Breathwork and Complex Decongestive Therapy (CDT) for Lymphedema

Episode 10 of the Breathwork and Lymphatic Wellness Class with Kathleen Helen CLT author of Stress Reduction for Lymphedema.

Episode 9    • Breathwork, Hypertension and Lymphedema  
Episode 1    • Episode 1 of Breathwork for the lymph...  

Effect of Resisted Deep Breathing on Post Mastectomy Lymphedema
Sixty eight patients with post mastectomy lymphedema
Either CDT or CDT + Breathing
3 session per week for 4 weeks
“significant improvement in deep resisted breathing group in axillary, mid arm, elbow, mid forearm and wrist circumferential measurement of lymphedema in comparison to that of control group after treatment”
(Ahmed et al., 2024)

“Deep resisted diaphragmatic exercise, resistance was applied with sandbag (0.5kg at the first 2 weeks then increased to 1 kg in the last 2 weeks). A metronome was used to control the rate of breathing. (an android application that gives an auditory feedback to allow the patient control the breathing pattern)” (Ahmed et al., 2024)

“Subject was asked in a supine position to place one hand on the rectus abdominal muscle just below the anterior costal cartilage and to inhale slowly and deeply through only the nose, inflating the abdomen without moving the top of the chest while relaxing the shoulders. Then exhale the air slowly through pursed lips with lips parted” (Ahmed et al., 2024)

A breath consists of:
3 seconds of inhalation
3 seconds of pause
6 seconds of exhalation
Continue for 20 minutes

“Subject was asked to place one hand on the chest and the other on the abdomen, to observe the movement coming from the abdomen and not from the chest” (Ahmed et al., 2024)
“RDB was at the same time of pneumatic compression session (30min of compression session (5min without breathing exercise then 20min with deep resisted breathing exercise and 5min without breathing exercise)” (Ahmed et al., 2024)

The breathing was controlled by a metronome.

“A weight (0.5kg in the first 2 weeks then increased to 1 kg in the last 2 weeks) was positioned above the diaphragm and tied up with strap” (Ahmed et al., 2024)

The rehabilitation efficacy of diaphragmatic breathing combined with limb coordination training for lower limb lymphedema following gynecologic cancer surgery

“Gynecologic cancer surgeries or treatments such as radiation and chemotherapy can disrupt normal lymphatic tissue, resulting in inadequate transport capacity, accumulation of interstitial fluid in the subcutaneous tissue, and the onset of lymphedema” (Wang et al., 2024)

Participants had either cervical, endometrial, ovarian or fallopian tube cancer.

“Before starting CDT treatment, breathing training occurred with patients lying supine and knees bent. Therapists placed their hands on the patient’s abdomen, offering resistance based on their ability to maintain diaphragmatic breathing. Meanwhile, patients were instructed to practice resistance diaphragmatic breathing while pursing their lips, inhaling through the nose, and exhaling slowly as if blowing out a candle. The inhalation-exhalation ratio remained at 1:2, with each group completing five breaths, totaling two sets before initiating CDT treatment. Each training session lasted for 10 min.” (Wang et al., 2024)

“Individuals undergoing diaphragmatic breathing coupled with limb coordination training experienced notable reductions in scores for the self-perceived symptom assessment questionnaire (GCLQ), bilateral lower limb circumference, as well as anxiety and depression scores.” (Wang et al., 2024). Exercise was completed on the LoopGO limb coordination training device.

The researchers concluded that “diaphragmatic breathing exhibits superior effectiveness in treating lower limb lymphedema after gynecologic cancer surgery compared to traditional CDT therapy” (Wang et al., 2024)

“30 min of diaphragmatic breathing in a supine position effectively induced thoracic duct lymphatic drainage” (Wang et al., 2024)

“Abdominal respiration during 30 min rest in the supine position is effective at inducing lymph drainage, and the associated induction of hemodilution and lowering of the blood ADH concentration (and increased micturition desire in some cases)” (Kawai et al., 2015)

Ahmed F, Aboelnour N, Elsebaie A, Abdel Wahid A. (2024). Effect of Resisted Deep Breathing on Post Mastectomy Lymphedema. The Medical Journal of Cairo University, 91(12), 1443-1448. doi: 10.21608/mjcu.2024.342772

Kawai, Y., Ajima, K., Nagai, T., Yokoyama, Y., Kaidoh, M., Seto, E., ... & Ohhashi, T. (2015). Abdominal respiration induces hemodilution and related reduction in ADH concentration of blood. Lymphatic Research and Biology, 13(3), 202-207.

Wang J, Ma J, Zhang Y, Tian Y, Wang X, Wang Y, Xiang D, Wang D, Huang K, Mao L, Zhang J, Fan H, Li Y. The rehabilitation efficacy of diaphragmatic breathing combined with limb coordination training for lower limb lymphedema following gynecologic cancer surgery. Front Bioeng Biotechnol. 2024 Jun 6;12:1392824. doi: 10.3389/fbioe.2024.1392824. PMID: 38903184; PMCID: PMC11187277.