LYMPHEDEMA EXERCISE and EXERCISES
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One thing that really bothers me is when I hear of people with lymphedema who give up on any activity of exercise because they have this condition. You have to want more from life than just being a couch potato, exercising only your thumb as you click that TV remote.
I envision life like a football game. The doctor may say you can only go to the 10 yard line. But, you must with all endeavor try for that goal. Even if you only really the 50 yard line, you know that you gave it your best shot!
To stay as healthy as you can, exercise is absolutely necessary, this is true for lymphedema people and non-lymphedema people. The body simply was not designed to sit on that back side for decades. I am a very strong proponent of doing as much as you can despite lymphedema. The key is to understand what type and how much exercise you can undertake.
Remember also, the lymphatic system does not have its own pump, like the heart. It moves through action, exercise and activity. Getting on and keeping an exercise activity will help increase that lymph flow.
I am not going to include the usual list of "exercises to avoid list, because, honestly, what exercise you are able to participate in depends on the stage of your lymphedema, other medical conditions,
and the advice of your doctor and therapist.
My favorite exercise is swimming. The gentle pressure of the water against the limb acts in many ways like the natural movements of our body that activates the lymphatics. In early stages of lymphedema, swimming can actually decrease the size of your lymphedema limb.
- - -
Cautions and Considerations
Remember, there are only three factors that will affect what type of exercise you will be able to do with lymphedema.
1. Accompanying medical conditions. These include, but are not limited to heart problems, diabetes, pulmonary conditions. You must
check with your physician.
2. Stage and type of lymphedema. Obviously those with arm lymphedema
would have a problem with bowling. But those with leg lymphedema and no arm involvement shouldn't. Stage 1 & 2 lymphedema would present no problem with hiking and walking. At stage 3, it is more difficult. So take the type and stage of your lymphedema into consideration.
3. Risk of injury is also a factor. At any stage you should consider the consequences of broken bones, torn ligaments and sprained muscles. These can be a serious complication with lymphedema.
Other points to remember
1. Work with your therapist and physician to design an exercise program that is both safe and effective for you.
2. Your should always wear the appropriate lymphedema garment when undertaking any exercise.
3. Swimming - Hot tubs, pools (especially community pools) and lakes during the summer (in warmer climates any time of the year) present an increased risk for all types of infections because of bacteria. I urge caution there.
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EXERCISES FOR LYMPHEDEMA
Exercises with Stage 1
In this stage you are able to participate in just about any and all exercises. The only ones to be concerned with are high impact ones.
Also, parachuting, hang-gliding and bungee jumping are definitely out (unless you are slightly jaded like I am, there probably is no need to warn about these).
Exercises with Stage 2
Stretch exercises - flexion, extension, abduction, rotation. The all include movements of the arms toward and away from you body, arms across your chest, behind your head and back.
Walking, Hiking, Jogging
Swimming, Canoeing, Rowing
Bowling, Archery, Bicycling
Dancing, Sailing, Scuba
Jiu Jitsu, Karate, Judo
Sailing, Frisbee, Fencing
Jogging, Skiiing, Shooting
What was that about being limited? This is only a partial list too.
Exercises with Stage 3
See the above - yes, even in stage 3 you can participate in all of the above sports. You may just have to modify how much and how long.
It wasn't until the I had the lymphomas that greatly complicated my life that I finally had to eliminate those that put a higher amount of strain on my legs.
SITES WITH ARTICLES RELATING TO EXERCISE AND LYMPHDEMA
Step Up, Speak Out
Decongestive and Breathing Exercises for Lymphedema
Joachim Zuther - Lymphedema Blog
Lymphedema and Exercise FAQS
Friends Families Suffers of Lymphedema
Challenging the Myth of Exercise-Induced Lymphedema
Dr. Susan R. Harris, PhD, PT, School of Rehabilitation Sciences - UBC
Abreast in the West
Exercise, Lymphedema, and the Limb at Risk
Arm Exercises After Breast Surgery
Lymphoedema Association of Australia
Light Arm Exercises That Can Help Prevent/Manage Lymphedema
The rationale behind doing mild exercise is that muscle contractions, especially in the calf and arm, help to promote lymph flow to veins in the neck region where it returns to the blood circulation. Exercise also helps the proteins in lymph fluid to be reabsorbed. Both result in a lesser severity of lymphedema.
