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

Takuya Fukushima, Tetsuya Tsuji, Yufuko Sano, Chieko Miyata, Michiyo Kamisako, Hiroka Hohri, Chikako Yoshimura, Megumi Asakura, Taro Okitsu, Kaori Muraoka, Meigen Liu, Takuya Fukushima, Tetsuya Tsuji, Yufuko Sano, Chieko Miyata, Michiyo Kamisako, Hiroka Hohri, Chikako Yoshimura, Megumi Asakura, Taro Okitsu, Kaori Muraoka, Meigen Liu

Abstract

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.

Keywords: Ergometer exercise; Gynecological cancer; Lymphatic system insufficiency; Rehabilitation.

Conflict of interest statement

Conflict of interest

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Study design: the randomized controlled crossover trial. Each intervention was performed for 15 min, and the three interventions were separated by a 1-week washout period to eliminate any carryover effects. Measurements were taken before and after each intervention. Six patterns of intervention order were applied, with randomization in blocks of six using computer-based random number tables to eliminate order effects
Fig. 2
Fig. 2
Correlations between severity of pre-intervention skin symptoms and changes in lower-limb volume. Severity of pre-intervention skin stiffness correlated significantly with changes in lower-limb volume for high-load (a) (r = 0.66, P < 0.01) and low-load AECT (b) (r = 0.53, P < 0.01), but not for CT (c) (r = −0.04, P = 0.86). Severity of pre-intervention pitting correlated significantly with changes in lower-limb volume for high-load (a) (r = 0.47, P = 0.02) and low-load AECT (b) (r = 0.45, P = 0.03), but not for CT (c) (r = −0.31, P = 0.15)

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