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Exercise With Leg Lymphedema

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Fitness articles: Sport for leg lymphedema…

I am writing this article from two perspectives, as an experienced fitness trainer/strength coach who has been involved with health issues for many years and as a patient who suffers from leg lymphedema on a daily basis. I’ve been able to maintain my lymphedema fairly well, but that’s because I’ve researched the issue extensively, listened to my doctors, and have a vast knowledge of exercise. I think about it every day, almost every moment, because it takes a lot of effort to maintain it properly. I’ve included the description of lymphedema below.

Lymphedema is a difficult thing and needs to be sustained all day, every day. Lymphedema cannot be cured. I have had lymphedema in my leg since my cancer surgery in 1991. I went from being a gymnastics and fitness instructor who exercised daily to being bedridden after my surgery as the lymph nodes were removed along with the cancer. My life changed drastically, but I got back to work and learned how to sustain it as quickly as possible. Several doctors told me I would be bedridden for the rest of my life and would never work again. That was in 1991.

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So what is lymphedema? Here’s the definition from the National Lymphedema Network…

“Lymphedema is a buildup of lymphatic fluid in the interstitial tissues that causes swelling, most commonly in the arms and/or legs and occasionally in other parts of the body. Lymphedema can develop when lymphatic vessels are absent or compromised (primary), or when lymphatic vessels are damaged or lymph nodes are removed (secondary).

When the impairment becomes so severe that lymph fluid exceeds the lymphatic carrying capacity, an abnormal amount of protein-rich fluid collects in the tissues of the affected area. Left untreated, this stagnant, protein-rich fluid not only leads to an increase in the size and number of tissue channels, but also decreases oxygen availability in the transport system, disrupts wound healing, and provides a breeding medium for bacteria that can lead to lymphangitis (infection).”

So, what types of exercises can a lymphedema patient do? It depends on the patient and whether they have a doctor’s license to exercise. Once cleared for exercise, swimming is the best exercise to reduce leg swelling because the person is horizontal, moving, and performing a non-bouncing motion. The second best exercise for a person with leg lymphedema is riding a recumbent bike. It’s also non-bouncing, it’s a smooth motion, and it lifts the legs slightly.

If the patient is otherwise in good physical condition and has lymphedema under control (as far as possible), they can use the elliptical trainer. That is, if they can take it from a fitness and medical standpoint. Make sure the patient with lymphedema has their doctor’s permission to exercise, especially high-intensity exercise like the elliptical trainer. Keep the person with lymphedema away from the treadmill. Walking and running make leg swelling MUCH worse because they have a powerful impact. Imagine someone puts ice cream in an ice cream cone and then wraps it. The swelling becomes dense if not properly cared for. The heavier, the harder it is to deal with.

In my experience, with the leg elevated, it can take an hour for the swelling to even BEGIN to subside, and several days or weeks for it to completely subside. People with lymphedema should wear their compression stockings if their doctor tells them to, and sleep with their legs elevated each night unless their doctor tells them otherwise. It’s important to keep moving and only do non-impact exercises. For example, squats are often better than walking lunges for someone with lymphedema. The walking lunge is a striking exercise. DO NOT encourage a person with leg lymphedema to participate in any exercise class that involves thrusting. If they’re in good shape, spinning classes will keep their circulation going and help them lose or maintain a healthy weight. It’s about keeping the body moving without punching exercises.

Remember that the lymphedema is from recent surgery, the patient MUST be cleared to start exercising because if he starts exercising before the doctors allow him to exercise, he will cause problems with the lymphatic system. My doctors told me that if I started exercising too early, the swelling from the surgery would never go down and that I would cause permanent damage. I was told to wait a full year after my surgery before I could exercise my legs. I waited 10 months and couldn’t take it any longer. I HAD to return to sport because I enjoyed it and it was my life. Not being able to train my legs was extremely difficult for me because I’ve been in the gym all my life. Again, ensure that the lymphedema patient has FULL medical clearance to exercise.

Here’s something a lot of people don’t know. If a person with lymphedema is not moving and is not wearing compression stockings on their leg, they need to elevate their legs to prevent swelling. Something as simple as standing in line at the grocery store can cause enough swelling to keep a person in bed the next day. The swelling literally starts in less than a minute if you stand still or sit without elevating your leg. It really is a challenge every minute of the day to keep the leg from swelling and people around lymphedema patients need to be patient and considerate.

There is a lot of information about lymphedema. It’s either primary or secondary. Secondary lymphedema would be caused, for example, by cancer surgery. Mine is secondary to having my lymph nodes removed from my thigh on one leg during my cancer surgery. If lymphedema is not controlled, elephantitis can occur. Yes, it’s a real disease and it’s very serious. In the US there are self-help groups for lymphedema. The National Lymphedema Network has a lot of information.

Let me know how I can help you…

Karen Goeller, CSCS

Thanks to Karen Goeller

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