I have a male client who suffers from lymphedema, due to surgery. He wears a compression stocking to his arm and suffers from the occasional bout of cellulitis. What restrictions do I have to consider when designing his program? You have wonderful information on your site regarding lymphedema, but it pertains mostly to the female client.
All clients with lymphedema should be under the care of a physician. This short response is not a substitute for medical advice.
Lymphedema does not discriminate!! Men can get lymphedema, too! In addition, both men and women can get breast cancer and/or melanoma and can suffer from lymphedema after lymph node removal. However, often men suffer more psychosocial problems than women because it is considered a “woman’s disease.” It is best to interface with a physician or occupational therapist who specializes in treating this condition, so that you can follow their recommendations.
Melanoma is a type of skin cancer. When this cancer has spread to the lymph nodes, a lymphadenectomy is performed to remove the cancerous lymph nodes. This procedure is undertaken to cure melanoma and to prevent the melanoma from spreading farther. Once lymph nodes are removed, one is at risk for infection. Cellulitis is an infection of the skin or subcutaneous tissue. The symptoms are heat, redness, pain and swelling. The client should be immediately referred to a physician and provided with a treatment regimen. Exercise should not be continued if the client is ill with a fever. Once the infection is under control, exercise can be resumed. Cellulitis increases lymphedema risk because the lymphatic system becomes overwhelmed fighting the infection.
The concern with exercise is that it promotes blood flow, which can overload and tax an impaired lymphatic system. The same precautions and procedures apply for all clients with lymphedema. The first priority is to make sure your client has full range of motion at all joints in the affected arm. Proximal to distal exercises should be utilized as a warm up (abdominal curls followed by neck, shoulder, arm and hand exercises) along with deep breathing exercises to promote lymphatic return. A well-fitting compression sleeve should be worn for both aerobic exercise and strength training. Start with very light weights (one pound) and low repetitions. Gradually increase the number of sets and alternate arms. Be sure to observe how the arm responds. An increase in swelling indicates that the weight was too heavy or too many repetitions were performed. Do not increase the weights the same time as you increase the repetitions. Work the musculature including the deltoids, biceps, triceps, rotator cuff, serratus anterior and rhomboids. Strength training to the other arm and body parts can continue in the usual manner. Swimming is an excellent exercise for lymphedema, as the water provides compression and allows freer movement. A sleeve is not worn in the water. It is advisable to exercise indoors with air conditioning when one has lymphedema. Heat can be a factor in an increase in swelling. If outdoor activities are engaged in, sunscreen is a must.