The effect of exercise in patients with lower limb lymphedema: a systematic review.

PURPOSE

To summarize the evidence of the immediate and long-term effect of exercise interventions in patients with either primary or secondary lower limb lymphedema (LLL) on health-related quality of life (HR-QOL), physical function, self-reported symptoms, lower limb volume, and adverse events.

DESIGN

Systematic review following the guidelines from the Cochrane Handbook of Systematic Reviews of Interventions.

DATA SOURCES

MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), and clinicaltrials.gov.

ELIGIBILITY CRITERIA

Prospective exercise trials investigating exercise interventions as a single- or multicomponent programme in patients with LLL including assessment of at least one of the following outcomes: HR-QOL, self-reported LLL symptoms (heaviness, tension, and pain), physical function, or lower limb volume. Randomized controlled trials (RCTs), single-group studies, and cross-over trials were eligible. Trials with participants at risk of LLL or a diagnosis of filariasis or lipedema were excluded.

RESULTS

Twelve studies were included: three RCTs, five single-group studies, and four cross-over trials with a total of three hundred and sixty-seven participants. In patients with LLL, irrespective of severity, exercise seemed to have small but positive effects on HR-QOL, physical function, pain, and lower limb volume. Quality assessment showed high risk of bias. Large heterogeneity in participants, interventions, and outcome measures hinders performing of meta-analyses.

INTERPRETATION

Based on a small number of studies with large clinical heterogeneity, poor methodological quality, hence low level of certainty of evidence, it was not possible to provide evidence-based recommendations on exercise for patients with LLL.