Gradient pressure garments (also known as lymphedema sleeves or stockings) generate greater pressures distally than proximally, which enhances mobilization of edema fluid. Some patients may require custom-made sleeves to achieve an appropriate fit. The use of these garments may be especially important at high altitudes, such as during air travel, because the ambient atmospheric pressure is less than the outlet transcapillary pressure within the superficial tissues, which can lead to worsening edema.
Bandaging involves the use of inelastic material to discourage reaccumulation of lymph by reducing capillary ultrafiltration and optimizing the efficacy of the intrinsic muscle pump. Bandaging may change an initially resistant limb to one with less edema, resulting in decreased limb volume and allowing a garment to be applied successfully.[Level of evidence: I]