The Efficacy of Home Based Exercise Regimes for Limb Oedemas
Moseley A; 2007
Synopsis: This dissertation investigates the efficacy of various cost effective and easy home-based regimes for the management of limb oedema.
Abstract: Both secondary lymphoedema and venous oedema of the limb are the consequence of an imbalance between tissue fluid infiltrate and drainage, which leads to interstitial fluid accumulation, tissue compositional changes, limb discomfort and morbidity. Numerous conservative therapies have been developed to address some of these negative outcomes, with a proportion of these being labour and cost intensive. This makes the investigation of cost effective and easy to implement home based regimes very important. One such therapy is limb exercise, which can be beneficial for limb oedemas through changes in both interstitial pressure and calf muscle activation. The potential benefits of exercise certainly justify further investigation to help determine its viability as a self instigated therapy for limb oedemas.
A systematic review of existing conservative therapies (including limb exercise) revealed varying, and at times not very rigorous outcomes for those with limb oedemas. Some claims of treatment outcomes were quite startling, with a volume reduction of 652mls in one complex physical therapy study. In other studies the limb volume reductions were smaller, especially in the self maintenance therapies. All reviewed therapies that measured subjective limb symptoms found that these were improved, whether the participants were receiving active or placebo treatment. Studies which included a follow up period demonstrated that a form of additional therapy needed to be undertaken to maintain the initial improvements in limb volume and subjective symptoms. This also needs to be considered when determining the benefits of the reviewed therapies, as some require significant clinical and economic resources.
Four clinical trials were then conducted on three new exercise regimes for oedematous limbs. The first regime investigated leg elevation and passive exercise for lymphoedema and venous oedema of the legs. Both groups experienced a significant reduction in limb volume, weight, and reported skin dryness, pain, heaviness, tightness, limb size plus improvements in quality of life parameters such as depression and physical activities. Some improvements were also maintained at the one month follow up, most notably body weight, skin dryness and perceived limb size.
A 10 minute deep breathing plus arm exercise regime for secondary arm lymphoedema initially achieved reductions in arm volume, truncal fluid and perceived heaviness and tightness, with greater reductions in these parameters being achieved when this regime was performed over a 1 month period. A pilot study of combined deep breathing, self massage and sequential limb exercises for secondary arm and leg lymphoedema demonstrated a small volume reduction for those with arm lymphoedema but a greater reduction in those with leg lymphoedema. However, both groups experienced positive improvements in perceptions of limb heaviness, tightness and range of movement. The limb reductions and improvements achieved by these exercise regimes were sometimes similar to and at other times greater then those obtained in previous exercise studies and existing conservative therapies administered by clinicians and/or the patient. The systematic review in combination with the clinical trials has demonstrated the multifaceted benefits of limb exercise, including limb volume reduction and improvements in subjective symptoms, limb function and quality of life issues. This makes exercise a cheap and easy to implement adjunct or alternative regime for those with limb oedemas.