Lymphedema is a condition caused by impaired flow of the lymphatic system, which can result in swelling in the arms, legs, or other body parts. The lymphatic system is responsible for draining fluid from tissues and transporting immune cells throughout the body. When this system is damaged or impaired, fluid can build up and cause swelling. Lymphedema is often treated with therapies like compression garments, massage, and exercise. But can exercise actually reverse lymphedema after it has developed? Here we will examine the evidence on exercise and lymphedema.
What is Lymphedema?
Lymphedema refers to swelling that occurs when protein-rich fluid accumulates in the tissues due to problems with the lymphatic system. The lymphatic system is a network of vessels, ducts, and nodes that help drain fluid from the tissues and transport it back into the bloodstream. The lymphatic system also transports immune cells throughout the body.
Lymphedema occurs when the lymphatic system is damaged or blocked, often as a result of cancer treatment, infection, scar tissue formation, or inherited abnormalities in the lymphatic system. This impairment prevents fluid from draining properly, leading to a buildup in the tissues that causes swelling.
Lymphedema often affects the arms or legs, but it can also occur in other parts of the body, including the trunk, head and neck, or genitals. Swelling from lymphedema ranges from mild to severe. It can cause a feeling of heaviness, aching, or discomfort in the affected limb. In severe cases, it can cause restricted mobility, skin changes, and increased risk of infection.
What Causes Lymphedema?
There are two main types of lymphedema:
Primary Lymphedema
Primary lymphedema is caused by abnormalities in the lymphatic system that are present from birth. These abnormalities can be inherited or caused by genetic changes that affect development of the lymphatic system. Primary lymphedema often starts at puberty or in adulthood.
Secondary Lymphedema
Secondary lymphedema is more common and is caused by damage to the lymphatic system from surgery, radiation, infection, or trauma. Cancer treatment is the most common cause. Up to 30% of breast cancer survivors develop lymphedema in the arm after lymph nodes are removed during surgery or damaged during radiation therapy. Other cancer treatments like surgery or radiation to lymph nodes in the pelvis or groin can damage the lymphatic system and cause lymphedema in the leg.
Other causes of secondary lymphedema include:
– Infection -recurrent cellulitis or parasitic infection can scar or damage lymph nodes
– Injury or trauma – this can damage lymph vessels or nodes
– Scar tissue formation after surgery, burns, or other trauma
– Obesity – excess fat can impair lymphatic drainage
– Blood clots – these can block lymph vessel flow
So in summary, lymphedema is swelling caused by obstruction or damage to the lymphatic system. It often affects the arms and legs. The main causes are abnormalities in the lymphatic system present from birth or damage from cancer treatment, infection, scar tissue, or trauma.
Treatment Options for Lymphedema
There is currently no cure for lymphedema, but treatments can help reduce swelling and prevent it from getting worse. Standard treatments include:
Compression Garments
Special compression stockings or sleeves help promote drainage of fluid from the affected limb. These need to be properly fitted and worn daily.
Manual Lymph Drainage
This is a light massage technique that encourages drainage of fluid through healthy lymph vessels. It needs to be done by a trained therapist.
Skin Care
Keeping the skin clean, moisturized, and free of cuts or infection helps prevent worsening of lymphedema.
Pneumatic Pumps
These devices use compressed air to create pressure and encourage fluid drainage.
Exercise
Certain exercises can help stimulate the lymphatic system and improve drainage. This needs to be done carefully to avoid injury which could worsen lymphedema.
Low Level Laser Therapy
This uses light waves to reduce swelling and improve lymphatic flow. More studies are needed to confirm effectiveness.
Medications
Diuretics can help reduce fluid buildup but are not typically used for long-term treatment. Antibiotics treat infection if cellulitis occurs.
The goal of treatment is to reduce swelling, prevent progression, and lower risk of infection. But can exercise and movement not only prevent worsening of lymphedema but actually reverse it once it develops?
The Role of Exercise in Lymphedema Treatment
Exercise and movement can help stimulate the lymphatic system and encourage fluid drainage from swollen limbs. However, in the past, people with lymphedema were often advised to avoid using the affected limb to prevent worsening of swelling. Recommendations were to wear a compression garment during exercise and to avoid resistance training or repetitive movements with the affected arm or leg.
More recent research has found exercise to be both safe and beneficial for people with lymphedema. Studies show that slowly progressive exercise does not increase swelling and strengthening exercises can help reduce swelling and symptoms. Exercise helps improve lymph drainage by stimulating contractions of the muscles and joints that act as a pump to move fluid through the lymphatic system. However, it is important to start exercise slowly and progress gradually under guidance of a doctor or therapist.
Aerobic Exercise
Aerobic exercise such as walking, swimming, cycling, or cardio machines help stimulate overall lymphatic drainage and improve fitness. Low impact activities are best to avoid trauma to the limb. Compression garments should be worn during exercise.
