EXERCISE:
WHEN AT LYMPHEDEMA RISK AFTER BREAST CANCER
Naomi Aaronson MA OTR/L CHT

This article is not intended to substitute for medical advice. Please see your doctor before engaging in any exercise program.

Are you in a quandary over exercise? How many of you were warned not to lift more than 5-10 lbs. after breast cancer surgery and treatment? Or advised not to take up favored leisure pursuits such as golf and tennis that you once enjoyed? My guess is that many of you live in fear of developing lymphedema and were warned about the risks. Lymphedema is a real concern! That is why it is so important to "arm" yourself with the power of knowledge. There is good news!! A recent update from the National Lymphedema Network has revised its guidelines for exercise. In addition, new research is finding that exercise can benefit those of you at risk of developing lymphedema.

You are considered to be at risk for lymphedema if you do not exhibit any signs and symptoms of the condition but have a disruption in your lymphatic system. Axillary lymph node removal and/or radiation are considered risk factors because they cause a break down in lymphatic flow. Other known risk factors include infection, obesity, and overuse. The main concern regarding exercise is that exercise increases blood flow. This can result in an increase in lymphatic load possibly leading to lymphedema. It is difficult to predict who will develop this chronic incurable condition. However, the benefits of exercise are profound to the cardiovascular and musculoskeletal systems (heart, lungs, muscles, and bones.) Avoiding it entirely, can be damaging to both mind and body. That is why it is so important to be cautious and to educate yourself thoroughly.
Here are some key points to know:

1) Be sure to obtain medical clearance before beginning any exercise program.

2) Use deep breathing techniques to minimize any pain and facilitate lymphatic flow. Pilates is excellent as it uses ribcage breathing which expands the chest and activates the transverse abdominas ( muscle responsible for your trunk stability) which helps to promote lymphatic flow.

3) Wear a compression garment if you have lymphedema when exercising or performing necessary repetitive work such as vacuuming or painting. However, this garment is not required when swimming as the water provides some compression!!

4) Start with a gradual program of flexibility exercises to stretch the pectoralis major/minor (where breast tissue is removed) and axillary region (where lymph nodes are removed.) These areas may become tight due to scar tissue and radiation and can block lymphatic flow. These stretches should be performed daily once your physician gives you clearance, and on a regular basis for the rest of your life. That may seem to be an awesome task, but will help you in the long run by preventing problems due to disuse and lack of range of motion. Wear a compression garment if you have lymphedema and start with light weights.

5) Strength training should be undertaken in a gradual manner to the effected arm. Muscular contractions can help to promote lymphatic flow. However, too much too soon, without proper attention to form is not safe. If you have lymphedema, you should wear a sleeve if recommended by your lymphedema therapist. One should begin with light weights (1lb) or light bands approximately 6 weeks after surgery. Do not wrap the band around your arm or hand. It is best to start slowly with 8-12 repetitions to each arm. You should alternate arms or take breaks between each set of 8-12 repetitions. Be sure to improve strength in your rotator cuff and back for injury prevention. Do not increase the weights the same time you increase the number of repetitions. For more information visit www.susanlovemd.org Lift the weights slowly and carefully and exhale on the effort. You may not feel any soreness if your arm is numb, therefore it is important to monitor your arm for any sign of swelling. If unsure of how to use weights, ask your physician for a prescription for occupational therapy to ensure that you are doing it properly.

6) Learn how to take circumferential measurements (the width around your arm, elbow, wrist and knuckles minimally.) Ask an occupational therapist to show you how to do this accurately. Take baseline measurements before you begin to exercise and on a regular basis. Know what the signs and symptoms of lymphedema are.

7) Aerobic exercise is exercise performed continuously for at least 20 minutes using the large muscles in the legs and arms which raises the heart rate. This in turn improves cardiovascular fitness, but may increase the lymphatic flow as blood flow increases. By improving this system, ones overall health is maximized. Swimming is especially beneficial, as there is no jolt as one moves in the water making it easier on the joints . In addition, the coolness and hydrostatic pressure of the water facilitates lymphatic flow. Swimming, bicycling, jogging, step aerobics, and walking are all considered to be aerobic. A sleeve should be worn for all activities, except for swimming, if you have lymphedema. Start slowly and gradually increase the duration (length of time you exercise) and frequency (number of sessions per week that you exercise.)

8) If exercising outdoors, exercise when it is cooler and be sure to wear sunscreen.

Taking a careful approach to exercise can get you back into the swing of things!! Hopefully, you will be able to take part in the activities that you once enjoyed and even learn some new ones!!

Click here to read the article "Weight Lifting in Women with Breast-Cancer–Related Lymphedema"

References

Burt, J and White, G Lymphedema 2006 Hunter House Publishers

Harris, S , Hugi, M. Clinical Practice guidelines for the care and treatment of breast cancer : 11. Lymphedema 2001 Canadian Medical Association.

National Lymphedema Network - Position Statement Topic: Exercise 2008
www.lymphnet.org

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