Immediate effects of active exercise with compression therapy on lower-limb lymphedema

Abstract

PurposeActive exercise with compression therapy (AECT) is a standard treatment for gynecological cancer-related lower-limb lymphedema (LLL) in clinical situations. However, there is insufficient evidence regarding the immediate effects of the use of AECT on LLL. The purpose of this study was to evaluate the immediate effects of AECT on LLL.MethodsParticipants in this randomized controlled crossover trial comprised 23 women with LLL who completed high-load AECT, low-load AECT, and compression-only therapy (CT). AECT was performed on a bicycle ergometer with short stretch bandages. Each intervention was performed for 15 min, with successive interventions separated by a 1-week washout period. Lower-limb volume was assessed using a Perometer™ sensor (Pero-system, Wuppertal, Germany). General symptoms (pain and heaviness) and skin symptoms (pitting and stiffness) were assessed using a visual analog scale and palpation, respectively. Measurements were taken before and after each intervention. Analysis of variance using linear mixed-effect modeling was used for statistical analyses.ResultsVolume decrement differed significantly between all three interventions (P < 0.05). Lower-limb volume was significantly reduced after high-load AECT compared to that after CT. General symptoms and skin symptoms were similar across the three interventions, but severity of pre-intervention skin symptoms correlated significantly with volume decrement after high- and low-load AECT. High-load AECT using the bicycle ergometer was more effective than CT for decreasing lower-limb volume.ConclusionsThese results suggest that high-load AECT has marked effects on severe LLL.

Efficacy and early results after combining laparoscopic harvest of double gastroepiploic lymph node flap and active physiotherapy for lower extremity lymphedema

“…As the lymph node flap represent the new functional lymph basin of the affected limb, the massage consisted in light, rhythmical and pumping hand movements starting from the proximal area toward the flap. Care was taken to perform gentle tissue movement in order to stimulate lymph flow without increasing blood flow (Fukushima et al, ). MLD took 30–60 min per treatment session and all patients underwent one treatment session a day for the first months and two treatment sessions per week for the following 5 months.…”

“…inset was done at the medial aspect of the ankle using the medial plantar vessels or the posterior tibialis vessels and at the popliteal fossa using the medial sural artery and venae comitantes as recipient vessels. The lymph node flaps were always covered using local flaps Care was taken to perform gentle tissue movement in order to stimulate lymph flow without increasing blood flow (Fukushima et al, 2017). MLD took 30-60 min per treatment session and all patients underwent one treatment session a day for the first months and two treatment sessions per week for the following 5 months.…”

Comprehensive Decongestive Therapy as a Treatment for Secondary Lymphedema of the Lower Extremity and Quality of Life of Women After Gynecological Cancer Surgery

“…A late-diagnosed and inadequately treated lymphedema can have a significant negative impact on a patient’s somatic, social, and psychological state, which can lead to permanent disability [ 1 , 12 ]. For secondary lymphedema of the lower extremities in patients who have undergone lymph node surgery, radiation, or chemotherapy in the treatment of cancer, the prevalence is 20–27.2% of patients [ 3 , 7 , 13 – 16 ].…”

The experiences, occupational performance impacts and needs of people who are at risk of, or have developed lymphoedema following groin or pelvic node dissection for Metastatic Melanoma: an interpretive descriptive study

“…The consequent negative impacts of LLL on quality of life (QoL), (Cromwell et al, 2015;Dunberger et al, 2013;Williams, Moffatt, & Franks, 2004) or health-related quality of life (HRQoL), (Montazeri, 2008;Morgan, Franks, & Moffatt, 2005), have led to many advocates favouring proactive, preventative approaches. Recommendations have included prophylactic wearing of compression garments post-surgery (Sarnaik et al, 2009;Spillane et al, 2008), teaching of simple lymphatic drainage (SLD) and exercises (Chang & Cormier, 2013;Fukushima et al, 2017;Reul-Hirche, 2011), risk management practices such as avoiding medical procedures on the operative limb (Clark, Sitzia, & Harlow, 2005;International Lymphoedema Framework, 2006;NLN., 2008), avoiding extreme temperatures (NLN., 2008) and other such recommendations. Some of these recommendations have been criticised for lacking rigorous scientific evidence (Cemal, Pusic, & Mehrara, 2011;McLaughlin, 2012) and require further research to confirm or refute claims.…”

“…Physically, lymphoedema may result in any combination of symptoms including limb swelling, visible lumps, puffiness or heaviness, tightness or hardness, pain, impaired sensation such as pins and needles, numbness, reduced function of the affected limb, increased risk of skin changes or skin infection and rarely the development of lymphangiosarcoma (Foldi & Foldi, 2006;Preston et al, 2004). Research about the physical implications of lymphoedema primarily focuses on LLL after gynaecological cancers (Brown et al, 2014;Dunberger et al, 2013;Finnane, Hayes, Obermair, & Janda, 2011;Fukushima et al, 2017;Iwersen et al, 2016;Tada, Teramukai, Fukushima, & Sasaki, 2009) and therefore relates solely to women. The experiences of women with LLL following gynaecological surgery, highlights physical symptoms including swelling, heaviness, various descriptions of pain and fatigue (Beesley et al, 2008;Finnane et al, 2011;Rowlands et al, 2014).…”