Although there is no consensus on the type of exercise regimen for people with lymphedema, all schools of thought agree that exercise is a necessary part of healing and that it should be tailored to each patient's needs and abilities. In general, it has been suggested that a monitored, progressive exercise program, in which a person slowly builds up their stamina and strength is far better than a strenuous one, no matter what the patient's previous athletic history. High speed activities such as golf, tennis, jogging or hiking at high altitudes are not suggested as they may actually increase lymphedema. Activities such as walking, swimming, light weights or cycling, in contrast are generally safe. For people with severe lymphedema who have a difficult time moving, even breathing enhances the pumping of lymph in the chest region. Deep breathing exercises such as mild yoga may be especially helpful to promote both relaxation and decrease lymph load.
Several rules about exercising with lymphedema should be observed:
Always start an exercise program gradually to avoid sprains and injury to muscles. It will also allow the person to observe how the edematous extremity responds to exercise. This will differ for each person.
A compression garment or bandages should always be worn during exercise. This provides pressure on the limb and assists in pumping lymph from the extremity.
For women with post breast cancer treatment lymphedema in the arm, arm exercises should begin as soon as the doctor okays it. If the shoulder or wounds are sore, begin with mild pendulum exercises. Lean forward and let your arms hang down, then make circles. You can also swing them forward, backward and sideways. Once you can lift the arm over your head, you can begin active exercises.
An exercise program should involve all of the following movements:
a.Flexion (arms over the head close to the ear, palms toward the head)
b.Extension (move straight arms toward your back)
c.Abduction (arms away from the body, palms down)
d.Horizontal abduction (move arms across the chest)
e.External rotation (put hands behind your head)
f.Internal rotation (put hands behind your back)
Once you can do these movements 30 times without weights, add one pound per week. Take your time. Begin with 10 and add 5 repetitions each day. If weight lifting adds to increased lymphedema, just do the exercise without the weight.
Daily exercise should be done as long as motion is limited. Once you have full movement, you can exercise 3x per week.
A Sample Progressive Exercise Program (12)
This exercise program has been devised to increase your strength and endurance. The program, which takes you from your bed to being up and around in three stages, can be started as soon as your physician says its ok. You can refer to the healthlibrary.stanford.edu/resources/videos.html website for videotapes of appropriate exercises.
Stage I is on one tape and Stages II and III are together on another tape. The demonstrations include warm-up and full-exercise programs with relaxation sessions at the end.
Stage I exercises are simple and help you to maintain and increase your range of motion. They require little exertion and can be done in bed.
Stage II exercises use a small added weight to increase resistance and can be done when you are spending part of the day out of bed. Once you have gotten back to your normal activities, you will need to establish an exercise routine that includes exercises like these to build up your body's reserves so that temporary bouts with bed rest will not deplete your energy stores.
Stage III exercises provide you with a strengthening and maintenance program for when you are able to spend the whole day out of bed. This series of exercises is a progressive and comprehensive physical rehabilitation program for people with acute or chronic illness. With your doctor's permission, you can begin these exercises even while you are recovering from surgery or undergoing cancer therapy.
Cancer Supportive Care Programs
Exercise - Harvard School of Public Health
Although there are no sure-fire recipes for good health, the mixture of healthy eating and regular exercise comes awfully close. Most of Nutrition Source is dedicated to singing the praises of a good diet. This is where exercise gets its due.
Regular exercise or physical activity can do everyone a world of good. It helps prevent heart disease, diabetes, osteoporosis, and a host of other diseases, and is a key ingredient for losing weight or maintaining a healthy weight (1).
With all these good things going for it, it's mind boggling that only a minority of Americans get enough exercise or leisure-time physical activity to benefit.(2)
Studies that have followed the health of large groups of people for many years, as well as short-term studies of the physiologic effects of exercise, all point in the same direction: A sedentary (inactive) lifestyle increases the chances of becoming overweight and developing a number of chronic diseases. Exercise or regular physical activity helps many of the body's systems function better and keeps a host of diseases at bay. According to the US Surgeon General's report, Physical Activity and Health (1), regular physical activity:
The cost of inactivity
If exercise and regular physical activity benefit the body, a sedentary lifestyle does the opposite. According to analyses by Graham Colditz, a professor of epidemiology at the Harvard School of Public Health, the direct medical cost of inactivity is at least $24 billion a year.(3) An analysis of health-care costs by a team from the federal Centers for Disease Control and Prevention suggests that because individuals who are physically active have significantly lower annual direct medical costs than those who are inactive, getting people to become more active could cut yearly medical costs in the U.S. by more than $70 billion.(4)
Reaping the benefits
A wealth of studies have established the benefits of exercise. Yet two related - and very practical - questions remain: What is the best kind of exercise? and How much exercise do we need each day?
