Influência da fisioterapia complexa descongestiva associada à ingestão de triglicerídeos de cadeia média no tratamento do linfedema de membro superior

Abstract

Objective: To investigate the influence of complex decongestive physical therapy (CDP) in association with diet therapy using mediumchain triglycerides (MCT), as an intervention in cases of upper-limb lymphedema. Methods: The lymphedema was evaluated by measuring circumferences, volumes, skin folds and whole-body water content. Feelings of discomfort, pain and heaviness in the arms were evaluated using a visual analog scale. Ten women who had undergone mastectomy and presented upper-limb lymphedema homolateral to the surgery participated in this study. Their mean age was 65.9 ± 10.4 years and their mean body mass index (BMI) was 26.8 ± 3.0kg/m². After nutritional evaluation, they were randomly divided into two groups: the Control Group (n= 5), which underwent physical therapy treatment consisting of CDP (classical massage, manual lymphatic drainage, compression taping and skincare) three times a week, for four weeks; and the MCT Group (n= 5), which underwent the same physical therapy protocol with the addition of daily diet therapy consisting of intake of MCT, for four weeks. Results: At the end of the intervention, analysis of the circumference and volume measurements showed significant differences between the groups (p≤ 0.05), with a greater reduction in lymphedema in the MCT Group. There were no significant differences in the skin fold measurements or whole-body water content. The feeling of heaviness in the arms after the intervention was significantly less in the MCT Group (p≤ 0.05), compared with before the intervention. Conclusion: Physical therapy treatment together with diet therapy with intake of MCT in women with upperlimb lymphedema following surgery and breast cancer treatment was effective in reverting this condition.

Physiotherapy treatments for breast cancer-related lymphedema: a literature review

“…Studies used all of its components (8)(9)(13)(14) or part of them (6,(15)(16)(17) . Applied to 36 women with post-surgical upper limb lymphedema, the CDT led to a mean reduction of 30.5% in the limb volume after the intensive phase, which was maintained during the studied periods (8) .…”

“…The assessment involved circumference and volume measurement, bioimpedance, cutaneous folds and visual analogue scale for feeling of discomfort. It was concluded that physiotherapy, together with the intake of medium-chain triglycerides (MCT), effectively acted on the involution of the disease, particularly in terms of circumference, volume and feeling of heaviness (15) .…”

“…Obesity is another risk factor for lymphedema and diet therapy with a view to weight loss seems to be useful for its treatment (15) . …”

Cuidado nutricional no linfedema pós-mastectomia

“…A gestão do linfedema é multidisciplinar, exigindo a atuação de vários profissionais da área da saúde em diferentes estágios da doença, incluindo: especialista em linfologia, psicólogo, fisioterapeuta, médico geneticista e, em alguns casos, um cirurgião especialista em distúrbios linfáticos 5 . Na área da nutrição há relatos de que o uso de triglicerídeos de cadeia média (TCM), associado com outros métodos, pode ajudar na redução do linfedema 8 . O tratamento do linfedema deve ser mantido por toda a vida, por se tratar de uma doença crônica, sendo a reabilitação um processo muito importante, porque é um recurso que procura prevenir e minimizar as incapacidades adquiridas, promover a maior funcionalidade possível e desenvolver o potencial psicossocial 1,8 .…”

“…Na área da nutrição há relatos de que o uso de triglicerídeos de cadeia média (TCM), associado com outros métodos, pode ajudar na redução do linfedema 8 . O tratamento do linfedema deve ser mantido por toda a vida, por se tratar de uma doença crônica, sendo a reabilitação um processo muito importante, porque é um recurso que procura prevenir e minimizar as incapacidades adquiridas, promover a maior funcionalidade possível e desenvolver o potencial psicossocial 1,8 . O presente artigo apresenta o tema cuidado nutricional no linfedema, embasado na literatura científica.…”