It is important for us to do all we can to get in and stay in shape, even with lymphedema. Exercises not only improve our overall health, but can be great in helping your body move fluids out of the areas effected by lymphedema.
Many of these arm exercises, by the way, can be done quietly at work.
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 lymphedema or involvement shouldn't. Stage 1 & stage 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.
The key is to NOT cause any inflammatory response in your hands and/or arms that will trigger an increase in swelling
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)
When I started doing arm exercises, I basically ran through the above list, not using weights. I thought I was stonger then I was (don't all men?), but quickly found out that before I could go on to the weights, I had to handle these comfortably.
Because light exercise after breast cancer surgery and lymph node removal can help reduce the chances of lymphedema, patients should discuss how and when to begin arm exercises. Some patients find that taking painkillers (analgesics) 30 minutes prior to exercising helps alleviate discomfort, although all medications should be approved by the patient’s physician.
The following are suggestions of exercises following breast cancer surgery from the Wessex Cancer Trust, an independent charity that provides information and support to patients with cancer. Each exercise may be performed five times in a row, three times a day (morning, afternoon, evening) with the physician’s approval.
With palms up and elbows straight, stretch arms high above head, linking fingers together. Bend elbows and clasp hands at the back of the neck. Push elbows out as far as possible and then bring them together to touch in front of the body. Repeat.
Place hands behind the back and lace fingers together. Slide hands as far as possible up the body toward the neck.
Place hands on shoulders (on the same side of the body) and move elbows up and then down toward the sides of the body.
Place hands on shoulders and make circular movements with the elbows. Circles should be as large as possible. Change directions periodically.
After breast stitches have been removed, stand with one foot in front of the other. Hold on to a chair or table. Lean forward and swing the arm that was involved in the surgery backwards and forwards, and then from side to side as far as it will go. Hold a small weight to gain momentum. Increase movement until arm reaches shoulder height. Keep elbows straight.
Stand with one foot in front of one another. Hold onto a chair or table for support. Lean forward and swing the arm on the side of the surgery in circles, first clockwise and then counter-clockwise. Keep elbows straight.
Face toward a wall. Place hands on the wall and inch fingers up the wall. Try to go higher each day until arms are fully straight over head.
Nicole L. Gergich MPT, MLD/CDT Lymphedema Specialist, Penn Therapy and Fitness Posting Date: May 6, 2001 Last Modified: January 3, 2002
Why Should I Exercise?
One very important component of a comprehensive treatment plan for cancer-related lymphedema is exercise. A program consisting of flexibility, strengthening and aerobic exercise is beneficial in reducing lymphedema when administered under the correct conditions. Exercise also allows cancer survivors a more active role in their own lymphedema management. Recent studies have shown no significant increase in the incidence of lymphedema after breast cancer, between women participating in an exercise program when compared to women who did not exercise.
What Type of Exercises are Helpful To Someone with Lymphedema?
Flexibility exercises help to maintain joint range of motion and allow for elongation or stretching of tissues. Flexibility exercises also help to prevent joint stiffness and postural changes after cancer surgeries or treatments. Muscle tightness may further complicate lymphedema.
Strengthening exercises are also important in reducing lymphedema when done at low intensity levels with the extremity wrapped (see below). These exercises often help increase lymphatic and venous flow, aiding in the removal of fluid from the involved extremity.
Aerobic exercise enhances the lymphatic and venous flow, further reducing swelling in the extremity. Aerobic exercise also combats fatigue, which plagues so many people during and after cancer treatment.
Finally, deep abdominal breathing or diaphragmatic breathing is important with all exercise, but especially so in people with lymphedema. When deep breathing is carried out, the pressure inside the chest and abdomen is altered and creates a pumping activity within the lymphatic system. The central thoracic duct, which carries lymph fluid from the abdomen and legs, travels through the chest cavity. Pumping action around the duct helps to increase lymphatic flow throughout the body. Deep breathing is also important to deliver adequate oxygen supplies to the working muscles so that they may work efficiently.
Exercises should be initiated by a physical or occupational therapist that specializes in lymphedema treatment. As with all exercise, you should discuss beginning a program with your physician.
How Much Weight Can I Lift?
There has been little research to date regarding the intensity of exercise in people with lymphedema and what is a safe level. Previously, intensive exercise was viewed as contraindicated, or not advisable. Currently, exercise and progressive weight lifting activities are used to assist in the removal of lymphedema from the affected areas. Therapists can guide clients in a weight lifting program that is tailored to their present fitness levels. How much you can lift depends on the stage of treatment and most importantly, you previous and present fitness levels. It is important to continuously monitor the limb for swelling or redness, which can be an indication that the exercise was too intense. A weight lifting program should be initiated by a therapist who specializes in the treatment of lymphedema.
Should I Wrap My Arm With Exercise?
