Fitness Article: Exercise with Lymphedema of the Leg

By Karen Goeller, CSCS

Copyright © Goeller This article is not for reprint without written permission from the author.

I am writing this article in response to a question from a fitness trainer on how to train a client with lymphedema. I am writing it from two points of view, as a fitness trainer and as a patient who has suffered with leg lymphedema since my cancer surgery. Before I discuss the effective exercises for lymphedema  I should explain what lymphedema is and what life is like with lymphedema.

I have been able to maintain my leg lymphedema pretty well because I understand the condition, I have listened to my doctors, I wear my compression stocking, I keep my leg elevated when not in motion, and I have extensive knowledge of exercise. I have been very disciplined with my daily care. It is on my mind nearly every moment of every day.

Lymphedema is a very difficult thing to deal with and must be maintained all day long, every day. There is no cure for lymphedema. I have had lymphedema in my leg since 1991. My lymphedema is the result of my lymph nodes being removed during cancer surgery. I went from being a gymnastics coach, gym owner, and fitness trainer who exercised daily to being bedridden after my surgery. My life changed drastically. I eventually went back to work, but with many physical limitations. I coached with my leg elevated and assigned more drills and conditioning exercises to my gymnasts because I could not lift them. (They ended up being better gymnasts as a result!)

I learned how to maintain my lymphedema quickly. Several doctors told me that I would be bedridden for the rest of my life and that I would never work again after the surgery. They were partially correct because I was instructed not to get out of bed in the morning if my leg is still swollen from the previous day. It does not normally take days or weeks for the swelling to go down, but there are still days that I remain in bed a few hours after waking up because of the swelling. I am able to eventually get up and go on with my day.

What is lymphedema? Here is the definition from VascularWeb.org...
"Lymphedema occurs when a clear fluid known as lymphatic fluid builds up in the soft tissues of your body, usually in an arm or leg. The lymphatic system consists of lymph vessels and lymph nodes that run through your body. Lymph vessels collect a fluid that is made up of protein, water, fats, and wastes from the cells of the body. Lymph vessels carry this fluid to your lymph nodes. Lymph nodes filter waste materials and foreign products, and then return the fluid to your blood. If your vessels or nodes become damaged or are missing, the lymph fluid cannot move freely through the system. The fluids can then build up and cause swelling, known as lymphedema, in the affected arms or legs. There are two types of lymphedema. Inherited lymphedema, sometimes called primary lymphedema, in which you are born lacking lymph vessels and nodes. The swelling usually appears during your adolescence and affects your foot or calf. A rare form of primary lymphedema develops in infancy and is called Milroy’s disease. Acquired lymphedema, sometimes called secondary lymphedema, in which an injury to your lymphatic system causes lymphedema. It is much more common than primary lymphedema."

What types of exercise can a lymphedema patient perform? That depends on the patient and whether they have medical clearance to exercise. Once medically cleared for exercise, the best exercise to reduce the leg swelling is swimming because the person is horizontal, the leg is in motion, and it is a non-impact exercise. The second best exercise for a person with leg lymphedema is riding a recumbent bike. It is also non-impact, it is a steady motion, and the legs are elevated slightly.

If the person with leg lymphedema is in good physical condition otherwise and they have the lymphedema under control they can use the elliptical machine. That is, if they can tolerate it from a fitness and medical standpoint. The elliptical is also non-impact because the foot is not lifted off and contacting a surface repeatedly. Make sure the lymphedema patient has permission from their doctor to exercise.

It is important to stay in motion and to perform non-impact exercises. An impact exercise is one where the foot leaves and strikes the floor. A non-impact exercise is one where the floor remains on the surface such as the bike or elliptical. Keep the person with lymphedema OFF THE TREADMILL. Walking and running cause the leg swelling to become MUCH worse because they are high impact. The swelling becomes dense / packed in from impact exercise. Squats with light dumbbells are a better choice than walking lunges for someone with lymphedema. The walking lunge is an impact exercise and the squat is non-impact. It's all about keeping the body in motion without any impact.

The more severe the swelling, the more difficult it is to deal with. In my experience, it can take over an hour with the leg elevated before the swelling even BEGINS to go down and several days or weeks of elevation for it to drain more completely. The longer it is swollen, the longer it will take to drain. Unless their doctor has instructed otherwise, people with leg lymphedema should be wearing a compression stocking and sleeping with her leg elevated every night. A compression level should be prescribed by the doctor. The stockings come in various compression levels. The Sigvaris stockings are made really well.

Keep in mind that the patient MUST be cleared to begin exercise. If they begin to exercise before the doctor allows them to exercise they can cause permanent damage to the lymphatic system. My doctors told me to wait one full year after my surgery before I was allowed to exercise. I waited 10 months and couldn't stand it any longer. Not being allowed to exercise was extremely difficult for me because I spent a lifetime in the gym. Again, make sure the lymphedema patient has FULL medical clearance to exercise.

When a person with lymphedema is not in motion and does not have a compression stocking on their leg, they MUST keep their leg elevated in order to prevent swelling. Something as simple as waiting in line at the grocery store can cause enough swelling to keep a person in bed the entire next day. The swelling begins in less than a minute when standing still or sitting without the leg elevated. It is truly a challenge every minute of every day to keep the leg from swelling. Those close to lymphedema patients must be patient and considerate. If lymphedema is not controlled it can end up being elephantitis. Yes, it is a real medical condition and it is very serious.

There are lymphedema support groups throughout the USA. The National Lymphedema Network has plenty of information, www.lymphnet.org.  And you might want to read more...  www.mayoclinic.com/health/lymphedema/DS00609,  www.vascularweb.org, or at http://en.wikipedia.org/wiki/Lymphedema 

Let me know how I can help you...

By Karen Goeller, CSCS

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