Exercise and complete decongestive therapy best ways to manage lymphedema, MU expert says

(Press-News.org) COLUMBIA, Mo. –Nearly 40 percent of breast cancer survivors suffer from lymphedema, a chronic condition that causes body limbs to swell from fluid buildup, as a result of lymph node removal and radiation therapy. A cure for lymphedema does not exist, so individuals with the condition must find ways to manage the symptoms throughout their lifetimes. Now, a team of researchers and clinicians working with a University of Missouri lymphedema expert has found that full-body exercise and complete decongestive therapy (CDT) are the best ways for patients to minimize their symptoms and maintain their quality of life.

"There's a sense of empowerment—of autonomy—that comes from meeting the challenge of living with lymphedema," said Jane Armer, an MU nursing professor. "Some breast cancer survivors say that they've become a new person after cancer because they met a challenge, and they like the stronger person they've become. The challenge of lymphedema is similar. It's something that is pervasive in every part of life. It takes problem solving and persistence to manage the condition without letting it interfere with their goals."

Armer and her colleagues reviewed published research about lymphedema self-management in order to determine which practices were most effective in managing the condition. The researchers found that full-body exercise, such as weight lifting and stretching, was likely to be effective in minimizing lymphedema symptoms. In addition, the researchers concluded that complete decongestive therapy (CDT), a comprehensive treatment approach that incorporates skin care, exercise, manual lymphatic drainage and bandaging of swollen limbs, also helps patients effectively manage the condition.

"Previous research suggests that, the earlier the interventions, the better the outcomes," Armer said. "If patients can learn how to successfully manage the condition early on, then they can continue those processes throughout their lives, and their outcomes will be better than those of individuals who resist participating in self-care."

### Armer is a professor in the MU Sinclair School of Nursing and director of nursing research at Ellis Fischel Cancer Center. The literature review, "Self-Management of Lymphedema," recently published in Nursing Research, was led by nurse colleagues, Sheila Ridner, professor at Vanderbilt University School of Nursing, and Mei Fu, associate professor at New York University College of Nursing and MU nursing alumna. The review is the fifth in a series of 12 to be published in conjunction with the American Lymphedema Framework Project (ALFP). Another literature review, "A Systematic Review of the Evidence for Complete Decongestive Therapy in the Treatment of Lymphedema From 2004 to 2011," was published by the American Academy of Physical Medicine and Rehabilitation earlier this year. This review was led by expert lymphedema clinicians and educators, Bonnie Lasinski, Long Island, N.Y.; Kathryn Thrift, Dallas; and DeCourcy Squire, Atlanta.

As director of the ALFP, Armer works alongside clinical experts and investigators to increase awareness of lymphedema and related disorders. The ALFP was founded in 2008 and is headquartered at the MU Center for Lymphedema Research, Practice and Health Policy. Its steering committee and staff currently are partnering with the International Lymphedema Framework (ILF) in producing an updated edition of the ILF Best Practice Document from 2006.