Immediate effects of active exercise with compression therapy on lower-limb lymphedema

T Fukushima, T Tsuji, Y Sano, C Miyata, M Kamisako, H Hohri, C Yoshimura, M Asakura, T Okitsu, K Muraoka & M Liu. Support Care Cancer (2017) 25:2603–2610.

Click to read the abstract

Immediate effects of active exercise with compression therapy on lower-limb lymphedema.

T Fukushima, T Tsuji, Y Sano, C Miyata, M Kamisako, H Hohri, C Yoshimura, M Asakura, T Okitsu,         K Muraoka & M Liu. Support Care Cancer (2017) 25:2603–2610.

PURPOSE:

Active exercise with compression therapy (AECT) is a standard treatment for gynecological cancer-related lower-limb lymphedema (LLL) in clinical situations. However, there is insufficient evidence regarding the immediate effects of the use of AECT on LLL. The purpose of this study was to evaluate the immediate effects of AECT on LLL.

METHODS:

Participants in this randomized controlled crossover trial comprised 23 women with LLL who completed high-load AECT, low-load AECT, and compression-only therapy (CT). AECT was performed on a bicycle ergometer with short stretch bandages. Each intervention was performed for 15 min, with successive interventions separated by a 1-week washout period. Lower-limb volume was assessed using a Perometer™ sensor (Pero-system, Wuppertal, Germany). General symptoms (pain and heaviness) and skin symptoms (pitting and stiffness) were assessed using a visual analog scale and palpation, respectively. Measurements were taken before and after each intervention. Analysis of variance using linear mixed-effect modeling was used for statistical analyses.

RESULTS:

Volume decrement differed significantly between all three interventions (P < 0.05). Lower-limb volume was significantly reduced after high-load AECT compared to that after CT. General symptoms and skin symptoms were similar across the three interventions, but severity of pre-intervention skin symptoms correlated significantly with volume decrement after high- and low-load AECT. High-load AECT using the bicycle ergometer was more effective than CT for decreasing lower-limb volume.

CONCLUSIONS:

These results suggest that high-load AECT has marked effects on severe LLL.

Main findings

  • All participants took part in the three interventions, comprising high-load active exercise with compression therapy (AECT), low-load AECT, and compression-only therapy (CT). There was a 1 week washout period between interventions.
  • Multi-layered compression bandaging was performed with the patient in a supine position. A foam padding bandage (Artiflex®; BSN Medical, Rue Guillaume, Luxembourg) on a cotton tube stockinette (Tricofix®; BSN Medical) was wrapped around the lower limb. Short stretch bandages (Comprilan®; BSN Medical) were sequentially wrapped around the entire limb. Bandage pressure at the calf was maintained at 40mmHg.
  • Active exercise was then performed using the training mode of the Strength Ergo™240 bicycle ergometer. Exercise intensity was set at 10% of the maximum extension muscular strength of the lower limb as evaluated at baseline for highload AECT and 5% for low-load AECT. Duration of exercise was set at 15 min in the present study.
  • Significant reductions in lower-limb volume were seen for all interventions from pre-to post-intervention. Changes in lower-limb volume were significantly greater with high-load AECT than with CT.
  • Severity of skin stiffness and pitting edema symptoms pre intervention correlated significantly with the volume decrement under both high- and low-load AECT.