Department of Physical Medicine and Rehabilitation at the Medical College of Wisconsin and Clement J. Zablocki VA Medical Center, Milwaukee, WI(⁎). Electronic address: firstname.lastname@example.org.
Improvements in cancer screening, diagnosis, and treatment have resulted in an increasing population of cancer survivors with impairments in physical function, cancer-related symptoms, and reduced quality of life. Exercise and physical activity have therapeutic value at multiple points along the cancer disease continuum, spanning disease prevention, treatment, survivorship, prognostic outcomes, and end-of-life issues. Molecular mechanisms for the influence of exercise in persons with cancer include altering tumor initiation pathways and affecting hormonal, inflammatory, immune, and insulin pathways. Physical activity has been found to play a role in the prevention of certain malignancies, including breast, colon, and other cancers. An increasing amount of evidence indicates that physical activity may affect prognostic outcomes in certain cancer diagnoses, especially breast cancer. Structured exercise and physical activity interventions can be helpful in addressing specific survivorship issues, including overall quality of life, cardio respiratory impairment, cancer-related fatigue, and lymphedema. Exercise also may be helpful during the palliative care phase to alleviate symptoms and increase physical well-being. This article will familiarize physiatrists with the current state of evidence regarding the role and efficacy of exercise in persons with cancer.
This is the first part in a three-part series covering exercises for patients affected by lymphedema. Part two will cover resistive exercises; part three will discuss decongestive and breathing exercises – so stay tuned.
Lymphedema patients can and should be active, and those who never exercised before should consider starting that daily walk, wim or spending twenty minutes on a stationary bicycle. The right type of physical activity helps to reduce the swelling by improving the flow of lymph, and presents a vital tool for patients to stay in shape and continue with normal activities of daily living.
So what is the right type of exercise for lymphedema?
Many patients ask if they can continue their pre-lymphedema activities, or if the should adjust, or replace them. The answer to that question really depends on the kind of activity. Tennis or golf for example does not rank very high on the list of beneficial activities for individuals with upper extremity lymphedema. For patients with lymphedema of the leg, kick-boxing and step-aerobics are activities that bear a great risk of injury and therefore should be avoided.
But the reality is that for some individuals exercise plays such a vital role in their daily routine, and is so engrained in their personality, that giving up these so called “high-risk activities” would have a serious impact on their well-being.
1. Get off a stop or 2 earlier during your bus or subway commute; walk the rest of the way.
2. Purposefully park you car a little further from the mall or store. It may not seem like much, but over weeks and months, these minutes of exercise add up.
3. Use the stairs instead of elevators and escalators whenever possible.
4. Consider buying a piece of cardiovascular equipment for your home (e.g. treadmill, bike, elliptical machine). Home models can be more reasonable than you think and you can't beat the convenience.
5. When you get busy, try to combine your cardiovascular exercise with something that you do already. Hop on that piece of home equipment while watching TV, reading the newspaper or returning phone calls.
6. Make it fun! Try a new sport like tennis or rollerblading. The more that you enjoy exercise the more likely you are to stick to it.
7. Make it social. Walk with a friend, your spouse, or your family in the morning or evening.
8. Keep an exercise log. It will help to make you more accountable. 9. Take a walk for 20 minutes of your lunch hour. 10. Hire a personal trainer for a session or 2 to help you with your weight training and flexibility training.
Then you'll have the confidence to branch out on your own.
Time for an Average 150 lb Adult to Burn 150 Calories:
Intensity Activity METs* Duration in minutes Moderate Volleyball, noncompetitive 3.0 43 Moderate Walking, moderate pace (3 mph, 20 min/mile) 3.5 37 Moderate Walking, brisk pace (4 mph, 15 min/mile) 4.0 32 Moderate Table tennis 4.0 32 Moderate Raking leaves 4.5 32 Moderate Social dancing 4.5 29 Moderate Lawn mowing (powered push mower) 4.5 29 Hard Jogging (5 mph, 12 min/mile) 7.0 18 Hard Field hockey 8.0 16 Very hard Running (6 mph, 10 min/mile) 10.0 13
* 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)
Department of Nursing, Cukurova University Medical Faculty, Balcali, Adana, Turkey.
To evaluate an educational and exercise program for the prevention and progression of post-mastectomy lymphedema of the arm and shoulder.
Fifty-five patients who had undergone mastectomy and axillary lymph node dissection between June 2009 and January 2010 were included in this study. The patients were informed by a trainer nurse about the precautions they should take to prevent the development of lymphedema. The patients were also trained for the appropriate exercises and were given written educational material prepared by the investigators.
Among the participants, 96.4% underwent modified radical mastectomy (MRM) and 3.6% breast-conserving (BCS) surgery. The mean postoperative follow-up period was 9.87 ± 17.55 months. The degree of lymphedema was found lower, even within 6 months, in the patients that exercised as compared to the patients that did no .
The results indicate that the risk of development and progression of mastectomy-related lymphedema was reduced with education and exercise provided by trained nurses at an early stage.
Decongestive and Breathing Exercises for Lymphedema
BY JOACHIM ZUTHER
In this last part of the three-part series about exercises, I would like to address decongestive- and breathing exercises, which are an integral part in the treatment and management of lymphedema.
Unlike the heart in the blood circulatory system, the lymphatic system does not have an active pump to propel lymphatic fluid back to the bloodstream. Effective lymph flow depends on sufficient muscle and joint activity, especially if the functionality of the lymphatic system is compromised. Decongestive exercises are most effective if performed while the patient wears compression garments or bandages, which are also essential components in lymphedema management. Ideally, decongestive exercise protocols are performed two to three times daily for about 10-15 minutes, and the patient should rest with the affected limb elevated for at least 10 minutes following the exercises.
These active, non-resistive and repetitive exercise protocols should be customized by the lymphedema therapist and/or physician to meet individual goals for patients affected by lymphedema. The stage and type of lymphedema, specific restrictions and limitations of joint and muscle activity, as well as additional medical conditions need to be considered.
The downward and upward movement of the diaphragm in deep abdominal breathing is an essential component for the sufficient return of lymphatic fluid back to the bloodstream. Patients affected by lymphedema of the leg benefit greatly from an exercise program including diaphragmatic breathing exercises. The movement of the diaphragm, combined with the outward and inward movements of the abdomen, ribcage, and lower back, also promotes general well-being, peristalsis and return of venous blood back to the heart.
Following are sample decongestive exercise protocols, combined with breathing exercises for the upper and lower extremity, which are published in the book Lymphedema Management. This book also contains self-MLD and self-bandaging protocols for patients affected by lymphedema. The exercise protocols below serve as guidelines and the movements outlined must not cause discomfort, pain, or soreness.
Before you engage in any exercise program, especially if you have additional medical conditions, please make sure to get your physicians approval.
Continuation of Article and additional exercise articles:
Editor's Note: I am including this article not only because of the quality of the information, but as an introduction to one of the best lymphedema information sites available. The blog was founded and is maintained by Joachm Zuther of the Academy of Lymphatic Studies. You really need to include this blog in your list of reading sites. Pat O'Connor