HMN 2025: How New global recommendations support exercise for leg lymphedema

Researchers from Macquarie University have published the world’s first ever consensus-based recommendations on exercise as part of the management of lower limb lymphedema, a condition affecting millions worldwide.

An estimated 70,000 Australians and as many as 250 million people worldwide live with lymphedema, an incurable chronic condition in which fluid accumulates in the limbs, causing swelling, pain, physical distortion and impaired function.

The consensus-based framework, published in the journal Disability and Rehabilitation, strongly supports exercise—once thought likely to trigger lymphedema or make it worse—as a fundamental component of lymphedema management.

“It’s clear from the amount of evidence supporting its use that exercise should be part of our comprehensive care for people with lymphedema,” says Dr. Luke Davies of the Department of Health Sciences at Macquarie, first author of the paper. “But we were surprised to find no published recommendations about the role of exercise in managing lower limb lymphedema.

“There were umpteen resources for exercise prescription, guidance and recommendations for upper limb lymphedema—probably because most cases are related to breast cancer—but absolutely nothing for the lower limb.”

Building the framework

Dr. Davies, along with fellow researchers and clinicians from the Australian Lymphedema Education, Research and Treatment (ALERT) Centre at Macquarie University, recruited an international panel of experts on exercise for lower limb lymphedema and used the Delphi method, a structured two-way communication and review process, to develop agreement on exercise recommendations.

The Delphi panel of 54 experts from 10 countries reached consensus on 26 recommendations for exercise frequency, intensity, type and duration across three different exercise categories: resistance exercise (20–30 minutes, two to four times per week), moderate aerobic exercise (such as walking, swimming or stationary cycling), and flexibility (stretching and mobility).

Panel members also agreed that patients with lower limb lymphedema should wear clinical compression garments when exercising or should wear commercially available sports compression garments if wearing clinical compression is a barrier to exercising.

Better care pathways

Dr. Belinda Thompson, Lecturer in the Department of Health Sciences at Macquarie and a co-author of the paper, says the consensus recommendations will be valuable to a broad range of clinicians and to patients with lymphedema in the legs.

“A large proportion of the patients we see in our specialized clinic have lower limb lymphedema and it has many potential causes and contributors, which can make it complex and challenging,” Dr. Thompson says. “Not all health professionals have expertise in lymphedema, so we hope these recommendations will be a useful foundation when a patient presents for something else and happens to have lymphedema.

“The purpose of this framework isn’t to dictate the way health care professionals should prescribe exercise; rather, it offers consensus-based exercise recommendations for individuals living with lower limb lymphedema in the absence of strong scientific evidence.”

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