The Effect of Aerobic Training on Gait, Postural Control, Lower Extremity Muscle Strength and Functionality in Patients With Lower Extremity Lymphedema

Lymphedema is a chronic and progressive condition characterized by the accumulation of protein-rich interstitial fluid in the subcutaneous tissue. Based on its etiology, lymphedema is classified as either primary or secondary. Primary lymphedema results from abnormal development of the lymphatic system and presents as progressive swelling without an identifiable underlying medical condition; its onset may vary from childhood to adulthood. Secondary lymphedema occurs due to disruption of the lymphatic system caused by factors such as trauma, infection, cancer-related surgery, or radiotherapy.

Lower extremity lymphedema most commonly develops secondary to cancer treatments in developed countries, whereas in developing countries it may also result from parasitic infections such as filariasis. In addition, venous insufficiency, obesity, and lymphatic damage following orthopedic surgeries are recognized contributing factors. Swelling, tissue fibrosis, and increased limb volume lead to both structural and functional alterations in the extremities, particularly affecting the hip, knee, and ankle joints. In individuals with advanced-stage lymphedema, reductions in joint range of motion, muscle strength deficits, and impairments in neuromuscular activation are frequently observed. Alterations in the body's center of gravity occur, and insufficient muscular strength to compensate for these changes results in impaired postural control and an increased risk of falls.

Dunberger et al. reported that lymphedema-related weight gain and pain, when combined with progressively reduced physical activity, lead to decreased muscle strength and negatively affect functional capacity over time. Furthermore, lymphedema has been shown to significantly influence gait function and kinetic-parametric gait characteristics. Increased limb volume in individuals with lymphedema alters mechanical loading within the musculoskeletal system, resulting in impairments in key gait parameters such as walking speed, step length, double support time, and balance control. Gait asymmetry is commonly observed, while increased proprioceptive deficits and pain contribute to impaired motor control.

Physiotherapy and rehabilitation interventions constitute a fundamental component of lymphedema management across all stages of the condition. The primary goals of lower extremity lymphedema treatment are to minimize swelling, prevent complications, and restore limb functionality. Management typically requires lifelong care and may involve conservative, medical, and, in some cases, surgical interventions. The gold standard treatment is Complex Decongestive Physiotherapy (CDP), which includes manual lymphatic drainage, compression bandaging, skin care, and exercise, and is administered by trained physiotherapists.

In a study conducted by Boris et al., an average limb volume reduction of 62.7% was observed following the application of Complex Decongestive Therapy in patients with lower extremity lymphedema. In addition, aerobic training is commonly recommended for individuals with lymphedema. Aerobic conditioning typically involves repetitive movements engaging large muscle groups. Cycle ergometer exercise is a form of aerobic training that enhances venous and lymphatic flow by increasing the muscle pump effect, improving functional capacity, strengthening lower extremity musculature, enhancing cardiovascular endurance, improving tissue oxygenation, and supporting effective weight management.

In a study by Do et al., 40 patients diagnosed with unilateral lymphedema following cervical, endometrial, or ovarian cancer were treated with Complex Decongestive Therapy for four weeks, with additional stretching, strengthening, and aerobic exercise programs. Both treatment groups demonstrated significant reductions in limb volume; however, no statistically significant difference was found between the two intervention approaches.