# 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 PMID: 40240614 Journal: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer Published: 2025 Apr 16 Authors: Wittenkamp MC, Juhl CB, Zerahn B, Vinther A ## 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. ## Population - Twenty-one adults with cancer-related lower limb lymphedema using daily made-to-measure compression garments. - Sample size: 21 - Age: 52.1 +/- 12.3 years - Sex: 18 women and 3 men. - Fitness level: Not fully characterized; final GCT-TT power output 127.1 +/- 22.6 W. - Health status: Cancer-related lower limb lymphedema, mostly stage I or early stage II; no ongoing oncologic treatment and no known metastases. ## Methodology - Randomized crossover trial with two acute HIIT sessions separated by a 7-day washout. - Two exercise sessions separated by 7 days; trial conducted September to November 2018. - Hospital setting. - Randomized and controlled study design. ## Protocol - Stationary-bike HIIT with compression garments. - Modality: 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. - Sets or repetitions: 7 intervals. - Intensity: Individualized prescribed power; final GCT-TT intensity approximately Borg 15-16 or 60-84% VO2max. - Session duration: 23 minutes. - Frequency: One acute session in this condition. - Program length: Acute crossover session. - Progression: None. - Stationary-bike HIIT without compression garments. - Modality: 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. - Sets or repetitions: 7 intervals. - Intensity: Individualized prescribed power; identical exercise protocol without compression garments. - Session duration: 23 minutes. - Frequency: One acute session in this condition. - Program length: Acute crossover session. - Progression: None. ## Outcomes ### Completion Status: improved Twenty-one of 35 eligible patients were included and 19 of 21 allocated participants completed both sessions. Recruitment/allocation 60%; completion 90%. ### Acceptability Status: improved 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 Status: no clear change 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 Status: no clear change 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 Status: mixed 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. ## Practical 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 And Adherence - 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. ## Original Sources - [PubMed](https://pubmed.ncbi.nlm.nih.gov/40240614/) (pubmed) - [DOI](https://doi.org/10.1007/s00520-025-09458-x) (doi) - [PMC full text](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12003536/) (full text) ## Agent Guidance Preserve the paper-level scope of this note. Do not generalize beyond the population, protocol, measured outcomes, and limitations above.