Johansson, K., Hayes, S., Speck, R.M., & Schmitz, K.H. (2013). Water-based exercise for patients with chronic arm lymphedema: A randomized controlled pilot trial. American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists, 92, 312–319.

To evaluate the effect of a water-based exercise program on women with breast cancer-related lymphedema

Women were randomly assigned to the exercise group or a wait list control group. The exercise intervention involved an initial instructional session followed by 30-minute sessions, three times per week for eight weeks, of specific exercises or swimming at moderate intensity on the Borg scale. After the initial instruction, sessions were unsupervised. Both groups completed weekly diaries of exercises performed. Measurement of outcomes was done at baseline and at the end of the study.

• The study reported on 29 patients with a median age of 63 years (range = 56–74 years).
• The sample was 100% female.
• All patients had breast cancer-related lymphedema. Duration of lymphedema ranged from 32.8–101.7 months. Time since diagnosis ranged from 92–152 months. Lymphedema was defined as an arm volume difference of at least 5%.
• Women who expressed interest after participating in another study were recruited.

This was a single site study in an unspecified setting in Sweden.

This study has clinical applicability for late effects and survivorship.

This was a single blind, randomized controlled trial.

Perometry, bioimpedeance spectroscopy, local tissue water measurement via tissue dielectric constant measurement, shoulder range of motion (ROM) measures, and exercise diaries were used.

A quarter of the patients in the intervention group did not complete the interventions. No differences were found between groups in lymphedema. Some shoulder ROM measures were better in the exercise group (p ≤ 0.05).

The water-based exercise used was feasible, but had no obvious impact on lymphedema severity. The water-based exercise regimen was associated with better shoulder ROM compared to controls.

• The sample size was small, with fewer than 30 patients.
• A risk of bias exists because no appropriate attentional control condition was included.
• Unintended interventions or applicable interventions that were not described could influence results.
• The study had a participant withdrawal rate of 10% or more.

Water-based exercises and swimming may improve shoulder ROM but had no demonstrated effect on lymphedema severity in this study. In general, some evidence supports the benefit of exercise in lymphedema, but whether this type of water-based exercise is effective for actual lymphedema reduction is not clear.