It is recommended that the affected limb (arm or leg) be wrapped with compression bandages during exercise to aide the muscle pump force on the venous and lymphatic systems. Wrapping also prevents further fluid from accumulating in the extremity. The bandages used for lymphedema treatment are short-stretch bandages. The short stretch bandages used in lymphedema treatment do not stretch much when applied to the arm or leg. When you exercise the wrapped limb, the muscles and the bandages place a force on the lymphatics that help move fluid out of the arm. ACE bandages stretch too much and are ineffective in the treatment of lymphedema. Do NOT USE Ace wraps when wrapping for lymphedema.
What Exercises Can I do After Breast Surgery?
Following a mastectomy it is important to maintain range of motion or flexibility in the shoulder. Frequently, women decrease the use of the shoulder and arm on the side of the body where surgery was performed due to pain or fear of hurting the incision. Protecting the arm may lead to stiffness and tightness in the shoulder which can make it difficult to move the arm. This is often followed by a loss of muscle strength and stability around the shoulder. Since the shoulder and neck are closely related, it is also important to maintain neck mobility to prevent further complications. Ask your doctor or physical therapist if you have questions about which shoulder exercises are right for you. If you have recently undergone a mastectomy accompanied by a breast reconstruction REFER TO YOUR SURGEON FOR INFORMATION REGARDING SHOULDER EXERCISE. It is important to discuss beginning an exercise program with your physician.
Acta Oncol. 2009 Jun
Sagen A, Kåresen R, Risberg MA. Department of Breast and Endocrine Surgery, Oslo University Hospital, Ullevaal, Norway.
Background The influence of physical activity on the development of arm lymphedema (ALE) after breast cancer surgery with axillary node dissection has been debated. We evaluated the development of ALE in two different rehabilitation programs: a no activity restrictions (NAR) in daily living combined with a moderate resistance exercise program and an activity restrictions (AR) program combined with a usual care program. The risk factors associated with the development of ALE 2 years after surgery were also evaluated.
Material and methods Women (n=204) with a mean age of 55+/-10 years who had axillary node dissection were randomized into two different rehabilitation programs that lasted for 6 months: NAR (n=104) or AR (n=100). The primary outcomes were the difference in arm volume between the affected and control arms (Voldiff, in ml) and the development of ALE. Baseline (before surgery) and follow-up tests were performed 3 months, 6 months, and 2 years after surgery. Data were analyzed using ANCOVA and regression analysis.
Results Voldiff did not differ significantly between the two treatment groups. Arm volume increased significantly over time in both the affected and the control arms. The development of ALE from baseline to 2 years increased significantly in both groups (p<0.001). The only risk factor for ALE was BMI > 25 kg/m(2).
Conclusion Patients that undergo breast cancer surgery with axillary lymph node dissection should be encouraged to maintain physical activity in their daily lives without restrictions and without fear of developing ALE.
This exercise is great for working the muscles in your fingers, your lower and upper arm and helps move fluid out of the hand. We always used these at work as a “stress” reliever. My boss was always nervous though, waiting for me to hit him with the ball.
You will need a squeeze ball, one that is slightly larger then the palm of your hand. The ball should have resistance to your grip and not simply “squish” on contact. To start off with, I would choose one that is comfortable when I squeezed it (in other words, one that would trigger any inflammatory arm reaction). The ball should spring back into shape when released, but should offer resistance to your squeeze.
You can sit or stand while doing these exercises, but it is important to keep your back and neck straight with your shoulders more relaxed. Start with grasping your ball slightly with you arm extended in front of your. Also, be sure your arm is slightly higher then your heart.
Squeeze the ball with your fingers as firmly as you can. Hold it for about 3 second and then release.
Starting out, you can do the exercise five times. The key is to remember not to overly strain the arm. It is better to start off doing only a few squeezes and then work you way up to as many as you can tolerate.
I was surprised at how many muscles this exercise uses and was surprised that when I started off doing them, I could do as many as I thought I should be able to. This is another good “pump” type exercise that helps move fluid out of yo arms.
This is an exercise to do while seated. Again, be sure your posture is good holding your neck and back straight. You will need a one pound weight in each hand. If you don't have weights, you might try a pound can of fruits or veggies.
Rest your hands on your lap with your palms up.
Now, slowly bend your elbows and lift both hands towards your chest. Halfway up, stio the lifting and hold your position for approximately 6 seconds.
Then slowly lower your hands back down to your lap. Starting off, you may need a tiny break before doing it again.
Some therapists say do this 10 times. But, again that depends on your and your individual situation. You can start off with several lifts and work your way up to doing more.
Elbow Extension - Floor Exercise
This is one exercise you can lie down doing. Lie down, as always, making sure your back and necek are in a straight line. You can slightly elevate you knees if your need to to keep your lower back flat. Your knees should not be together though. Remember to keep your shoulders relaxed and hold your one pound weight in each hand with your palms facing towards each other. Raise both arms straight up above your body.
