>>>Joan Shulmistras: What we need to remember
when we are doing exercise with lymphedema patients is that because we are increasing
the blood flow and the lymphatic levels, we want to make sure that they are wearing compression
garments or their compression sleeves on bandaging, because adding the compression on the outside
of the limb along with the muscle pumping action on the inside, we are facilitating
that lymph drainage and clearing it out of the limb, getting the fluid back up to the
venous system where it gets dropped into the heart and gets processed out of the body. Because there is a risk for in the blood flow,
with the increased blood flow you have increased lymph, we want to make sure that that compression
is on the arm. There are different kinds of exercises that
we are looking at. The first one is a lymphedema exercise which we consider a very easy, slow-moving
range of motion exercise. That is just doing a gentle pumping action – done slowly and
carefully within an easy pain-free range of motion. We progress slowly. We want to encourage deep-breathing
or diaphragmatic breathing because again, the muscle pumping action of the diaphragm
helps to clear what is the thoracic duct or the main ducts that travel through the diaphragm
that again help to clear the arms and help to clear the legs of the lymph system. Another form of exercise that we want to look
at is strength training. But again, we want to look at it and be very careful with it
– slow, gradual progress, increasing the amount of poundage, duration, frequency, just
on a gradual basis because again, there is a higher risk here because of dealing with
strength that it may have a greater risk for lymphedema. But again, we can do it, progress it because
we want the limb to get stronger. The other is cardiovascular – looking in either jogging,
or walking or swimming, bicycling and those activities, again help with the cardio functioning
and increasing and improving endurance and stamina.