Mechanical Exercise Device

Mechanical Exercise Device

PEP Topic 
Lymphedema
Description 

One exercise facilitating device studied consisted of a pulley system with a metal wheel fixed on a support at a specified distance from the patient's body, aimed at controlling joint movement and spine posture during arm exercises. Other types of devices have been designed and studied to provide mechanical assistance for exercise.

Effectiveness Not Established

Research Evidence Summaries

Bordin, N.A., Guerreiro Godoy Mde, F., & Pereira de Godoy, J.M. (2009). Mechanical lymphatic drainage in the treatment of arm lymphedema. Indian Journal of Cancer, 46(4), 337–339.

doi: 10.4103/0019-509X.55556
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Study Purpose:

To evaluate a method of mechanical lymphatic drainage using the RAGodoy apparatus

Intervention Characteristics/Basic Study Process:

Lymphedema was confirmed with lymphoscintigraph and volumetry and defined as a difference in arm volumes of more than 200 ml. Patients had a one-hour session with the RAGodoy mechanical apparatus, which provides 15–25 elbow bending and stretching exercises per minute. Pre- and post-treatment volumetry was taken.

Sample Characteristics:

  • The study sample was comprised of female patients with breast cancer who were experiencing arm lymphedema.
  • The sample age range was 42–86 years.

Setting:

The study took place at a single outpatient site in Brazil.

Study Design:

The study used a prospective trial design.

Results:

The reduction in the volume was an average of 59.2 ml (p < 0.001). In two cases, there was an increase in volume with the intervention. In the remaining 23, there was a decrease in volume. It appeared that for those where there was an increase, the patients did not fully allow the device to passively work.

Conclusions:

Passive mechanical exercise for lymphatic drainage may be helpful in the management of lymphedema

Limitations:

  • The sample size was small, with less than 30 participants.
  • The report was brief with limited data and sample characteristics provided.
  • The apparatus appeared to have been developed by the authors, so potential for bias must be considered.
  • The study reported on single use only; repeated or longer-term use of the approach is unknown.

Nursing Implications:

Use of a device for provision of passive limb exercise in the management of lymphedema requires further study.

de Fatima Guerreiro Godoy, M., Guimaraes, T.D., Oliani, A.H., & de Godoy, J.M. (2011). Association of Godoy & Godoy contention with mechanism with apparatus-assisted exercises in patients with arm lymphedema after breast cancer. International Journal of General Medicine, 4, 373–376.

doi: 10.2147/IJGM.S17139
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Study Purpose:

To determine the effectiveness of the use of apparatus-assisted exercises with Godoy and Godoy contention (a cotton and polyester sleeve) for volume reduction of the upper limbs in patients with arm lymphedema secondary to breast cancer treatment

Intervention Characteristics/Basic Study Process:

Each of the participants was given four apparatus-assisted exercises to complete using a pedal, pulley, horizontal bar, and elevation bar along with a Godoy and Godoy contention device (sleeve made of a cotton and polyester material). Each exercise was used for 15 minutes under low intensity (less than 10 movements per minute) in a seated position.

Sample Characteristics:

  • The study sample was comprised of female patients who were experiencing edema of the arm (greater than 200 ml) after breast cancer treatment.
  • Mean age was 57 years, with a range of 42–72 years.
  • Types of breast cancer treatment included radiotherapy, chemotherapy, and surgery with axillary lymph node resection.

Setting:

The study took place at an inpatient setting in Brazil.

Phase of Care and Clinical Applications:

Patients were undergoing transition and active treatment for lymphedema.

Study Design:

 The study used a quasi-experimental design.

Measurement Instruments/Methods:

  • Measurements were taken one hour before and after the completion of each of the four individual exercises.  
  • Water displacement volumetry was used to measure the arm volume in the upper limbs.

Results:

There was a significant loss in arm volume (mean decrease of 57.32 g) after using the four different apparatus-assisted exercises (p = 0.0032).

Conclusions:

The study suggests that there is a positive correlation between the use of apparatus-assisted arm exercises and the reduction of edema in patients with arm lymphedema secondary to breast cancer treatment.  However, the data should only be used for evaluation purposes because the study has many limitations.

Limitations:

  • The sample size was small, with less than 30 participants.
  • The study had a risk of bias because of no control group, blinding, random assignment, or appropriate attentional control condition.
  • The study had a single observation only with immediate pre- and postmeasurement only.
     

Nursing Implications:

The results from this study can be used as a tool to nurses when identifying treatment strategies for patients with arm lymphedema. However, nurses should be aware that not enough research has been done to validate the point that the use of Gody and Godoy during arm assisted-apparatus exercises has a strong relation to a reduction on peripheral edema. Further research needs to be conducted to validate the findings of the study using a more rigorous study design.

