The circulatory system is made up of arteries, veins and the lymphatic system. The lymphatic system relies on the movement of muscles to circulate the lymph fluid throughout the body. You can think of the lymphatic system as a road system. When one or more roads are blocked due to lymph node removal, the system does not flow smoothly. The “traffic congestion” can cause swelling known as lymphedema. Lymphedema is a swelling produced by an accumulation of lymph fluid in tissue. Too much lymph fluid can accumulate in an area of the body that has been damaged because of the removal of lymph nodes or radiation to the area. Fibrosis of the axilla due to surgery or radiation can also cause lymphatic obstruction. Symptoms include a feeling of tightness, leathery skin texture, and heaviness. Lymphedema can be debilitating, painful and can affect emotional health.

Lymphedema and Your Client

Even if your client had only had a few lymph nodes removed, they should still understand the lymphedema precautions. Lymphedema can occur right after surgery, or years later.
The body will work better if engaged in regular physical activity. Moreover, exercise is very helpful for lymphedema control, but it must be done in a safe manner if lymph nodes have been removed or radiated. If your client has lymphedema, they should begin to exercise under your professional guidance after receiving medical clearance. It is important to learn the right exercises for the particular situation, and how to perform them properly and with good form. Exercise needs to progress slowly using a properly fitted garment. Our goal is to promote physical activity without incurring pain or injury, which can make lymphedema worse.

In our Cancer Recovery Specialist course, we teach abdominal breathing and relaxation breathing. These breathing techniques are beneficial because they:
 Stimulate lymph flow and lymphatic drainage
 Act as a lymphatic system pump, moving the sluggish lymph fluid
 Enable oxygen to get to the tissues
 Reduce stress, a common cancer side effect


It is also helpful to incorporate Pilates into your client’s exercise routine because of the deep breathing used with each movement. When they begin Pilates exercises, have them perform just a few repetitions and use no weight, or the lightest machine tension. After they are able to exercise for several sessions without flare-ups, you can add resistance bands, light weights, and modified body weight exercises.

A cancer survivor can develop a good fitness level without triggering lymphedema.
Swimming is a very good exercise for those with lymphedema. The water creates compression. Since repetitive motions are risky, swimming strokes should be varied. The water should not be hot and the pool area should be clean to help avoid infection. When leaving the water, your client should follow proper skin care precautions and moisturize to prevent dry skin that can lead to cracks in the skin and infection.

Yoga poses can cause flare-ups. Your clients should not perform the following poses: downward facing dog, upward facing dog, plank, and side plank. Avoid hot yoga.

Exercise helps the lymphatic fluid to move throughout the body. Muscles pump and push the lymph fluid and can help move the lymph away from the affected area. Strength training may help pump the lymph fluid away from the affected limb, but it does not necessarily prevent lymphedema. Slow progression of exercise will allow you to monitor your client for fullness or aching, which can indicate stress to the lymphatic system. A cancer survivor should stop exercise if tired or if the limb aches or feels heavy.

Check out the NFPT Cancer Recovery Specialist course to learn more about becoming a Cancer Recovery Specialist.

Carol Michaels

Carol is a nationally recognized, highly educated cancer exercise specialist and consultant and has been a fitness professional for more than 20 years. She is the 2016 Idea Personal Trainer of the Year recipient. Check out the course that she worked with NFPT to develop: Cancer Recovery Specialist.