Rosalind Deacon, Marcos de Noronha, Leah Shanley, Kaye Young. Brazilian Journal of Physical Therapy 2018

Main findings

• The current study aimed to investigate whether slow aquatic exercise in the form of Ai Chi modified to include extra diaphragmatic breathing and lymph node massage is more effective than conventional (faster pace) aquatic therapy at reducing arm volume in women with breast cancer related lymphoedema. The intention of the study was to look at the short term effects of the intervention.
• Cross-over randomized controlled trial. Participants received two aquatic therapy interventions on two different days, a low speed aquatic exercise (LSAE) session and a conventional aquatic exercise (CAE) session.
• On each of the two intervention days data collection took place prior to intervention (Pre-I), immediately after (Post-I) and one hour after intervention (1h-I). Outcomes used for analyses were arm volumetry (measured via water displacement) and body composition (bioimpedance). They also collected data on satisfaction.
• The results of the current study show that slow pace aquatic therapy, as presented in this study (Ai Chi combined with additional diaphragmatic breathing and lymph node massage) is a viable and more effective form of therapy to reduce arm volume in women with BCRL when compared to conventional aquatic therapy, immediately after therapy.
• One possible explanation for the better results for the LSAE intervention is combination of diaphragmatic breathing and hydrostatic pressure.
• Also, during the LSAE participants are immersed neck deep during the entire session, with arms fully submerged. In contrast, during the CAE participants are generally chest deep, with occasions when participants have their arms completely out of water. As a consequence the LSAE utilizes the positive benefits of hydrostatic pressure for longer periods, which is known to reduce peripheral volume.
• The LSAE intervention included a rhythmic, slow and gentle intervention in time with the breath, while for the CAE participants were exercising at intermittent rates involving, walking, punching, cycling and jumping actions, all of which are faster and likely to increase blood flow. Although these water activities can be beneficial for other aspects of health, they could potentially be ineffective or increase arm volume.
• Unfortunately, the results showed that the positive effect seen immediately after the LSAE intervention was not carried over after 1 h, which can be seen as a negative outcome.
• However findings could be an indication that undesirable increases in arm volume are unlikely to still be present 1 h after the end of the treatment. This could be used as an incentive for these population to engage in water exercise with the aim to improve their general health. Further investigation should be conducted to confirm this possibility
• Possibility that the study was under powered.
• Some of the characteristics that largely varied were time since surgery and regular use of compression garments. The use of compression garments, in this study could have also influenced results. The only instructions between Post-I and 1h-I was to have a non-caffeinated drink and to avoid sleeve use (if this was their usual habit). These could be considered as minimum control during the intervention and the hour awaiting for the 1h-I measurement. It is possible that the intervention would be more or less effective depending on how regularly the patient wore compression garment. Another limitation was that the equipment used for bioimpedance assessment was only capable of measuring extracellular fluid of the arm.
• In this cohort of participants, there was a high proportion of participants with BMI greater than 25, including several with BMI above 40.