Exercise and cancer-related lymphedema in the lower limbs-a randomized cross-over trial on high-intensity interval training (HIIT) with and without compression garments
Question
Is supervised stationary-bike HIIT acceptable and safe for people with cancer-related lower limb lymphedema, and do immediate responses differ when performed with versus without compression garments?
Summary
This randomized crossover trial tested two supervised stationary-bike HIIT sessions in adults with cancer-related lower limb lymphedema: one with compression garments and one without. Completion and acceptability were high, no adverse events were reported, and symptom and limb-volume changes did not differ meaningfully between compression conditions, although small objective changes in soft tissue mass and extracellular fluid favored compression.
Methodology
- Twenty-one adults with cancer-related lower limb lymphedema using daily made-to-measure compression garments.
- 21 participants.
- Stationary cycling.
- Work intervals: Seven 1-minute intervals at the final power output reached during GCT-TT.
- Recovery: 1-minute recoveries at approximately 50% of final GCT-TT power, Borg 10-11.
- Intensity: Individualized prescribed power; final GCT-TT intensity approximately Borg 15-16 or 60-84% VO2max.
- 23 minutes.
- One acute session in this condition.
- Acute crossover session.
- Randomized crossover trial with two acute HIIT sessions separated by a 7-day washout.
- Acceptability, Adverse events, Pain, heaviness, and tension, and Affected-limb volume were tracked.
Outcomes
Completion
Twenty-one of 35 eligible patients were included and 19 of 21 allocated participants completed both sessions.
Recruitment/allocation 60%; completion 90%.
Acceptability
Most participants were satisfied or very satisfied after both conditions.
No compression: 18/20 very satisfied. Compression: 15/19 very satisfied and 3/19 satisfied.
Adverse events
No adverse events or serious adverse events were reported. Two participants reported DOMS after the first session but completed both sessions.
Serious adverse events: 0/20 no compression and 0/19 compression.
Symptoms and limb volume
There were no between-condition differences in pain, heaviness, tension, or affected-limb volume change.
Volume between-session difference -18.7 ml (95% CI -150.2 to 112.8), p=0.8; symptom CIs crossed no difference.
Soft tissue mass and extracellular fluid
Soft tissue mass and L-Dex differences favored compression, but authors interpreted the differences as small and not clinically important.
Soft tissue mass difference -164.2 g (95% CI -298.2 to -30.2), p=0.02; L-Dex difference -4.8 (95% CI -9.1 to -0.5), p=0.03.
Insights
- For selected adults with lower limb lymphedema, supervised cycling HIIT can be feasible acutely when intensity is individualized.
- Compression during exercise may not be necessary for every short supervised session, but decisions should be individualized and clinical.
- Some compression configurations can reduce comfort or perceived movement freedom during exercise.
- This is safety/feasibility evidence, not evidence for long-term fitness or lymphedema improvement.
Limitations
- Only two acute HIIT sessions were tested.
- No long-term follow-up for lymphedema symptoms or objective outcomes.
- No participant blinding and assessor blinding was not feasible.
- Selection bias risk because HIIT may appeal to fitter participants and recruitment included social media.
- Participants were relatively young with low BMI and low affected-limb volume compared with other LLL exercise trials.
- Sub-garment pressure was not measured.
- No objective reassessment at 3-4 hours or 24 hours.
Safety
- No adverse events were reported.
- No serious adverse events occurred in either condition.
- Two participants reported delayed onset muscle soreness after the first session and completed both sessions.
- Three participants needed target power reductions of 10, 20, and 25 W.