A Proposed Exercise Pathway for Recovery. Enhancing the lymphatics during recovery. Understand how exercise can enhance lymphatic function

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2 A Proposed Exercise Pathway for Recovery Enhancing the lymphatics during recovery Review of the Lymphatic System Understand how exercise can enhance lymphatic function Finding your limits

3 Evidence-based guidelines: an exercise pathway for recovery including a model for weights training Post-op exercises (evidence-based) Encore program (evidence-based) Yoga/Pilates/ tai-chi (some evidence) Dragon boating (evidence-based) Gym Cardio, Weights (evidence-based guidelines) Physio, exercise professional (follow guidelines)??? Other

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5 Lymphatic System Waste disposal system ( storm water drain ) Essential for effective circulation How does lymph fluid circulate? Intrinsic pump of lymphatic vessels Pump of large arteries close by Deep breathing Muscle pump 2-3L of fluid is returned to the blood in 24hrs 40% of lymph is produced in muscles

6 One-way system Fluid forms in the interstitial space = lymph Initial lymphatics lymph vessels lymph nodes Contains water, protein, electrolytes, fats, fat/chyle, antigens Surgery vs. Lymphatics System becomes sluggish, clogged/slow stormwater drain. Initial lymphatics lymph vessels lymph nodes

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8 What goes in must come out!! Initial lymph formation Exercise Lymph nodes /stormwater processing Heat e.g. sun/sunburn, hot spas, Infection Exercise Garments, other strategies Waste disposal + back to general circulation

9 Courtesy of NBOCC

10 Risk factors for the development of BCRL include; Extent of breast and axillary surgery Axillary radiotherapy Being overweight/obese Infection and trauma to the affected side Air travel?exercise Approximately 20% likelihood

11 Lymphatic Function and Arteries 40% of the body s lymph fluid is produced within muscles Lymph formation is directly proportional to arterial flow i.e. more vigorous activity, more lymph formed Implications for lymphoedema??? By-products of exercise like lactic acid further increase blood flow to the muscles Leads to increased lymph fluid production Arteries pulse near lymph vessels

12 Lymphatic Function and Veins Veins transport the blood from the muscles back to the heart Return of blood to the heart is increased by a combination of movement and muscle activity (similar to lymphatic flow) Static positions and exercises decrease venous flow and increase pressure in the surface veins Increase load on the lymphatic system

13 Faster lymph formation Enhanced lymph flow overall - Consider lymphatic principles to enhance the overall effect!! - WHAT COMES IN MUST COME OUT!!

14 Deep breathing Slow and controlled exercises/movements Consider exercise in the water e.g. swimming Warm up and cool down periods recommended Build up both aerobic and strength activities over time (weeks/monghts) to allow circulation, including lymphatics to adapt to new activities

15 ??Caution with high intensity + highly repetitious weights programs e.g. Pump classes and sustained positions during exercise More research required to determine the whether high intensity aerobic and resisted exercise increases risk of BCRL

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17 Components of Lymphatic Massage Deep breathing Lymph node massage Stroking Exercises

18 DOES LYMPHOEDEMA CHANGE THIS?? Post-op exercises (evidence-based) Encore program (evidence-based) Yoga/Pilates/ tai-chi (some evidence) Dragon boating (evidence-based) Gym Cardio, Weights (evidence-based guidelines) Physio or personal trainer (follow guidelines)??? Other

19 What comes in must come out Exercise as medicine Optimise your lymphoedema selfmanagement regime, stabilise for exercise?? Address barriers to this regime Do something you enjoy!!

20 Questions? Positive Motion Physiotherapy University of Canberra Faculty of Health Clinic (Bruce Campus) ph:

21 Early Intervention Skin Care + treat/prevent infections Lymphatic Massage Self-massage (TMEPR) Lymphoedema Therapist (MLD) Compression Garments Exercises (specific lymphatic) General Activity ( Exercise as medicine ) Aim to reverse the backflow or unclog the pipes of the stormwater drain!!

22 Low level laser therapy Handheld Scanning Pneumatic Pumps Bodyflow/TENS

23 Kinesiotape for chronic swelling Various shapes e.g. fans, strips Application

24 Courtesy Kinesiotape for Lymphoedema and Chronic Swelling

25 Moderate to Severe Lymphoedema Multilayer compression bandaging Short stretch bandages + padding Various treatment regimes Courtesy lymphademaininfo.blogspot.com

26 Exercise!! Massage Compression garments Special stretches/lymphatic pumping exercises General activity Bandaging and CPT Emerging Treatments