Slowly bend your elbows and lower both hands towards you chest. When your elbows are bent at a 90 degree ange, stop moving and hold the position for about six seconds.
Then, slowly raise your hand back up to the starting position.
Again start off with a small number that is comfortable and work your way up. Try setting 10 times as your initial goal.
This type of exercise uses the should and arm muscles to help reduce the swelling.
Again lie down on your back, keeping your back and neck in a straight line. Feet should be flat on the flor, with your feet and knees shoulder width apart. You will need your one pound weights in each hand.
Extend your arms away from your body, resting them on the floor. Be sure you are holding the weights with your palms facing the ceiling.
Without bending your elbows, slowly raise both arms straight up above your body until you can bring your palms together. Hold the position for about six seconds.
Then, bring you arms back to the starting position. Finally, start with as many as is safe and comfortable. I would set my longer term goal at least repeating it 8 times.
This exercise uses your should muscles. Again, the gently muscle movement you feel while doing this exercise should help drain fluid, moving it back into circulation.
Stand straight with your arms at your side. Hold your one pound weights with palms towards your body.
Slowly raise both arms, using a systemic, steady motion. When your arms are almost directly overhead, hold your position for about 6 - 8 seconds.
Then slowly lower your arms in a steady smooth motion until the arms are back at your side. Start with a number that is comfortable and work you way up to an initial goal of 10 times.
This exercise moves your arms and shoulders away from the body and works the muscles in your shoulders shoulder blade, and arms. use a steady motion while doing them.
Stand straight in a good position with your arms at yor side. Hold your one pound weights in each hand with your palms facing each other.
Slowly raise your arms out to your side, keeping the arms straight. When they are almost overhead, stop and hold your position for aproximately 6 - 8 seconds.
Then, slowly lower your arms, using the same steady smooth motion you used to start the exercise with.
Finally, start out doing what is comfortable and then work your way up to a initial personal goal of 10 times.
Remember, if your arms start to feel tired, or crampy stop doing the exercises and rest. If you notice any additional swelling starting while doing the exercises, stop immediately. Don't worry about how many you do as these exercises will build both stamina and strength.
Incidentally, any or all of these exercises can be done without the weights if you need to, to start your exercise program.
Both light exercise and aerobic exercise (physical activity that causes the heart and lungs to work harder) help the lymph vessels move lymph out of the affected limb and decrease swelling.
Talk with a certified lymphedema therapist before beginning exercise. Patients who have lymphedema or who are at risk for lymphedema should talk with a certified lymphedema therapist before beginning an exercise routine. (See the Lymphology Association of North America Web site for a list of certified lymphedema therapists in the United States.)
Wear a pressure garment if lymphedema has developed.
Patients who have lymphedema should wear a well-fitting pressure garment during all exercise that uses the affected limb or body part.
When it is not known for sure if a woman has lymphedema, upper-body exercise without a garment may be more helpful than no exercise at all. Patients who do not have lymphedema do not need to wear a pressure garment during exercise.
Breast cancer survivors should begin with light upper-body exercise and increase it slowly. Some studies with breast cancer survivors show that upper-body exercise is safe in women who have lymphedema or who are at risk for lymphedema. Weight-lifting that is slowly increased may keep lymphedema from getting worse. Exercise should start at a very low level, increase slowly over time, and be overseen by the lymphedema therapist. If exercise is stopped for a week or longer, it should be started again at a low level and increased slowly.
If symptoms (such as swelling or heaviness in the limb) change or increase for a week or longer, talk with the lymphedema therapist. It is likely that exercising at a low level and slowly increasing it again over time is better for the affected limb than stopping the exercise completely.
More studies are needed to find out if weight-lifting is safe for cancer survivors with lymphedema in the legs.
Treatment of Lymphedema National Cancer Institute
Exercise Step Up, Speak Out
Decongestive and Breathing Exercises for Lymphedema Joachim Zuther - Lymphedema Blog and Academy of Lymphatic Studies (ACOLS)
Exercise and Lymphedema discussion from online support group
Exercise, Lymphedema, and the Limb at Risk Bonnie B. Laninski, MA, PT, CLT-LANA
Exercise Lymphoedema Association of Australia
Arm Elevation and Exercise Breast Cancer.org
Getting (and Staying) Aerobically Fit through Swimming! Dr. Susan Harris, Phd. PT, School of Rehabilitation Sciences – UBC
Shoulder Rehab Exercises Include isometric rotator cuff shoulder exercises.
Challenging the Myth of Exercise-Induced Lymphedema Dr. Susan HarrisPh.D. editor's note: Article is very misquoted and author is NOT a medical doctor She is a Physical Therapist.
Getting (and Staying) Aerobically Fit through Swimming! Dr. Susan Harris, Phd. PT, School of Rehabilitation Sciences – UBC