Researchers from Macquarie University have published the world's first ever consensus-based recommendations on exercise as part of the management of lower limb lymphoedema.
An estimated 70,000 Australians and as many as 250 million people worldwide live with lymphoedema, an incurable chronic condition in which fluid accumulates in the limbs, causing swelling, pain, physical distortion and impaired function.
Macquarie University researchers Dr Luke Davies and Dr Belinda Thompson have contributed to world-first recommendations confirming exercise as essential therapy for lower-limb lymphoedema.
The consensus-based framework, published in the journal Disability and Rehabilitation, strongly supports exercise – once thought likely to trigger lymphoedema or make it worse – as a fundamental component of lymphoedema management.
"It's clear from the amount of evidence supporting its use that exercise should be part of our comprehensive care for people with lymphoedema," says Dr Luke Davies of the Department of Health Sciences at Macquarie, first author of the paper.
"But we were surprised to find no published recommendations about the role of exercise in managing lower limb lymphoedema.
"There were umpteen resources for exercise prescription, guidance and recommendations for upper limb lymphoedema – probably because most cases there are related to breast cancer – but absolutely nothing for the lower limb."
Building the framework
Dr Davies, along with fellow researchers and clinicians from the Australian Lymphoedema Education, Research and Treatment (ALERT) Centre at Macquarie University, recruited an international panel of experts on exercise for lower limb lymphoedema and used the Delphi method, a structured two-way communication and review process, to develop agreement on exercise recommendations.
The Delphi panel of 54 experts from 10 countries reached consensus on 26 recommendations for exercise frequency, intensity, type and duration across three different exercise categories: resistance exercise (20-30 minutes, two to four times per week), moderate aerobic exercise (such as walking, swimming or stationary cycling), and flexibility (stretching and mobility).
Improving flexibility is one of the recommendations in the framework.
Panel members also agreed that patients with lower limb lymphoedema should wear clinical compression garments when exercising or should wear commercially available sports compression garments if wearing clinical compression is a barrier to exercising.
Better care pathways
Dr Belinda Thompson, Lecturer in the Department of Health Sciences at Macquarie and a co-author of the paper, says the consensus recommendations will be valuable to a broad range of clinicians and to patients with lymphoedema in the legs.
"A large proportion of the patients we see in our specialised clinic have lower limb lymphoedema and it has many potential causes and contributors, which can make it complex and challenging," Dr Thompson says.
"Not all health professionals have expertise in lymphoedema, so we hope these recommendations will be a useful foundation when a patient presents for something else and happens to have lymphoedema.
"The purpose of this framework isn't to dictate the way healthcare professionals should prescribe exercise; rather, it offers consensus-based exercise recommendations for individuals living with lower limb lymphoedema in the absence of strong scientific evidence."
Dr Luke Davies and Dr Belinda Thompson, from the Department of Health Sciences, are both lymphoedema specialists at Macquarie University's ALERT Centre.
