Developing a sound, individually tailored exercise program is one of the steps recommended to help improve your client’s general physical and psychological well-being. This is regardless of whether they are at risk of developing lymphoedema or actually have it. The goal is to address five key factors to ensure a suitable program is established for your client. This may mean that you need to call upon the skills of a variety of health professionals if it’s beyond your scope of practice.

When you initially discuss exercise with your clients, images of working out in the gym on a treadmill or lifting weights might come to their mind. We need to educate them that engaging in physical activity to sustain or improve health and fitness can be manageable. They need to see how it can be incorporated easily in their everyday routine.

When structuring an exercise program for your lymphedema client, the five key factors you need to consider are:

1. Range of movement
2. Strength
3. Fitness
4. Osteoporosis
5. Weight control

1. Range of Movement

Programs that address individual range of movement assist your client in having the best chance to regain their mobility after cancer surgery.

Important areas to remember are:

• Previous musculoskeletal issues.
• Scars and making sure they are not impeding the movement of the skin. Watch how the skin moves around these areas when the client moves their limb.
• Muscle tightness and weakness.
• Tight skin after radiotherapy.
• Impact of oedema on movement.
• Clients goals and expectations
• Functional range of movement.
• Management of Axillary Web Syndrome (AWS) or cording if it’s after breast cancer surgery.

Klose Training has an excellent online module on AWS. This online course describes the clinical presentation of AWS, outlines possible causes, and recommends current therapeutic options for this condition. The course format includes numerous video segments of patients with AWS, common exercises, and treatment techniques to use in your practice.

2. Strength

There is strong evidence that progressive strengthening exercises are safe in the breast cancer population. I believe that it is essential that our clients are monitored as they progress these exercises either, as part of a lymphoedema surveillance program, or if they have lymphoedema, as part of their lymphoedema management program.

Kathryn Schmidt has completed vast amount of research in this area and her Strength After Breast Cancer program is a comprehensive online program. This program is based on the Physical Activity and Lymphedema (PAL) Trial which assessed the safety and efficacy of slowly progressive weightlifting for breast cancer survivors with or at risk for lymphedema. This online course provides all the materials needed to set up the program in your own facility.

For other forms of cancer, the level of evidence is not as strong and further research is required. But what we know from the breast cancer arena can inform strength programs for other forms of cancer.

The following are recent research papers that you might find interesting.

click on abstract title below to open

This article reviewed nine randomised controlled trials over a short time range in 2014 and the main outcomes from this paper are:

• Supervised exercise is safe and beneficial for cancer survivors through strengthening programs by health professionals.
• Personalised supervision can optimise patient’s adherence to and compliance with interventions.

click on abstract title below to open

Twenty-five women with clinically diagnosed, stable unilateral breast cancer-related lymphedema completed two resistance exercise sessions, one with compression and one without.

There was no difference in lymphedema status for bioimpednace pre- and post-exercise sessions or between the compression and non-compression condition. Circumference values and symptom severity were stable.

The sample size is small and further research is required before concluding that moderate-load, upper-body resistance exercise, performed in the absence of compression, does not exacerbate lymphedema in women with BCRL.

3. Fitness

When we have the discussion with our clients about fitness, we need to clearly assess their current level of fitness. If this assessment is undertaken when they have already commenced their cancer treatment, then a pre cancer fitness level should be ascertained. It is also essential to get an understanding of what their goals are in relation to fitness. It is well known that individuals are more likely to continue with fitness programs if they enjoy it.

For many that can be simply implementing a walking program. Walking is great as they can do it anytime and they can motivate themselves by using a pedometer to count the number of steps.

For others they may want to commence or return to various forms of sport. Once again there is increasing evidence supporting that they can safely do this whether they are at risk of lymphoedema or already have lymphoedema.

click on abstract title below to open

This article compared a strength training program with an aerobic program. Both programs did not change lymphedema status, but led to improvements in function and quality of life, with findings suggesting that neither mode is superior with respect to lymphoedema impact.

4. Osteoporosis

As you may be aware some of the cancer treatment regimens have the side effect of reducing bone density. This can impact both men and women. But for women, who are tipped into menopause with treatment or who are currently in menopause, the risk of osteoporosis development may be increased.

As health professionals, it is important to stay up to date with current information on osteoporosis and it management. There are a number of good web sites in particular www.osteoporosis.org.au which has excellent resources that can be found at http://www.osteoporosis.org.au/resources

When developing exercise programs for our clients we should also include exercises that promote strengthening our bones. Osteoporosis Australia has an interesting table shown below. Obviously not all our clients can play netball or basketball but they can add into their walking routine some hills or some steps. They have a useful exercise and bone density fact sheet and a fact sheet for osteoporosis and breast cancer.

Taken from www.osteoporosis.org.au/exercise

5. Weight control

The effects of obesity are far reaching. We are well aware that it can increase the risk of developing lymphoedema after cancer treatment and for those that have lymphoedema it can exacerbate it and make it more difficult to manage.

The good news is there is growing evidence that exercise induces changes in mood, body image, self-efficacy, and coping leading to increased physical activity, improved eating, and weight loss.
There are significant effects of exercise-induced mood change on weight loss and psychosocial predictors of weight loss. Emotion- triggered eating can be regulated by the effects of mood change that occurs with exercise.

Annesi J. Supported exercise improves controlled eating and weight through its effects on psychosocial factors: Extending a systematic research program toward treatment development. Permanente Journal. 2012. Vol 16.