Every little bit helps

Updated: Oct 27, 2019

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 article on a study conducted in Japan has shown that even 10-minutes a day can improve people's experience of their lymphedema.


An example of the rajio taiso (radio exercise) broadcast widely throughout Japan to encourage daily exercise

The advantages of this program is that it is based on the Japanese rajio taiso, a 3-minute national health exercise which is broadcast on TV and radio several times a day by the Japan Broadcasting Corporation. This means that not only are there daily reminders to perform the self-care but it also normalises the exercises - everybody is encouraged to do them, not just people affected by lymphoedema.


The program also prescribes:

  • gentle arm exercises combined with deep breathing which we know improves proximal clearance in the lymph system

  • self lymphatic drainage (SLD) using with grapefruit essential oil and sweet almond massage oil. Grapefruit EO has antibacterial and anti-inflammatory properties.

I made this handout for my clients many years ago after the initial research at Flinders showed a reduction in the volume of arm lymphoedema







The breathing exercises are taken from tai-chi and involve opening out the arms during deep inhalation and returning the fingers to the mid chest during exhalation without dropping the elbows.


Usually this is done 5 times in a row several time throughout the day.













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 study measured limb volume calculated from arm circumference and by water displacement, fibrosis using tonometry, and self-reported symptoms and quality of life.


There were 23 women in the final analysis aged between 29 and 71 years (mean 61 years). Mean BMI was 23.1 (range 19.3 - 31.1). Most had had BCRL for at least 18 months (mean 17, range 1 - 144 months). There were 14 women with stage one, 9 with stage 2, and none had stage 3 lymphoedema. Prior to the intervention most had focussed their self-care activities on avoiding behaviours such as heavy lifting and sunburn, only 9 were performing any SLD. Thirteen women were using compression garments. The average time spent of self- acre was 3 minutes per day.


After six months there was a significant volume reduction in both the affected arms and unaffected arms. Both forearms showed softening on tonometry measures. 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 forearm on the affected side and this was more obvious than the volume change which occurred on both sides.


The main limitation to this study was the lack of a control group which means that the results detected cannot be attributed with certainly to the intervention. The sample size was also too small to give a definite effect on some of the measures. Furthermore most of the women had very mild lymphoedema, with 14 of them not having even a 5% difference between the affected and unaffected arms. This means we can't tell from this study if only 10-minutes a day of self-care will be enough for women with more advanced arm lymphoedema.


Despite these limitation this study gives us a good indication that regular daily exercise is beneficial, especially 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.


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.

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