If you don't currently exercise and aren't very active during the day, any increase in exercise or physical activity is good for you. Some studies show that walking briskly for even one to two hours a week (15 to 20 minutes a day) starts to decrease the chances of having a heart attack or stroke, developing diabetes, or dying prematurely.
The U.S. Surgeon General,(1) along with the Centers for Disease Control and Prevention and the American College of Sports Medicine,(5) recommend getting a minimum of 30 minutes of moderate-intensity physical activity on most days of the week. You can do all 30 minutes at once or break it up into 10- or 15-minute periods.
Moderate intensity exercise or physical activity is activity that causes a slight but noticeable increase in breathing and heart rate. One way to gauge moderate activity is with the "talk test" - exercising hard enough to break a sweat but not so hard you can't comfortably carry on a conversation.
Exercise experts measure activity a different way. They talk about metabolic equivalents, or METs. One MET is defined as the energy it takes to sit quietly. For the average adult, this is about one calorie per every 2.2 pounds of body weight per hour someone who weighs 160 pounds would burn approximately 70 calories an hour while sitting or sleeping.
Moderate intensity activities are those that get you moving fast enough or strenuously enough to burn off three to six times as much energy per minute as you do when you are sitting quietly, or exercises that clock in at 3-6 METs.
Brisk walking fills the bill for moderate-intensity activity. How fast is brisk? For the average person, it means walking 3-4 miles an hour, or about as fast as you'd walk if you were late for an important appointment. Walking is an ideal exercise for many people - it doesn't require any special equipment, can be done any time and any place, and is generally very safe.
Energy requirements of common daily activities*
|Playing the piano||2.3|
|Golf (with cart)||2.5|
|Walking (2 mph)||2.5|
|Walking (3 mph)||3.3|
|Calisthenics (no weight)||4.0|
|Golf (no cart)||4.4|
|Walking (4 mph)||4.5|
|Ballroom (fast) or square dancing||5.5|
|Skiing (water or downhill)||6.8|
|Climbing hills (no load)||6.9|
|Walking (5 mph)||8.0|
|Jogging (10 min mile)||10.2|
|Sitting; light activity||1.5|
|Walking from house to car or bus||2.5|
|Taking out trash||3.0|
|Walking the dog||3.0|
|Household tasks, moderate effort||3.5|
|Lifting items continuously||4.0|
|Gardening (no lifting)||4.4|
|Mowing lawn (power mower)||4.5|
|*These activities can often be done at variable intensities, assuming that the intensity is not excessive and that the courses are flat (no hills) unless so specified. Categories are based on experience or tolerance; if an activity is perceived to be more than indicated, it should be judged accordingly.|
|** MET indicates metabolic equivalent. One MET is the amount of energy used when sitting quietly.|
|Source: Fletcher et al., Exercise standards for testing and training, Circulation 2001.(18)|
What's more, studies such as the Nurses' Health Study,(6, 7) Health Professionals Follow-up Study,(8) Women's Health Study,(9) Harvard Alumni Health Study,(10) National Health Interview Survey,(11) Women's Health Initiative,(12) Honolulu Heart Program,(13) and others have demonstrated that this simple form of exercise substantially reduces the chances of developing heart disease, stroke, and diabetes in different populations.
If you don't like walking, any activity that makes your heart work harder will suffice, as long as you do it long enough and often enough.
Keep in mind that 30 minutes of moderate-intensity activity a day is an excellent starting point, not an upper limit. Exercising longer, harder, or both can bring even greater health benefits.
If you are exercising mainly to lose weight or maintain a healthy weight, 30 minutes or so a day will work if you're careful about how much you eat.(14) But you may need to exercise more, or more vigorously. A report from the Institute of Medicine concluded that it takes 60 minutes a day of moderate-intensity activity to maintain a healthy weight.(15)
Among the 3,000 men and women who are part of the National Weight Control Registry, a select club that includes only people who lost more than 30 pounds and kept them off for at least a year, the average participant burns an average of 400 calories per day in physical activity. That's the equivalent of about an hour of brisk walking.(16)
Feeling what's right
The current recommendations for exercise and physical activity call for moderate intensity activities, or those measured at 3-6 METs (see table). Keep in mind that these are general recommendations aimed at the general population.
The problem with guidelines is that they try to cover as many people as possible. In other words, they aren't right for everyone. How much exercise you need depends on your genes, your diet, how much muscle and fat you carry on your frame, how fit you are, and your capacity for exercise.
