Lymphedema

Overview of Lymphedema

This condition is usually caused by decreased capacity of the lymphatic system to maintain normal flow of lymphatic fluids. The most common causes of lymphedema are invasive procedures and surgical resection of tissues for the treatment of cancer. Severity progresses in three stages (see following). Clients with this condition are unable to use their affected extremities in a normal manner, limiting their daily activities and ability to participate in recreational activities.¹ Clients with advanced stages of lymphedema will need a comprehensive treatment program to manage their condition.

Stages of Lymphedema

Stage I: Development of pitting edema in extremities, which is reversible on elevation of the limb.

Stage II: Irreversible edema with development of connective tissue fibrosis.

Stage III: Severe fibrotic edema with atrophic changes throughout the affected extremity.

Comorbidities to Consider

• Clients who have developed this condition secondary to treatment of cancer may have severe fatigue that limits their activity level.

Client Examination

Keys to Examination of Clients

• Limb volume can be measured with circumferential measurements or by water volumetry.

• Heart rate and blood pressure are important in assessing the effects of changes in fluid levels upon the cardiovascular system.

• Clients may have undergone imaging studies to determine if other causes of limited lymphatic flow are present or a lymphoscintigraphy to measure peripheral lymphatic function using radiotracers.

• Examine for signs of skin breakdown as repetitive movements may cause stress to the skin.

Recommended Baseline Testing of Fitness Levels

• Exercise tolerance can be assessed with an arm ergometer test or with a walking test of short durations.

• Strength assessment of the involved limb will be difficult as the client may be unable to support the limb independently, and excessive pressure on the limb should be avoided.

Exercise Prescription

Type: Walking, arm ergometry, weight training^2,3,4

Intensity: Start with low intensities

Duration: Start with short bouts with rest periods

Frequency: Three to five times per week

Getting Started

The exercise program needs to be coordinated with other aspects of the client's medical management. Clients who have undergone treatment for cancer, especially after mastectomy, may be counseled to limit the use of their involved upper extremity and may fear that overusing their involved extremity will worsen their condition. Exercise has the potential to have negative effects on the client's condition and should be carefully prescribed and monitored. Recommended programs for clients with upper-extremity lymphedema include a supervised circuit of weight training exercises for the upper and lower extremities along with an aerobic component using arm ergometry.^1,2...