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Tips and Exercises for Lymphedema From Cathy Skinner

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Published on April 12, 2019

In the past, exercise wasn't recommended for lymphedema patients, but clinical studies have shown that strength training can actually help people manage the condition and live well. What is the best way to exercise with lymphedema? Tune in to hear CEO and Founder of THRIVORS Cathy Skinner shares an exercise and wellness regimen tailored to the specific needs of those living with lymphedema.


Transcript | Tips and Exercises for Lymphedema From Cathy Skinner

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Cathy Skinner:

Hello.  My name is he Cathy Skinner, and I'm the CEO and founder of THRIVORS.  I'm really excited to be here with you today on Patient Power to talk about an important health condition and then what can you do in terms of physical activity to work through it, live with it, make it better. 

So what we're going to talk about today is lymphedema.  We're going to look at what is lymphedema, what does exercise protocol say about lymphedema, what are the exercises that you can do, and then give you some examples and help you work through those specific exercises.  So if you or somebody you know has lymphedema, then you know first-hand that it's a swelling of the limbs, usually an arm.  It can be in the chest or in the trunk of the body.  You can also find swelling in a leg. 

And how does lymphedema come about?  Well, imagine a breast cancer patient who is diagnosed, and then she has her lymph nodes tested to see if the cancer has progressed beyond the chest wall into the lymphatic circulatory system.  So a person would have a sentinel tested. And if there's cancer in that, then they go to the next lymph node and the next one, and cancer patients, breast cancer patients can have sentinel node tested as well as multiple nodes, and then they can be removed. 

And so if you remove lymph nodes, imagine it's a part of the circulatory system that doesn't work as well, because the nodes aren't there anymore.  And the damage is that there's protein-rich fluid that builds up in the arm or the limb and that causes swelling.  It can cause tightness, pain, redness, feels hot, feels heavy, and anyone who has that swelling is actually at risk for be infections, and I mean a serious, life-threatening infection. 

So folks with lymphedema wear compression garments.  They also see a lymphedema therapist who helps them with trigger points to help them move the fluid out of the extremity so that they can reduce their risk of infection, reduce their pain and discomfort and improve their quality of life and function. 

So for a long time physicians were recommending that cancer patients with lymphedema didn't lift anything or do anything, but thank goodness for Katy Schmitz out of the University of Pennsylvania who did a research study with almost 300 breast cancer patients and asked the question can strength training improve lymphedema or at least manage it?  And the good news is yes, it can. 

So through her exercise protocol she discovered that the folks who were in the intervention arm who did the strength training versus the control arm that didn't do any exercise at all, the folks who were in the intervention arm actually had better outcomes.  They had lower incidence of lymphedema.  So Katy was able to prove that through her clinical trial. 

But what she also discovered along the way was the other benefits of strength training for breast cancer patients who are either at risk for lymphedema or have lymphedema, and those benefits are weight management, managing stress, improving muscle mass, decreasing fat mass. And so not only does strength training benefit someone who has lymphedema, but there are all these other additional benefits that the cancer patient will experience. 

So what is Kate's protocol?  She describes it as a slow, progressive weight-training protocol, and there's a combination of volume plus rest.  And volume is the amount of weight that a person moves and the number of repetitions.  Think about volume.  And the other side of the coin is rest, and so how much time in between those sets can a person provide the limb, the muscle so that it's not overtaxed?  Because what happens with someone with lymphedema is that if the muscle is overtaxed, it's not really moving the lymphatic fluid the way it needs to be moved, but it actually could trigger a lymphatic flare-up, which is something we don't want to do. 

So if you're a person with lymphedema or predisposed at risk for lymphedema, first of all you should ask your physician for permission to do strength training, and reference Katy Schmitz's study and if your physician doesn't know, then you can walk in there and point to the data and the research that supports your efforts and can your wishes. 

The other thing is if you have upper arm extremity—excuse me, upper extremity lymphedema you should wear something called a compression garment.  It's a compression sleeve that's personally fitted for you.  You can also wear a glove on your hand called a gauntlet, and those things are often covered by insurance, and you have to go to a specific garment specialist, and they measure you a certain way.  Your lymphedema therapist will know how to get this garment, and it's essential to wear every time you exercise. 