A study of more 7,000 men who graduated from Harvard before 1950 suggests that older people, those who are out of shape, or those with disabilities may get as much benefit from 30 minutes of slower walking or other exercise as younger, more fit people get from the same amount of more intense activity.(17)
In other words, if an exercise or physical activity feels hard, then it is probably doing your heart - and the rest of you - some good, even if it doesn't fall into the "moderate" category.
Don't get stuck in a rut, though. As your body adapts to exercise, you'll need to push yourself more and more to get the same cardiovascular workout. Another way to know that it's time to pick up the pace is if you see your weight or waist size start creeping up on you.
Beyond the heart
When talking about the benefits of exercise, keeping the heart and blood vessels healthy usually gets most of the attention. For many older individuals, though, stretching and strength training exercises that barely raise the heart rate - and so aren't considered moderate at all - may be just as important. Such exercises can maintain or improve balance, muscle strength, and overall function.
Resistance training or weight training is probably the most neglected component of fitness programs but one of the most beneficial. Our body can basically be divided into 2 components. Fat mass consists of the body's fat store, while fat free mass is a combination of non-fat tissue such as muscle, bone, internal organs etc. An important part of fat free mass is lean body mass, which is essentially muscle.
Muscle is metabolically active tissue. This means that it utilizes calories to work, repair and refuel itself. Fat requires very few calories, it just kind of sits there. As we enter our mid to late twenties, we slowly start to lose muscle as part of the natural aging process. This means that the amount of calories we need each day starts to decrease and it becomes easier to gain weight. By engaging in regular strength training exercise, it is possible to decrease this loss of lean muscle tissue and even replace some that has been lost already. Studies have shown strength training to increase lean body mass, decrease fat mass and increase resting metabolic rate (a measurement of the amount of calories burned per day) (19,20,21). These effects may make it easier to manage one's weight.
Another beneficial effect of resistance training pertains to bone health. In addition to weight bearing cardiovascular exercise, weight training has been shown to help fight osteoporosis. For example, in postmenopausal women, 2 strength training sessions a week for one year increased bone mineral density by 1%. A sedentary control group lost 2% in the same time period (22).
Finally, in older populations, resistance training can help maintain the ability to perform functional tasks such as walking, rising from a chair, climbing stairs and even carrying their own groceries.
Many people are intimidated by the idea of resistance training or are afraid of injury. They need not be. A great idea is to consult an expert. Consider hiring an exercise physiologist or personal trainer for a few sessions until you have the confidence to branch out on you own. For more information and to locate a trainer contact, The American Council on Exercise.
Flexibility training or stretching exercise is another important part of overall fitness. It has been shown to increase range of motion, decrease muscle soreness associated with exercise and may decrease exercise related injury.
Tips for Getting Exercise Into Your Life
Time for an Average 150 lb Adult to Burn 150 Calories
Duration in minutes
|Moderate||Walking, moderate pace (3 mph, 20 min/mile)||
|Moderate||Walking, brisk pace (4 mph, 15 min/mile)||
|Moderate||Lawn mowing (powered push mower)||
|Hard||Jogging (5 mph, 12 min/mile)||
|Very hard||Running (6 mph, 10 min/mile)||
|* MET indicates metabolic equivalent. One MET is the amount of energy used when sitting quietly.|
|Source: Physical Activity and Health: A report of the Surgeon General (1)|
The Role of Exercise in Treating Lymphedema
Arm Elevation and Exercise
(and Staying) Aerobically Fit through Swimming!
Dr. Susan Harris, Phd. PT, School of Rehabilitation Sciences – UBC
NATIONAL LYMPHEDEMA NETWORK
Exercise: A thorough review of exercise
National Lymphedema Network
Backpacking and Lymphedema
Q: I am an avid backpacker and mountaineer for many years, as high as 20,000 feet. Recently, I had a modified radical mastectomy (MRM) with positive lymph nodes involved and finished my six months of chemotherapy and radiation with minimal complications, except losing my hair. I continued to work full time as a legal secretary and do low impact aerobics, including pushups. My concern: what are the odds of developing LE from carrying a heavy backpack (45 lbs. or more)?
