Every little bit helps

Next time one of your clients tells you they don't have time to do their own self-treatment for lymphoedema - tell them it only takes 10 minutes! A recently published study conducted in Japan has shown that even 10-minutes a day can improve people's experience of their lymphedema (1). The program is based on the Japanese rajio taiso, a 3-minute national health program to encourage daily exercise which is broadcast several times a day on public TV and radio.

The study program included :

Gentle arm exercises and deep breathing,

There were 23 women in the final analysis age (mean 61 years). Most had had BCRL for at least 18 months. Most had stage one lymphedema (n=14) or stage 2 (n=9) and none had stage 3. Prior to the intervention most had focussed their self-care activities on avoiding behaviours such as heavy lifting and sunburn and only 9 were performing any SLD. Thirteen women were using compression garments. The average time spent of self-care was 3 minutes per day.

The study measured limb volume tissue fibrosis, self-reported symptoms, and quality of life.

After six months there was a significant volume reduction in both arms (affected and unaffected). Both forearms showed tissue softening and there was some improvement in lymphedema-related symptoms such as discomfort, sensory alteration, perceived swelling, and heaviness but no improvement in activities of daily living, social or psychological activities. Three women reacted to the massage medium and changed to using moisturiser to do the SLD. The biggest benefit was in the softening of fibrotic tissue in the affected forearm and was more obvious than the volume change.

Why did it work?

We know from prior studies that breathing exercise and SLD support lymphatic function. The sweet almond massage oil is emollient and grapefruit essential oil has antibacterial and anti-inflammatory properties.

The breathing exercises used were similar to the gentle Tai Chi style exercises and have been recommended to women affected by breast cancer-related lymphedema since research at Flinders showed a reduction in the volume of arm lymphoedema.

The self lymphatic drainage (SLD) was a simplified, effleurage stroke beginning by stroking up over the shoulder towards the neck, then the upper arm toward the shoulder, forearm toward the upper arm, and from the hand all the way up over the shoulder. The main limitation to this study was the lack of a control group.

The intervention increased the average time spent on self-care from 3 minutes to 10 minutes per day which makes it achievable for most people. The rajio taiso program is broadcast widely which means that there daily reminders to perform the self-care, and also a normalisation of the exercises - everybody is encouraged to do them, not just people affected by lymphoedema. The study provides a good indication that regular daily exercise is beneficial in the early stages of lymphoedema. One of our primary roles as lymphoedema therapists should be to educate and encourage out clients in daily lymphoedema self-care.

The paper is not available open access but you can read the abstract below.

1. Arinaga, Y., et al., A 10 minute self-care program may reduce breast cancer-related lymphedema: a six-month prospective longitudinal comparative study. Lymphology, 2016. 49(2): p. 93-106.

Abstract

Patients with breast cancer-related lymphedema (BCRL) need a life-long self-care program that they can adhere to enable them to manage their lymphedema. The objective of this study was to assess the effectiveness of a holistic BCRL self-care program that patients could easily adhere to and comply with. A prospective, longitudinal, comparative study between affected arms and unaffected arms in unilateral breast cancer patients was implemented over a six-month period. Both the lymphedematous and unaffected arms of 23 patients with unilateral BCRL were followed and measured. The daily 10-minute holistic BCRL self-care program consisted of modified Japanese rajio taiso (Japanese radio calisthenics), a gentle arm exercise combined with deep breathing, skin moisturizing care using a traditional lymphatic drainage technique, and basic self-care education. Arm and edema volume, relative volume change, resistance of the skin to compression (fibrosis), lymphedema-related symptoms, skin condition, and self-care were assessed. At the end of six-months the volume of all limb segments and resistance of the tissues to compression at all measurement points of the affected arm were significantly reduced. On the unaffected side, only the volume of the forearm and the whole arm was significantly reduced and fibrosis significantly reduced only in the forearm. There was no significant difference in edema volume and relative volume change. Lymphedema-related symptoms significantly improved. Perceived adherence, effectiveness, burden, score and average time for self-care significantly increased. Our results demonstrate that this 10-minute self-care program may improve BCRL and its self-care.