Godoy Mde, F., Pereira, M.R., Oliani, A.H., & de Godoy, J.M. (2012). Synergic effect of compression therapy and controlled active exercises using a facilitating device in the treatment of arm lymphedema. International Journal of Medical Sciences, 9(4), 280–284.

doi: 10.7150/ijms.3272
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Study Purpose:

To evaluate the effects of active exercise using a facilitating apparatus with compression on arm lymphedema secondary to breast cancer

Intervention Characteristics/Basic Study Process:

Patients received two sessions of four, 12-minute stints of exercise using an active apparatus pulley system. The device was a vertical iron wheel fixed to a 30-cm-high support on a metal bench. The patient revolved the wheel, thus elevating the shoulder and stretching the arm. A homemade short-stretch compression sleeve made of a cotton polyester material was used during one of the exercise sessions. Arm volume measurements were taken before and immediately after each exercise session.

Sample Characteristics:

  • The study sample (N = 20) was comprised of female patients who had breast cancer.
  • Mean age was 63.3 years, with a range 49–82 years.
  • All patients had a mean difference in arm volumes of at least 200 ml.

Setting:

The study took place at an outpatient setting in Brazil.

Phase of Care and Clinical Applications:

The study has clinical applicability for late effects and survivorship.

Study Design:

The study used an observational single group design.

Measurement Instruments/Methods:

Arm volume was measured by water displacement.

Results:

A mean reduction in arm volume of 24.6 ml was seen in the exercise session while wearing the compression garment (p < 0.0004). Without the compression garment, arm volume increased by a mean of 9.7 ml.

Conclusions:

The apparatus used here was effective for provision of active exercise. Without the compression garment, exercise increased arm volume slightly. The low stretch, inelastic compression had a synergistic effect with exercise to reduce arm volume.

Limitations:

  • The sample size was small, with fewer than 30 participants.
  • The study had a risk of bias because of no control group or blinding. 
  • The standard deviations reported showed high variability of results in the study sample, suggesting actual effects were highly variable even within this small sample. 
  • Whether the mean is truly representative of overall group results was not clear.

Nursing Implications:

Findings demonstrated the importance of use of a compression mechanism during exercise in patients with lymphedema.

Guerreiro Godoy Mde, F., Oliani, A.H., & Pereira de Godoy, J.M. (2010). Active exercises utilizing a facilitating device in the treatment of lymphedema resulting from breast cancer therapy. German Medical Science: GMS e-Journal, 8, Doc31.

doi: 10.3205/000120
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Study Purpose:

To determine the effectiveness of an assistive mobile flexion bar during exercise to reduce arm volume in patients diagnosed with lymphedema related to breast cancer treatment

Intervention Characteristics/Basic Study Process:

Participants were randomly selected, and all participants received the intervention. Participants received a single one hour of active exercising split into 12-minute sections with 3 minutes of flexion bar use between each section. The flexion bar is a T-shaped apparatus, the vertical bar remains fixed (10 cm away from the patient on a tabletop), and the horizontal bar rotates (30 cm above the tabletop) to allow extension and flexion of arm muscles. All of the participants wore a compression sleeve on the affected limb. The participants independently performed the exercise routine, and the sole purpose of the interventionist was to control the time of exercise intervals and to help participants maintain proper posture and spinal alignment.

 

Sample Characteristics:

  • The study sample (N = 21) was comprised of female patients with breast cancer who were diagnosed with arm lymphedema.
  • All patients had radiotherapy postoperatively and were 2–12 years postoperative.

Setting:

The study took place at a rehabilitation facility in Brazil.

Phase of Care and Clinical Applications:

Patients were undergoing active lymphedema treatment.

Study Design:

The study used a prospective trial design.

Measurement Instruments/Methods:

  • Water displacement measured limb volume before and after the flexion bar intervention.
  • Participants' arm volume was measured before and after each exercise session.

Results:

The participants initial mean volume was 2,089.9 ml. After the exercise session, the mean final volume decreased to 2,023.0 ml. The study used a paired t-test with an alpha error of 5% as acceptable. The results concluded in a mean loss of 66.9 ml (p < 0.001). There was a significant reduction in limb volume, using active exercises with a facilitating device (mobile flexion bar).

Conclusions:

The trial suggests that the use of an apparatus mobile flexion bar may improve the efficacy of lymphedema reduction by myolymphokinetic exercises. Active exercises are beneficial to patients with lymphedema because it promotes muscle contraction and lymphatic drainage. The study has its risks for bias based on the small sample size and the lack of a control group.

Limitations:

  • The sample size was small, with less than 30 participants.
  • The time in years from surgery is a large range.
  • The study has a risk of bias because of no control group, blinding, or random assignment.

Nursing Implications:

Because of the statistical significance of the findings of the study, it is important for nurse researchers to repeat the study using a more rigorous study design. If the experiment were repeated as a randomized controlled trial with a larger sample size, the results would be more generalizable. It would also be interesting to compare the use of a mobile flexion bar to active exercise without the use of a facilitating device to determine the necessity.


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