Postural differences in the immediate effects of active exercise with compression therapy on lower limb lymphedema

Abstract

Purpose Although regarded as an important treatment for lymphedema, the therapeutic effects of active exercise with compression therapy (AECT) are supported by little evidence. The purpose of this study was to determine the relative benefits of AECT with different postures for patients with lower limb lymphedema (LLL). Methods Eighteen women with LLL secondary to surgical treatment of gynecological cancer, completed (1) AECT in a seated position (seated AECT), (2) AECT in a supine position (supine AECT), and (3) compression-only therapy in a supine position (CT) in this randomized, controlled, crossover trial. AECT was performed on a bicycle ergometer while wearing elastic compression bandages. Each intervention was performed for 15 min, and the three conditions were separated by a 1-week washout period. Lower-limb volumes were evaluated using a PerometerTM sensor (Pero-system, Wuppertal, Germany), and symptom severity was assessed before and after each intervention using a visual analog scale (pain, heaviness) and palpation (pitting, stiffness). The effects of the interventions were estimated using linear mixed-effect models. Results The magnitude of limb volume decreases differed significantly among the interventions, with a greater decrease after supine AECT than after CT. Pre-intervention pitting severity and skin stiffness were significantly correlated with the magnitude of volume decrease after all interventions and after AECT in the supine position, respectively. Conclusions Supine AECT using a bicycle ergometer has marked immediate effects to decrease the fluid volume of severe LLL. Clinical trial registration UMIN clinical trial registry (UMIN-CTR; ID000020129) by CONSORT 2010, TRN R000023253, December 9, 2015

Evidence Summary of Stress Intervention in Patients with Gynecologic Malignant Tumor Related Lower Extremity Lymphedema

“…If the time is longer than one year, the long-term curative effect is the smallest, while the pressure intervention in supine position is more helpful to reduce symptoms than sitting and upright position. In terms of the selection of materials, high-density foam bandages and special compression methods have a good effect on the tissue fibrosis caused by LEL [9,29,30]. Clinical medical staff should individualize the mode, duration and position of stress intervention according to the degree of edema of patients, and consider whether to combine different stress intervention methods according to the disease progression, so as to achieve better results.…”

Surgical Treatment and Rehabilitation Strategies for Upper and Lower Extremity Lymphedema: A Comprehensive Review

“…Due to the functional limitations commonly associated with LLL, exercise therapy is one of the treatments proposed in lymphedema management, which is commonly combined with compression therapy [ 37 ]. In this scenario, the recent study by Abe et al [ 38 ] assessed the effects of compression bandages and 15 min of physical exercise in volume reduction, symptoms, and tissue stiffness. The short period of physical exercise was set, aiming at improving patients’ adherence to exercise intervention, which is to date still considered one of the main limitations to treatment efficacy.…”