Does exercise reduce the incidence of lymphoedema more than advice alone following inguinal and pelvic node dissections for gynaecological cancer? – A Pilot Study.

The intervention in this study will be the provision of a lower limb exercise programme. The 6 exercises are designed to slowly pump the muscles which will help squeeze fluid up the leg. They will be taught by the same physiotherapist to all the participants. The programme starts and finishes with diaphragmatic breathing to stimulate the deep lymphatic system. abdominal muscle contractions are followed by gluteal contactions, quadriceps and hamstring contactions and then gastrocnemius contractions. each exercise is repeated 20 times. theraband resistance is used for each exercise except for the abdominal contractions. the exercises will be taught by a physiotherapist on an individual basis. exercises will be undertaken twice a day for the 3 month trial period. The exercises should take 15 minutes to complete in the patient's own home Each exercise will be repeated for 20 repetitions at intensity 13 on the Borg Rating of Perceived Exertion (RPE) The Borg Scale is a patient’s subjective measure of physical activity intensity level based on the physical sensations a person experiences during physical activity such as increased heart rate, increased respiration or breathing rate, increased sweating, and muscle fatigue (Borg, 1998). It is agreed that perceived exertion ratings between 12 to 14 on the Borg Scale suggests that physical activity is “somewhat hard” being performed at a moderate level of intensity. The exercises are graded level 1 (easier) or level 2 (harder)and commence day 1 after surgery with no hip movement for the first 48hours to reduce strain on the suture line in the early post-operative period. Patients can choose which exercise level suits them best to gain level 13 on the Borg Scale. Each participant will be provided with an exercise protocol sheet containing written and pictorial description of all the exercises to ensure they are replicated exactly. Each participant will have their exercise regime checked at every review appointment by the same physiotherapist that prescribed the regime to ensure consistency of technique between the participants. review appointments consist of 40 minute consultations with the physiotherapist at baseline, 1 month, 6 weeks after chemotherapy, 6 weeks after radiotherapy or at 3 months if no adjuvant therapies occur The intervention group will also receive current standard care. They will be provided with an education leaflet by the physiotherapist detailing strategies to reduce the risk of triggering lymphoedema. Ryan et al (2004) report that patients identified the initial trigger for lower limb lymphoedema and those that exacerbate LLL symptoms. Trigger factor avoidance includes:Skin care – avoiding trauma and injury to reduce infection risk. Avoiding limb constrictions – items that leave deep tissue indentations, Weight maintenance – including the promotion of general exercise to maintain weight and stimulate the lymphatic system, Travel – regular foot and leg exercises for prolonged travel. Compression garments for flights longer than 4 hours, Avoiding extremes of temperature – including saunas and steam rooms, Pre-existing medical condition control – hypertension, cardiac disease, diabetes, thyroid disease, kidney and liver disease. Pre-existing lower limb oedema may require compression therapy especially in those with occupations where prolonged sitting and standing Written informed consent will be gained from each participant adherance will be monitored by an exercise partcipation diary completed by the patient