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

Meigen Liu,Asako Oka,Aiko Ishikawa,Michiyo Kamisako,Junichi Shoji,Hiroka Hohri,Tetsuya Tsuji,Kiriko Abe

doi:10.1007/s00520-020-05976-y

Meigen Liu, Asako Oka + Show 6 more

Open Access

https://doi.org/10.1007/s00520-020-05976-y

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Abstract

PurposeAlthough 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).MethodsEighteen 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.ResultsThe 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.ConclusionsSupine AECT using a bicycle ergometer has marked immediate effects to decrease the fluid volume of severe LLL.Clinical trial registrationUMIN clinical trial registry (UMIN-CTR; ID000020129) by CONSORT 2010, TRN R000023253, December 9, 2015

Highlights

Lymphedema is the accumulation of high protein fluid in the interstitium due to the failure of lymphatic transport or Lymphedema can progress from mild to severe swelling with accompanying leakage of lymph from the skin and cellulitis; severe symptoms can adversely affect patients’ quality of life, ability to perform their activities of daily living, and psychosocial health [2,3,4]
The only report of the immediate edema-relieving effects of exercise is our previous study [14], in which we demonstrated that 15 min of active exercise with compression therapy (AECT) in a seated position using a bicycle ergometer significantly decreased lower extremity volume
The interventions were AECT in a seated position, AECT in a supine position, and compression-only therapy in a supine position (CT) (Fig. 2)

Summary

Introduction

Lymphedema is the accumulation of high protein fluid in the interstitium due to the failure of lymphatic transport or Lymphedema can progress from mild to severe swelling with accompanying leakage of lymph from the skin and cellulitis; severe symptoms can adversely affect patients’ quality of life, ability to perform their activities of daily living, and psychosocial health [2,3,4]. Combined physical therapy (CPT) is the recommended treatment for lymphedema [1, 5, 6]. CPT consists of skin care, manual lymph drainage, compression therapy using multilayered bandages and elastic garments, and exercise. CPT is widely practiced in clinical settings, there is little evidence regarding its effects, especially for LLL [1, 5].

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