Q: What is the difference between "exercising" and the remedial lymphedema exercises that are part of my CDT (Complete Decongestive Therapy)?
A: Remedial exercises are designed to assist with lymph drainage from the areas of the body in which lymph fluid is congested. During Phase I CDT, these are performed with compression bandages on. Lymphedema exercises are performed in repetitions, without resistance, and are specific to the involved area(s). Many other types of exercise can improve physical function and also stimulate lymphatic flow. Strengthening exercises use weights or resistance to load the muscle(s); muscle strength improves over time. Flexibility exercises work to lengthen or stretch muscles to increase ease of movement. Both strengthening and flexibility exercises focus on particular muscles or groups of muscles. "Cardio" exercises such as walking, running, and bicycling, involve multiple muscle groups and are focused on increasing heart rate, blood circulation and respiration, resulting in improved cardiac function and endurance over time. All of these types of exercises can be beneficial for individuals with lymphedema when appropriately applied, avoiding strain, overuse, fatigue, and injury.
Q: I do not have lymphedema, but have been told I am at risk due to removal of lymph nodes. Should I wear a compression garment to avoid potential swelling when I exercise?
A: This is an excellent question, but one that has not been adequately studied. Most of the exercise research to date has investigated upper limb edema in individuals after breast cancer intervention. Fewer studies have focused on leg lymphedema, however more investigations are underway.
Until there is adequate evidence one way or the other, wearing of a compression garment during exercise for individuals at risk for lymphedema remains an individual choice. Some clinicians advice a Class I (low compression) garment for the at-risk body part, others do not. If you decide to wear a compression garment, it should be well-fitted and cover the entire area of the limb at risk. For example, an arm sleeve must also include a gauntlet or glove. A leg garment should cover the foot up to the top of the thigh. Before obtaining a compression garment, you should consider consulting with a lymphedema therapist for baseline measurements, garment suggestions, and exercise guidelines tailored to your needs. Whether or not you choose to wear a compression garment when you exercise, be mindful of your body's response to physical activity. Do not ignore pain or discomfort. If you notice that your at-risk limb feels heavy or full, or shows signs of swelling after exercise, rest and elevate the limb. Consult with your physician and lymphedema therapist.
Q: I like to swim, but have heard that warm water is not good for lymphedema. I have swelling in both of my legs and am not sure if I should go in my pool at home.
A: When the water temperature is excessively warm, there is an increase in circulation which is a concern for a swollen limb. The heat can cause more fluid to move into and remain in the edematous area, resulting in an increased fluid burden, potentially causing an increase in swelling. This is why hot baths, hot tubs, or saunas are not recommended for individuals with lymphedema. If your pool temperature is 90 degrees Fahrenheit (32 to 33 Celsius) or less, the temperature of the water should not present a concern for increasing your swelling. Do be mindful of the air temperature and sun exposure, however, if your pool is outdoors in a warm climate.
Q: How should I begin to exercise? How do I know if I have overdone my exercise program? I wear a Class 2 sleeve and glove for lymphedema. I have been quite sedentary.
A: Consult with your physician before beginning an exercise program; there may be other medical factors requiring you to modify your plan. Begin your exercise regime slowly; build up gradually. This is important if you have been sedentary. Know how your body feels on a "good day." Understand your energy level; be aware of how hard or easy the exercise may seem. Try to work in a range that may feel moderately hard to you: not too difficult or too easy. While exercising, you should be able to talk normally without feeling "out of breath".
Choose an activity that you enjoy. Repeat the same routine for at least 2 sessions before increasing one of the following: duration or time spent; amount of weight or resistance; or speed. Progressing gradually and staying "in tune" with your body's response will be keys to your success to maintain an exercise program in the long term. Make sure that you have sufficient rest between sessions (for example, exercise every other day), stay well hydrated (drink water), and, if exercising outdoors, avoid the heat of the day, or extremely cold temperatures.
Exercise should not be painful. A slight sensation of stretching when performing a flexibility exercise, or feeling a muscle "work" during movement are normal sensations, but pain that lingers after you have stopped may reflect that you have done too much and may indicate that an injury has occurred. Delayed discomfort which arises a day or two after a workout is a result of the physiology of muscle action, it may represent that the workout was harder than you may have realized, potentially resulting in some tissue micro-trauma and inflammation. Monitor your body's response to swelling, and modify or cut back on the intensity of the next exercise session.
Wear your compression garment when you exercise. Be aware of your lymphedema response. If your arm, hand, chest, or upper back (on the same side) feel heavy, full, or if you notice an increase in your edema, the exercise may have been more than your lymphatic system could handle. Rest, elevation, continued use of compression garments or bandaging, and self-manual lymph drainage (MLD) may be needed. Follow up with your physician and/or lymphedema therapist for advice specific to your needs.
Catherine Tuppo, PT, MS, CLT-LANA
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