Fitness Article: Exercise with Lymphedema of the Leg...
I
am writing this article from two points of view, as an experienced
fitness trainer / strength coach who has studied health issues for many
years and as a patient who suffers with lymphedema of the leg daily. I
have been able to maintain my lymphedema pretty well, but that is
because I have done extensive reading on the subject, I listened to my
doctors, and I have extensive knowledge of exercise. It is on my mind
every day, at almost every moment because it takes great effort to
maintain properly. I have included the description of lymphedema below.
Lymphedema
is a difficult thing to deal with and must be maintained all day long,
every day. There is no cure for lymphedema. I have had lymphedema in my
leg since my 1991 cancer surgery. I went from being a gymnastics coach
and fitness trainer who exercised daily to being bedridden after my
surgery as a result of the lymph nodes being removed along with the
cancer. My life changed drastically, but I went back to work and learned
how to maintain it as soon as possible. Several doctors told me that I
would be bedridden for the rest of my life and that I would never work
again. That was in 1991.
So, what is lymphedema? Here is the definition by the National Lymphedema Network...
"Lymphedema
is an accumulation of lymphatic fluid in the interstitial tissue that
causes swelling, most often in the arm(s) and/or leg(s), and
occasionally in other parts of the body. Lymphedema can develop when
lymphatic vessels are missing or impaired (primary), or when lymph
vessels are damaged or lymph nodes removed (secondary).
When the
impairment becomes so great that the lymphatic fluid exceeds the
lymphatic transport 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 causes tissue channels to increase
in size and number, but also reduces oxygen availability in the
transport system, interferes with wound healing, and provides a culture
medium for bacteria that can result in lymphangitis (infection)."
So,
what types of exercise can a lymphedema patient perform? That depends
on the patient and whether they have medical clearance to exercise. Once
cleared for exercise, the best exercise to reduce the leg swelling is
swimming because the person is horizontal, in motion, and performing a
non-impact movement. The second best exercise for a person with leg
lymphedema is riding a recumbent bike. It is also non-impact, it's a
steady motion, and the legs are elevated slightly.
If the patient
is in good physical condition otherwise and they have the lymphedema
under control (as much as possible) they can use the elliptical machine.
That is, if they can tolerate it from a fitness and medical standpoint.
Make sure the lymphedema patient has permission from their doctor to
perform exercise, especially an intense exercise such as the elliptical.
Keep the person with lymphedema OFF THE TREADMILL. Walking and running
cause the leg swelling to become MUCH worse because they are high
impact. Picture someone putting ice cream into an ice cream cone and
then packing it in. The swelling becomes dense, packed in if not
maintained properly. The more severe, the more difficult it is to deal
with.
In my experience, it can take an hour with the leg elevated
before the swelling even BEGINS to go down and several days or weeks for
it to completely drain. People with lymphedema should be wearing their
compression stocking if their doctor prescribed it and sleeping with her
legs elevated every night, unless their doctor has told them otherwise.
It is important to stay in motion and to only perform non-impact
exercises. For example, squats are often better than walking lunges for
someone with lymphedema. The walking lunge is an impact exercise. Do NOT
encourage a person with leg lymphedema to participate any exercise
classes that include impact exercises. If they are in good shape the
spin classes will keep the circulation going and help will lose or
maintain a healthy body weight. It's all about keeping the body in
motion without ANY impact exercises.
Keep in mind that of the
lymphedema is from a new surgery the patient MUST be cleared to begin
exercise because if they begin to exercise before the doctors allow them
to exercise they will cause problems with the lymphatic system. My
doctors told me the swelling from the surgery would never go down if I
started to exercise too soon and that I would cause permanent damage. I
was told to wait one full year after my surgery before I was allowed to
exercise my legs. I waited 10 months and couldn't stand it any longer. I
HAD to return to exercise because it was what I enjoyed and it was my
life. Not being allowed to exercise my legs was extremely difficult for
me because I spent a lifetime in the gym. Again, make sure the
lymphedema patient has FULL medical clearance to exercise.
Here is
something that many people do not know. When a person with lymphedema
is not in motion and does not have compression stocking on their leg,
they must keep their legs elevated in order to prevent swelling.
Something as simple as waiting in line at the grocery store could cause
enough swelling to keep a person in bed the next day. The swelling
begins in less than a minute, literally, when standing still or sitting
without the leg elevated. It is truly a challenge every minute of the
day to keep the leg from swelling and those around lymphedema patients
must be patient and considerate.
There is plenty of information on
lymphedema. It is either primary or secondary. Secondary lymphedema
would be caused from something such as a cancer surgery. Mine is
secondary because my lymph nodes were removed from my upper thigh on one
leg during my cancer surgery. If the lymphedema is not controlled it
can end up being elephantitis. Yes, it is a real medical condition and
it is very serious. There are lymphedema support groups throughout the
USA. The National Lymphedema Network has plenty of information.
Let me know how I can help you...
Karen Goeller, CSCS
Karen Goeller, CSCS