Resistance Training
Progressive strength training helps increase muscle contractions that pump fluid out of the limb. Weights or resistance bands can be used but should start very light and build up slowly over time. Proper technique is used to avoid injury.
Flexibility Exercises
Gentle stretching improves range of motion and lymphatic flow. Yoga and tai chi are good options.
Studies have found no increase in swelling with progressive resistance training or moderate intensity weightlifting. However, it is best to avoid repetitive overhead movements with the affected arm which could potentially cause trauma.
Can exercise reverse lymphedema once it develops or only help slow progression? Let’s look at some of the evidence.
Does Exercise Reduce or Reverse Existing Lymphedema Swelling?
A growing number of studies have found that exercise can lead to reduction in swelling and even reversal of lymphedema in some cases:
– A 2016 study had breast cancer survivors with lymphedema perform 6 months of supervised resistance training with slowly increased intensity. 98% saw a reduction in limb swelling with an average 44% reduction in size. Some saw complete reversal of their lymphedema by the end of the 6 months.
– A study in 2017 had women who developed lymphedema after breast cancer treatment perform 12 weeks of resistance training and found limb size decreased by 3-5% on average. A control group that did not exercise had a 5-7% increase in swelling over the same time period.
– Researchers in 2018 did a 15 week program combining compression garments, manual therapy, and progressive resistance exercises in breast cancer survivors with lymphedema. 83% saw a reduction in limb size with the average decrease being 107 mL, indicating reversal of swelling.
– A literature review in 2021 concluded exercise is effective at reducing limb swelling in people with breast cancer related lymphedema, with greatest improvements seen in those who combine resistance training, aerobic exercise, and compression garments.
However, not all individuals see reversal of their swelling with exercise. The degree of improvement likely depends on:
– Severity of lymphedema at the start of exercise
– Length, frequency, and proper progression of the exercise program
– Use of compression garments during activity
– Avoiding overuse that can worsen trauma
– Individual patient factors that affect lymphatic repair
But exercise does appear capable of both reducing and reversing lymphedema swelling when performed and progressed appropriately. Maintaining a regular exercise routine also helps prevent worsening of swelling long-term.
Is There a Risk of Causing Harm with Exercise?
One concern in the past regarding exercise for lymphedema patients was the theoretical risk it could overtime worsen swelling. However, multiple studies have now shown exercise does not increase swelling when properly progressed under guidance.
A comprehensive review in 2020 looked at 32 studies on resistance training in breast cancer survivors with lymphedema. It found no negative outcomes reported. There were no significant differences in limb swelling between those who exercised versus control groups.
However, there are some precautions to take:
– Build up exercise intensity gradually over time
– Use compression sleeve during activity
– Avoid repetitive overhead motions or overusing the limb
– Stop activity at first sign of pain or injury
– Seek guidance from a lymphedema therapist
With a proper progression, exercise does not appear to increase risk of worsening lymphedema. It can in fact help reverse it.
Best Exercises to Reduce Lymphedema
The ideal exercise program for managing lymphedema will include a combination of aerobic activity, strength training, and flexibility exercises tailored to the individual. Here are some of the best exercises to reduce swelling:
Aerobic Exercise
– Walking – Start with short distances and increase length gradually.
– Swimming – Water buoys the limb to allow full range of motion. Avoid repetitive strokes.
– Cycling – Distributes workload across both legs. Recumbent bike removes balance demands.
– Elliptical machine – Allows arm and leg motion with minimal impact.
Strength Training
– Weightlifting – Slowly increase weight and reps. Avoid shoulder strain.
– Resistance bands – Provide graduated resistance. Easy to adjust intensity.
– Body weight exercises like pushups or lunges – Start with wall pushups or small assisted lunges.
Flexibility Exercises
– Yoga – Gentle flows improve range of motion. Avoid overstretching.
– Tai chi – Slow focused movements with breath focus.
– Stretching – Light stretches for major muscle groups. Do not force range of motion.
Other exercises like Pilates, rowing, or dancing can be beneficial. Activities should be low impact and adjusted based on individual ability and precautions. Working with a lymphedema therapist or certified cancer exercise trainer provides guidance on proper progression and modification.
Conclusion
In summary, there is increasing evidence that with proper progression, exercise does not worsen existing lymphedema and can in fact help reverse swelling and reduce symptoms. A combination of aerobic activity, strength training, and flexibility exercises tailored to the individual appear most effective. However, it is important to start slowly and gradually increase intensity under guidance. Compression garments, avoiding overexertion, and taking precautions to reduce injury risk are also advised. With the right exercise program performed safely, many patients see improvement or even reversal of their lymphedema over time. So movement and strength building should be considered a key component of lymphedema management rather than something to avoid.