Lymphedema and Exercise

by Fitcoachion | Last Updated: August 5, 2020

Several research studies have found that a program of gradually increasing exercise supervised by a certified lymphedema therapist — meaning you start gently and intensify slowly over time — is not likely to increase the risk of lymphedema. This is also the recommendation made in the National Lymphedema Network’s Position Statement on Exercise. Some experts believe that exercise may even play a role in rehabilitating the arm so that it can better withstand the day-to-day stresses that can lead to lymphedema.

“I believe that cardiac rehabilitation is a great analogy for this,” says Kathryn Schmitz, Ph.D., MPH, professor in the Division of Clinical Epidemiology at the University of Pennsylvania. “Let’s say you have damage to the heart muscle because of a heart attack. Well, those damaged cells are never coming back. But the more you strengthen the rest of your heart through exercise, the smaller the chance of another problem down the line.

“People who recover from heart attacks go on to run marathons,” she adds. “There is no reason why a woman with damage to her lymphatic system should have to spend the rest of her life avoiding anything that puts too much stress on her arm. Rather, she can take her cue from cardiac rehab and very slowly increase the amount of stress her arm can handle through weight training or other forms of exercise. That way, if she has a day when she gets a bee sting or ends up washing 200 dishes at the church dinner, her arm can handle it. This doesn’t mean throwing all precautions to the wind, though — she still has to be smart about how she uses her arm.”

Dr. Schmitz and her team conducted the Physical Activity and Lymphedema Trial, or PAL, which played a key role in overturning restrictive activity limits on people at risk for lymphedema. The trial enrolled 154 women at risk for breast cancer-related lymphedema, assigning them to either a program of slowly progressive weight training, starting out with very light weights, or no exercise. Among women who had five or more lymph nodes removed, the weight training made a difference: 7% in the intervention group experienced an incident of lymphedema, versus 22% in the no-exercise group.

Also as part of PAL, the research team completed a study with 141 breast cancer survivors who had stable lymphedema, assigning them to either a slowly progressive weight training program or no intervention. Women in the weight-training group were not found to be at any higher risk of developing arm swelling. They also had a lower incidence of lymphedema flare-ups — 14% in the exercise group, versus 29% in the control group — as assessed by a certified lymphedema therapist.

More research is needed to determine whether weight-training and other forms of exercise help reduce the risk of lymphedema and flare-ups. We do know that exercise makes the muscles into a pump that can push lymph fluid where it needs to go. “The lymphatic vessels lie between the muscle and the skin. With activity, the muscle contracts and relaxes against the skin. So by pump and release, the activity massages the lymph vessels and moves extra lymphatic fluid out of there,” says Linda T. Miller, PT, DPT, CLT, clinical director of the Breast Cancer Physical Therapy Center, Ltd., in Malvern, PA.

Designing an exercise plan

Typically, an exercise plan for anyone at risk for or diagnosed with lymphedema includes some combination of:

“This is very different than simply going out and joining a gym, or starting to run the same 3 or 4 miles you used to do before,” says lymphedema specialist Nicole Stout. “If you are exercising without guidance, it can be difficult to tell the difference between exercising and straining your limb. I always tell women, ‘Start low, go slow, listen to the limb.’ Exercise is important, but you have to do it wisely with specific guidance from someone who knows your situation.”

The following tips may be helpful as you make an exercise plan that is right for you:

You also may want to consult the National Lymphedema Network’s Position Statement on Exercise.

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Expert Quote

“We used to tell women never to lift 5 pounds, 10 pounds for the rest of their lives. That is absolutely not true. Women should be using the arm and exercising, but in a wise way. There is danger in exercise if they overdo it and strain the limb. I have never told a patient, ‘No, you can’t do that’ — whether she wants to try yoga for the first time, get back on the golf course, go rock climbing, or, in one case, even return to power-lifting. It’s a matter of working the limb gradually, exercising it to get in shape to do those activities.”

– Nicole Stout, MPT, CLT-LANA