1. Multimodal Exercise Recommendations

The Delphi panel recommended combining resistance, aerobic, and flexibility exercises. 

• Resistance: 2–4 sessions per week, moderate intensity (2 sets of 8–15 reps at ~60% of 1RM), 20–30 minutes per session. Examples include free weights, resistance bands, or bodyweight exercises. 

• Aerobic: 3–7 sessions per week, moderate intensity (Borg 11–14), 5–40 minutes per session, targeting 150 minutes per week. Activities included walking, swimming, cycling, or water-based exercises. 

• Flexibility: At least 2 sessions per week, stretching to mild discomfort. Included static or dynamic stretches and mobility exercises. 

Key point: The panel highlighted tailoring programs to individual patient needs, progressing gradually, and considering co-morbidities. 

 

2. Recommendations on Compression Garments

The panel provided nuanced guidance on compression use during exercise. 

• Wearing traditional compression garments during exercise was recommended to support fluid management and symptom control. 

• Alternatives, such as sports compression garments or exercising without compression under supervision, were suggested for individuals who find standard garments uncomfortable. 

Key point: Flexibility in garment choice was emphasised to facilitate adherence while monitoring response. 

 

3. Supporting Long-Term Exercise Engagement

The Delphi study highlighted the importance of gradual progression and behavioural support. 

• Patients may initially struggle to meet the recommended activity thresholds. 

• Emphasis was placed on the potential long-term health benefits of regular exercise, including improved quality of life and reduced co-morbidity risk. 

• Monitoring progress and adjusting programs were recommended as part of ongoing management. 

 

4. Addressing Barriers

The panel acknowledged that barriers such as discomfort, motivation, or access can impact adherence. 

• Suggested strategies included identifying patient-specific challenges and providing alternative or modified exercises, such as water-based activities. 

• Participation in group programs or support networks was noted as a potential facilitator of adherence. 

 

5. Evidence-Based Practice

The recommendations are grounded in international expert consensus. 

• They reflect the opinions of a multidisciplinary panel of clinicians and researchers. 

• The framework provides a reference for clinicians seeking evidence-informed guidance on exercise in lower limb lymphoedema. 

 

Emerging Considerations

The Delphi study also identified areas for future research. 

• Further investigation of the effectiveness of compression garments during exercise. 

• Exploration of the optimal balance of resistance, aerobic, and flexibility exercises. 

• Potential use of wearable technology to monitor patient progress and adherence.