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Trial design: A randomized controlled trial was performed to evaluate the effect of the combination of compression therapy with active exercising using a facilitating apparatus on arm lymphedema. Method: Twenty women with a mean age of 63.3 years were evaluated; all had lymphedema resulting from breast cancer treatment. The inclusion criterion was a dif-ference of 200 mL in size between arms. The apparatus used, called ‘pulley system’, is a ver-tical iron wheel fixed on a support at a distance of 10 cm from the patient’s body. Participants were submitted to two series of active exercises using this facilitating device, one series using a compression sleeve and the other without. Each series consisted of four 12-minute sessions of exercises separated by 3-minute rest intervals. Volumetry was performed before and after each series of exercises. The paired t-test was utilized for statistical analysis (p-value < 0.05). Results: A significant mean reduction (p-value < 0.007) and non-significant mean increase (p-value < 0.2) in volumes were observed during exercising with and without compression, respectively. Conclusion: Controlled active exercising utilizing a facilitating apparatus while wearing a compression sleeve reduces the size of lymphedematous arms.
ACESSARThe adaptive mechanisms that prevent edema of the lower limbs when standing involve the action of muscles pumping fluids against the force of gravity. The objective of the current study was to evaluate the interference of gravitational pressure on active exercises of lower limbs with lymphedema. A total of 24 male and 5 female patients with a mean age of 34.6 and lymphedema of the lower limbs were evaluated. Volumetric evaluations were made before and after one hour performing three different activities utilizing the displacement of water technique similar to the method used by the ancient Greeks. Three different activities were utilized: 1) one hour laid down at rest with the affected limb on a sofa; 2) one hour with the limb supported on a sofa performing plantar bending and stretching exercises at about 20 to 30 movements per hour controlled by an observer and 3) one hour laid on a mattress performing plantar bending and stretching exercises at about 20 to 30 movementsper hour also controlled by an observer. The student t‐test was employed for statistical analysis with an alpha error of 5% considered acceptable. The greatest volume losses were experienced by individuals exercising with the limbs supported on a sofa which when compared to the lowest reductions for exercises performed on a mattress gave a p‐value = 0.023. There was no significant difference between resting on the sofa and exercising on a mattress (p‐value = 0.59).
ACESSARThe aim of this study was to evaluate a form of programmed exercises in the recumbent position using leisure resources. Ten female patients aged between 42 and 72 years old (mean age of 66 years) referred for an evaluation of lymphedema were enrolled in this study. Inclusion criteria were a history of treatment for cancer leading to arm edema evidenced as a difference in volume greater than 200 mL compared to the contralateral limb. Women with active infections, skin lesions or active disease were excluded from the study. Four types of exercises were selected including using a ball, a bat for arm lifting movements, flexion and extension movements of the arm and flexion and extension movements with the arm supported on a foam wedge. These exercises were performed as four 15-minute stints over one hour. All participants were supervised during activities and warned to perform few movements (maximum 10 per minute) in the supine position and to use a compression arm sleeve. Changes in volume were calculated using plethysmography before the start and after completing the exercises. The paired t-test was used for statistical analysis with an alpha error of 5% being considered acceptable (p-value < 0.05). For the group as a whole, the change in volume of the lymphedematous arms was insignificant; for seven patients the volume increased and for three it diminished. The types of exercises used in this study did not reduce the volume of lymphedematous arms.
ACESSARLymphedema is one complication of breast cancer treatment. The hypothesis of the authors is that these procedures damage the lymphatic system and make drainage of proteins and macromolecules from the cell interstice difficult.
ACESSARThe aim of this study was to evaluate the reduction in volume of arm lymphedema secondary to breast cancer therapy utilizing an exercise facilitating device. Twenty-one women with arm lymphedema resulting from the surgical and radiotherapeutic treatment of breast cancer were randomly selected. Evaluation was made by water-displacement volumetry before and after each session. The patients were submitted to a series of active exercises using a facilitating device for four 12-minute sessions with intervals of 3 minutes between sessions in the sitting position with alignment of the spinal column. The lymphedematous arm was maintained under compression using a cotton-polyester sleeve. The active exercising device used was a mobile flexion bar fixed on a metal base at a height of 30 cm from the tabletop and at a distance of 10 cm from the patient’s body. The paired t-test was utilized for statis- tical analysis with an alpha error of 5% (p-value ≤0.05) being considered significant. The initial mean volume of the arms was 2,089.9 and the
final volume was 2,023.0 mL with a mean loss of 66.9 mL (p-value <0.001). In conclusion, active exercises utilizing facilitating devices can contribute to a reduction in size of lymphedematous limbs.
