Exploring the potential role of health resort medicine in the management of breast cancer-related lymphedema: a viable alternative for innovative rehabilitation opportunities?

Lymphedema is a chronic and progressive disorder of the lymphatic system that impairs the return of lymphatic fluid. Breast cancer treatment can cause breast cancer-related lymphedema (BCRL), with axillary lymph node dissection and regional lymph node radiation being established risk factors. BCRL can cause severe morbidity, disability, and reduced quality of life. Early detection and treatment are essential to prevent the disease from progressing and causing complications. According to the International Society of Lymphology, complex decongestive therapy (CDT) is the most effective conservative treatment for lymphedema. Aquatic exercise is a safe and effective form of therapeutic CDT exercise that can improve joint range of motion, reduce pain, and positively impact limb volume. Additionally, health resort medicine and thermal mineral-rich waters may provide synergistic benefits for therapeutic exercise programs. Therefore, we believe that consideration should be given to whether the spa setting could represent a viable alternative for the rehabilitation of BCRL patients.

Water-based exercise for upper and lower limb lymphedema treatment.

BACKGROUND: Lymphedema is a debilitating illness caused by insufficient lymph drainage, which can have serious physical and psychological consequences. Although water-based exercise can be useful, at present, little evidence is available regarding the outcomes of aquatic treatment for patients with lymphedema. Therefore, the aim of the present scoping review was to evaluate, from reported studies, the effects of water-based exercise on pain, limb motor function, quality of life (QoL), and limb volume among patients affected by primary and secondary upper and lower limb lymphedema. METHODS: We performed a scoping review to examine clinical studies and randomized controlled trials reported in English from 2000 to 2021 by screening the MEDLINE (PubMed) and PEDro databases. RESULTS: The search produced a total of 88 studies. Eight randomized controlled trials and one clinical study of patients with primary or secondary lymphedema of upper or lower limbs who had undergone water-based treatment were included in the present study. Most trials had focused on breast cancer-related lymphedema. The shoulder range of flexion, external rotation, and abduction have been shown to improve after performing a water-based exercise protocol. Some evidence has also demonstrated that the lymphedematous limb strength can improve. Moreover, water-based exercise seemed to improve pain perception and QoL for patients with upper or lower limb lymphedema. In contrast, in the control groups, the QoL showed a tendency to worsen over time. Although some studies had not reported beneficial effects on the lymphedematous limb volume, most of the studies examined had reported a reduction in volume, especially in the short term. No adverse events were reported in the included studies. CONCLUSIONS: The findings from the present review have shown the potential for aquatic exercise in lymphedema management. However, at the same time, the findings underline the multiple limitations resulting from the heterogeneity in the study populations and related physical activity protocols. The role of aquatic exercise in the conservative treatment of lymphedema requires further investigation in the future to define specific protocols of application.

Do Chest Expansion Exercises Aid Re-shaping the Diaphragm Within the First 72 Hours Following Lung Transplantation in a Usual Interstitial Pneumonia Patient?

BACKGROUND AND PURPOSE: Usual interstitial pneumonia is a chronic pulmonary disease, and it is characterized by progressive and rapid lung fibrosis and typically affects patients older than 50 years. This study sought to discuss the use of chest expansion exercises during the immediate post-operative phase in a lung transplantation recipient. METHODS: This was a non-experimental case report study. A 58-year-old man who was affected by usual interstitial pneumonia with severe respiratory insufficiency requiring continuous oxygen therapy underwent double lung transplantation. Pre-operative x-ray showed elevation of the diaphragm. Rehabilitation treatment started within the first 24 h. Pain intensity was assessed using a numeric rating scale, and pulmonary function was evaluated based on variation in tidal volume. Each treatment lasted about 1 h, and the sessions were initially carried out twice daily, increasing over the intensive care unit stay to three or four times daily. RESULTS: At 72 h, the tidal volume increased to 850-900 mL (approximately 400 mL more than baseline) during the chest expansion exercises. The diaphragm began to gradually lower. Chest x-ray examination on post-operative day 6 showed further reshaping of the diaphragm. CONCLUSION: Chest expansion exercises seem to be suitable in order to re-establish lung volume and diaphragmatic function as early as within the first 72 h after bilateral lung transplantation.