Fluid Shifts Induced by Physical Therapy in Lower Limb Lymphedema Patients

Šerý

Onorato³

et al. 2021

Self Cite

This narrative review portrays the lymphatic system, a poorly understood but important physiological system. While several reviews have been published that are related to the biology of the lymphatic system and lymphedema, the physiological alternations, which arise due to disturbances of this system, and during lymphedema therapy, are poorly understood and, consequently, not widely reported. We present an inclusive collection of evidence from the scientific literature reflecting important developments in lymphedema research over the last few decades. This review aims at advancing the knowledge on the area of lymphatic system function as well as how system dysfunction, as seen in lymphedema, affects physiological systems and how lymphedema therapy modulates these mechanisms. We propose that future studies should aim at investigating, in-detail, aspects that are related to fluid regulation, hemodynamic responses, and endothelial and/or vascular changes due to lymphedema and lymphedema therapy.

Section: Complete Decongestive Therapymentioning

confidence: 99%

Biology of Lymphedema

Šerý

Onorato³

et al. 2021

Self Cite

“…An optimal and functioning lymphatic transport system is necessary to transport lipids absorbed in the gut, immune cells and to maintain fluid and macromolecular homeostasis [ 1 , 2 ]. Therefore, the lymphatic system is involved in several physiological processes, which has been reviewed elsewhere [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…The lymphatic system is involved in the transport of fluid from tissue interstitial spaces. The lymphatic vessels move fluids and different compounds (such as immune cells, macromolecules and lipids) from the interstitium to larger veins [ 1 ]. Therefore, lymphatic transport is a fundamental component of the processes such as lipid absorption, management of body fluids, immune function and macromolecular homeostasis [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Lymphatic Senescence: Current Updates and Perspectives

Filelfi

Onorato

et al. 2021

Self Cite

Lymphatic flow is necessary for maintenance of vital physiological functions in humans and animals. To carry out optimal lymphatic flow, adequate contractile activity of the lymphatic collectors is necessary. Like in all body systems, aging has also an effect on the lymphatic system. However, limited knowledge is available on how aging directly affects the lymphatic system anatomy, physiology and function. We investigated how senescence leads to alterations in morphology and function of the lymphatic vessels. We used the strategy of a review to summarize the scientific literature of studies that have been published in the area of lymphatic senescence. Searches were carried out on PubMed and Web of Science using predefined search queries. We obtained an initial set of 1060 publications. They were filtered to 114 publications based on strict inclusion and exclusion criteria. Finally, the most appropriate 57 studies that specifically addressed lymphatic senescence have been selected for the preparation of this review. Analysis of the literature showed that lymphatic senescence is associated with alterations in lymphatic muscles and nerve fibers, lymphatic glycocalyx function of lymphatic endothelial cells, effects of chronic ultraviolet light exposure and oxidative stress as well as changes in lymphatic pump, acute inflammation responses and immune function. The current review underscores the relevance of the understudied area of lymphatic senescence. Continued research on the impact of aging on the structure and function of the lymphatic vasculature is needed to provide further insights to develop innovative clinical diagnostic—and treatment—modalities as well as to reduce the morbidity associated with diseases related to the lymphatic system.

“…This fluid accumulation can reach up to 5-15 L [12]. Complete decongestive therapy (CDT) is a noninvasive, multicomponent physical treatment over three weeks that is usually applied to reduce swelling [13]. The physical treatment consists primarily of manual lymphatic drainage (MLD) and compression, as well as bandaging of the swollen body part, along with additional aerobic movements that provide leverage over the swelling.…”

Section: Introductionmentioning

confidence: 99%

“…In lymphedema patients, cardio-postural control might be affected due to different fluid volumes in the lower limbs, pre-and post-therapy, as well as due to plasma volume changes during physical therapy [10,13,15,16]. However, to our knowledge, there is no previous study focusing on investigating orthostatic intolerance during lymphedema therapy.…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic Responses in Lower Limb Lymphedema Patients Undergoing Physical Therapy

White

Ure³

et al. 2021

Self Cite

Background: Lymphedema arises due to a malfunction of the lymphatic system, leading to extensive tissue swelling. Complete decongestive therapy (CDT), which is a physical therapy lasting for 3 weeks and includes manual lymphatic drainages (MLD), leads to fluid mobilization and increases in plasma volume. Here, we investigated hemodynamic responses induced by these fluid shifts due to CDT and MLD. Methods: Hemodynamic parameters were assessed continuously during a sit-to-stand test (5 min baseline, 5 min of standing, and 5 min of recovery). This intervention was repeated on days 1, 2, 7, 14, and 21 of CDT, before and after MLD. Volume regulatory hormones were assessed in plasma samples. Results: A total number of 13 patients took part in this investigation. Resting diastolic blood pressure significantly decreased over three weeks of CDT (p = 0.048). No changes in baseline values were shown due to MLD. However, MLD led to a significant decrease in heart rate during orthostatic loading over all epochs on therapy day 14, as well as day 21. Volume regulatory hormones did not show changes over lymphedema therapy. Conclusion: We did not observe any signs of orthostatic hypotension at rest, as well as during to CDT, indicating that lymphedema patients do not display an elevated risk of orthostatic intolerance. Although baseline hemodynamics were not affected, MLD has shown to have potential beneficial effects on hemodynamic responses to a sit-to-stand test in patients undergoing lymphedema therapy.