So what is Katy's protocol look like?  So imagine the ability to start with low weight and low repetition and then progress slowly over time assuming you don't see any trigger of lymphedema.  So what does that really mean?  So I've got some little bitty weights here, and so imagine that if you're just getting started with strength training and you've got lymphedema in an affected limb, you've got your garment on and your gauntlet if you need it for your hand, then you would start with as simple as one-pound weights, and you can do biceps curls.  So you do a set of 10 or 12 repetitions with this very little weight, and then what you would do is jump to a lower body exercise. 

Now, why is that?  Because you want to give the upper body time to rest.  Again, it's a combination of volume and rest in between sets.  So you did your biceps curls with that little bitty weight, and you're going to think I'm crazy, but you'll understand the progression in just a moment.  Then you jump to your lower body exercise, a nice combination is perhaps a squat.  So while you're working your lower body, believe it or not, your upper body is getting a little bit of a break, and then you go back to that cute little weight and then you do a second set of that biceps curl.  And once you do a set of 10 or 12 repetitions you're back to the squats. 

And this idea of coupling exercises upper body, lower body is a means of making good use of your time, because it's great that you want to exercise but probably don't have an hour-and-a-half to wait in between every set, so let's be efficient with our time, so it's strength train upper body, strength train lower body. 

Then another combination of exercises might be a chest press.  And again you could do that with little bitty weights.  And then maybe you could do, we've talked about this in my other video segment, a table top lift where you're working on the legs.  Then perhaps a combination of exercises is a row where you're squeezing the upper back.  And then you couple that with perhaps a lunge.  I hope you’re getting the method to my madness here.  And then another couple might be shoulder exercises, and perhaps coupling that with a leg raise.  So I'm giving you options in terms of exercises, and when you're working with the upper body, again remember, slow progressive exercises. 

So let's say you spend a week and you strength train twice a week.  You're doing your biceps curls on Monday, Wednesday, and you don't have any lymphedema flare-up, great.  The second week of strength training do that again.  Do the little bitty weights on Monday, Wednesday.  If you can add Friday, that's even better.  Then after two weeks of training at that very modest weight take a little jump up to the next level and then strength train with that amount of weight.  What you're doing is you're being methodical about measuring the amount of weight that you're moving to be safe and not trigger a lymphedema flare-up.  At the same time you're building muscle mass, you're building strength and connectivity in your joints, and what this it does is provide you with a safe foundation for training.  Eventually you can progress and progress and lift more and more weight as long as there is no lymphedema trigger. 

In fact, Katy Schmitz did a fabulous follow-up study where she asked what's the upper limit.  How heavy can someone go?  And what they discovered is with the right training, with the right pacing, with the right progression there is no upper limit that is out of reach assuming a person continues to be safe and injury-free. 

So there are people who are trained, like myself as a cancer exercise specialist, who understand the lymphedema protocol, who understand lymphedema as a concern for exercise, so I wouldn't recommend that you just run out and jump into any exercise class but really find someone who knows what they're doing to help you along the way.  Our THRIVORS platform actually has this sense of progression and timing and alternating upper body and lower body exercises with it. 

I do have to qualify by saying that people who have lower extremity lymphedema right now there is no really strong research protocol that points to how to train well and exercise well with lower extremity lymphedema, which is often found in people with colon cancer, maybe gynecological cancer, perhaps some prostate cancer, so the same kind of swelling in the lower extremities occurs, but sadly there's no great protocol for that. 

So hopefully I've given you things to work with in terms of coupling upper and lower body exercises.  Hopefully I've been able to teach you about lymphedema if you have not heard of it before.  And I thank you so much for your time today.  A big shout-out to everyone at Patient Power.  Thank you again for this opportunity to share cancer exercise with you.  And check us out at if you have additional questions.  I'm Cathy Skinner.  Have a great day.  Thank you.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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