|Andrea Branas, MSE, MPT, CLT & Joy Cohn, PT, DPT, CLT|
|Good Shepherd Penn Partners|
Is it safe to exercise with lymphedema? Won't I swell more if I exercise?
Yes, exercise is safe with lymphedema as long as you pay attention to a few basic principles. If you have lymphedema you should exercise wearing your compression bandages or your compression garments.
Will exercise make my lymphedema worse?
No. Research has shown us that in women with breast cancer related lymphedema, exercise is safe. In fact, women who participated in a supervised, slowly progressive weight lifting program had a 50% reduction in the likelihood of lymphedema flares during the time of the study. 1
The research to find out how exercise effects lower extremity lymphedema has not yet been done. This is an area where researchers will be looking in the future. However, our best evidence shows us that exercise will not make lymphedema worse.
Why should I wear compression when I exercise?
The compression garments, or bandages, increase the efficiency of the muscle pumps in moving the fluid from your limb(s), trunk, or face. Without the compression the increased circulation and increased production of lymph fluid will collect in the areas that are lymphedematous, or swollen.
How do I begin to exercise?
First, get clearance from your physician that it is okay to begin exercising.
Then begin slowly with no weight, doing active range of motion exercises.
Your exercise should be:
Low intensity Pain free Within the guidelines for the surgical procedures you may have had Done while wearing compression bandages or garments Enjoyable!
What kind of exercises should I do?
Your exercise program should include the following:
How can I start my own exercise program?
Set parameters for exercise:
Intensity – target heart rate for aerobic, endurance exercise. Time of day – set a time of day that works best for you. Try to be consistent with the time so that it becomes part of your daily routine
Vary your exercise routine, for example:
Strength and flexibility training every other day Aerobic exercise on the days you don't do strength and flexibility Find someone to exercise with you – it's more enjoyable that way Incorporate deep breathing and posture into your exercise
What are some examples of aerobic exercise?
Aerobic exercise is any exercise that you do for a continuous period of time at your target heart rate with the goal of attaining 25 – 30 minutes of exercise. Start slowly and gradually build up the amount of time you are exercising until you reach 25 – 30 minutes. You should be able to complete the exercise without being short of breath, overly fatigued, or sore.
Continuous walking or walking on a treadmill Riding a bicycle or a stationary bicycle Jogging Swimming or walking laps in the pool with water above waist height Going up and down a flight of stairs Exercising on a stepper or an elliptical machine
Target Heart Rates for Exercise:
What should I expect to feel once I start exercising?
You will likely experience some muscle soreness at first that will resolve after a few days as your body gets used to the new activity. Pay attention to what your body is telling you and do not push yourself to the point of over fatigue. Your health care provider can help you start an exercise program that is appropriate for your level of conditioning. The important thing to remember is that you need to start out with low levels of exercise and gradually increase the intensity and length of time of your exercise as you get stronger and more conditioned.
If you notice increased, persistent swelling after exercise, you may have done too much. Remember, you need to start with small amounts and build gradually.
Do you need more information or help starting an exercise program?
Some people prefer to start an exercise program under the guidance of a physical therapist or exercise professional. If you have any concerns about starting an exercise program on your own, talk to your doctor about a referral to a physical therapist or work with a qualified exercise professional.
Are there special therapists or exercise professionals who work with people with lymphedema?
Physical Therapists with specialized training as Certified Lymphedema Therapists are the best people to work with you. Some facilities have specific programs designed to address the needs of people with lymphedema. Good Shepherd Penn Partners has a Strength After Breast Cancer Program to help people start a strength training exercise program.
Have fun! Enjoy your new level of activity! Notice your new level of energy!
Schmitz K.H., Troxel A.B., Cheville A., Grant L.L., Bryan C.J., Gross C., Lytle L.A., Ahmed R.L. Physical Activity and Lymphedema (The PAL Trial): Assessing the safety of progressive strength training in breast cancer survivors. Contemporary Clinical Trials, 30(3):233-45, 2009
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