A: I can understand your concerns, especially after reading in all the literature that carrying heavy bags over the shoulder is contraindicated. First of all, you seem to be in superb condition, which certainly was in your favor going through your surgery and follow-up treatment. The question again arises, why does one and not the next person develop LE? Despite living the same healthy lifestyle, there are people who already have a compromised lymphatic system and who develop lymphedema shortly after surgery. It is often unpredictable, but if you really want to know, there is a diagnostic procedure called Lymphangioscintigraphy which can visualize the lymphatics and determine if your lymphatic system shows normal drainage capacity; if this is the case, you have little to worry about. My recommendation is that whatever you do, always wear a compression sleeve while exercising, especially in high altitude (simply going to a ski resort in low range mountains, for example, without a sleeve has caused the onset of lymphedema in some patients). Slowly build up your weight training and the weight of the backpacks you wear.
Make sure that you have soft, padded shoulder straps. Always ask one of your fellow climbers to lift the pack onto your back to avoid the extra strain on your arm and shoulder. And something good to know: in February of 1995, 17 women who survived breast cancer climbed Aconcagua, the highest mountain in the western hemisphere, located in Argentina. None of them developed, or have developed, any problems or signs of lymphedema.
Mastectomy, Exercise and Lymphedema
Q: I had a Modified radical mastectomy in August 1994 and about 6 month ago developed mild lymphedema of my right arm. I want to resume exercising and need to know if push-ups and other arm exercises are precluded by the lymphedema.
A: Anybody who has had breast cancer, with or without lymphedema, needs to exercise. However, it is important to know the proper type of exercise, as well as proper weight (not more then 15 lbs). The motion of lymph fluid through lymph vessels is supported by skeletal muscles. Deep breathing exercises also help by dropping the intrathoracic pressure which facilitates drainage in the thoracic duct. Also be sure to wear a compression sleeve/glove while in the gym to support the limb while exercising. Of course if you notice an increase of swelling, discontinue that particular exercise. (Note: An excellent exercise videotape is available for arms as well as for legs through Lymphedema Services in New Jersey - see the Resource Guide for contact information
NLN Link no longer available
Jogging and Lower extremity Lymphedema
Q. I have primary LE in both feet. I am currently trying to lose weight and a friend suggested that I try jogging instead of walking (I've been walking on a treadmill at home for 30 min/three times a week). I told him that I am not supposed to run because I have LE (I read in a book that if you run or jump it can cause the LE to worsen). He thought that the circulation would actually help my legs. Which is true?
A. First of all, congratulations on being proactive in your personal weight loss program. In terms of aerobic activity to burn calories, walking at a pace of 4 miles per hour (fifteen minute miles) for at least 45 minutes daily will help you lose weight safely, while tightening and toning your body. Daily, brisk walking will burn calories nicely. Exercising 3x/week for only 30 minutes may not be enough for you to lose weight. It is not necessary to jog, although jogging is not "contraindicated" if you have LE. Each individual reacts differently to different activity levels. I have had some patients who did well jogging, despite their lower extremity lymphedema, although I must say that none of them was overweight and they were runners before they developed lymphedema.
The idea that better circulation will help the LE in your legs is not entirely true. Remember, the problem with LE is that there is not enough lymph transport capacity for the normal amount of lymph fluid that is produced. When you exercise, the muscles need more blood to supply them with oxygen. With the extra blood, comes the extra lymph fluid. That is the problem with LE and "too much exercise": there is extra lymph to transport in a system that is already overloaded.
Only you can discover where your "overload" point is in relation to exercise. My suggestion would be to increase your activity level slowly so that you can monitor its effect on your legs/feet. I hope that you have properly fitted compression garments to wear, which will assist your "muscle pump" to move the extra lymph fluid that is produced during the exercise. Good luck and here's to a healthier, trimmer you in 2000!
Exercise, Lymphedema, and the Limb at Risk
Bonnie B. Laninski, MA, PT, CLT-LANA
Sit and Be Fit
Information and Exercises
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The time has come for families, parents, caregivers to have a support group of their own. Support group for parents, families and caregivers of chilren with lymphedema. Sharing information on coping, diagnosis, treatment and prognosis. Sponsored by Lymphedema People.
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Support group for parents, patients, children who suffer from all forms of lymphangiectasia. This condition is caused by dilation of the lymphatics. It can affect the intestinal tract, lungs and other critical body areas.
Disorders Support Group @ Yahoo Groups
While we have a number of support groups for lymphedema... there is nothing out there for other lymphatic disorders. Because we have one of the most comprehensive information sites on all lymphatic disorders, I thought perhaps, it is time that one be offered.
Information and support for rare and unusual disorders affecting the lymph system. Includes lymphangiomas, lymphatic malformations, telangiectasia, hennekam's syndrome, distichiasis, Figueroa
syndrome, ptosis syndrome, plus many more. Extensive database of information available through sister site Lymphedema People.
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