Q: I am now dealing with lymphedema after breast cancer surgery. What exercises can I do? What else would help? — Anonymous, Pacifica, Calif.
A: The lymphatic system, which works closely with the circulatory system, is a major part of our immune system. The lymph nodes filter toxins and provide the transportation for immune cells and antigens that will be concentrated in the lymph nodes. The lymphatic system also maintains fluid balance throughout the body. But unlike our blood, which is circulated by the pumping action of the heart, it is our breathing and the movement of our skeletal muscles and skin that move the lymph through its complex system of thin vessels and glands (nodes).
A large number of white blood cells (which defend the body against disease) are mainly lymphocytes (concentrated in lymph nodes) where “bad cells” will be immobilized and neutralized. When cancer is found in lymph nodes, it can easily spread to other lymph nodes. This means that some nodes could be removed or radiated along with other affected tissue.
Unfortunately, unless the lymph can find another pathway, this often interrupts the natural flow and drainage of the lymph fluid in the areas where the nodes are removed or damaged. In order to avoid dangerous swelling from fluid accumulation (called lymphedema) you have to take matters into your own hands. Literally.
Because the lymphatic system does not have its own pump, you must move the lymph through your own movements. The stage and development of your condition (and any other related problems) will determine where you need to start in an exercise program, so it is imperative to consult with your physician first.
That being said, “manual lymph drainage” and stretching are where most will start. Find a therapist trained in dealing with lymphedema because the therapist needs to know how to gently move the accumulated fluid from the affected area.
The therapist also should be able to teach you how to perform self-drainage. Most stretching that moves the skin, muscle and tissue in the area affected will help relieve the feeling of bloated tightness, restore flexibility and improve range of motion. Yoga is a good activity to consider.
Compression bandages or clothing help, once you resume or begin an exercise program. They are made of a specialized elastic knit that provides gentle pressure to the affected area and aid in maintaining good fluid circulation, encouraging the flow of fluids to the capillaries.
It is very important that the clothing fits properly, so have your specialist help you choose the right garment. Please note that most of these garments are worn only when you are moving around during the day, flying or traveling at higher altitudes. There are different, special garments for nightwear.
A pool is a good place to start exercising because the gentle pressure of the water stimulates the lymphatic system. Aerobic exercise — such as walking, dancing, bouncing on a trampoline — are also recommended. Returning to activity should be gradual and under the guidance of a medical professional.
Until recently, most resistance exercise was discouraged. But recent research published in The Journal of the American Medical Association in 2010 found that slowly progressive weightlifting didn’t increase the risk of lymphedema in many of the research test subjects. The emphasis is on “slow.” Again, this does not work for everyone, so monitor yourself, and stay active in ways that work for you.
“Act at the first sign of swelling,” notes cancer survivor, fitness professional and lymphedema support group founder Jayah Paley. “Breast cancer involves a path of treatment; lymphedema requires a lifetime of management.” Paley recommends being pro-active because living well with lymphedema takes diligence.
For additional information: National Lymphedema Network, .
Linda J. Buch is a certified fitness trainer in Denver; linda@ljbalance.com.
