The Effect of Muscles in the Treatment of Lower Limb Lymphedema: Respiratory Muscles or Leg Muscles

Abstract

Purpose This study aimed to compare the effects of manual lymphatic drainage and bandaging (MLDB) combined with calf muscle exercise training (CMT) and/or inspiratory muscle training (IMT) on edema, muscle strength, functional capacity, functionality, and quality of life (QoL) in patients with secondary lower limb lymphedema (LLL). Method A total of 76 patients (mean age: 47.06 +/- 16.16 years; 84.2% female) with LLL were included in the study and randomized into four groups: MLDB alone (Group 1), MLDB + CMT (Group 2), MLDB + IMT (Group 3), and MLDB + CMT + IMT (Group 4). The training programs were administered for 30 min per day, five days per week, over three weeks. Edema was assessed using circumference measurements (CM) and tissue dielectric constant (TDC). Muscle strength was evaluated using maximum inspiratory/expiratory pressure (MIP/MEP) and a dynamometer. Functional capacity was assessed with the 6-Minute Walk Test (6MWT), functionality with the Lower Extremity Functional Scale (LEFS), and QoL with the Lymphedema Quality of Life Scale (LYMQOL). Results In the intra-group analyses, all assessments improved in all groups, except for MIP, MEP, and gastrocnemius muscle strength in Group 1 and MIP in Group 2 (p < 0.05). In the inter-group analyses, Group 3 showed the largest effect sizes (ES) for reductions in TDC (ES: 2.34) and improvements in LYMQOL (ES: 1.74), MEP (ES: 1.46), and LEFS (ES: 1.44) (p < 0.001 for all). Group 4 had the largest ES for increases in MIP (ES: 1.42, p < 0.001). Group 2 showed the largest ES for improvements in gastrocnemius muscle strength (ES: 1.41, p < 0.001). However, there were no significant differences among the groups in CM or 6MWT results (p > 0.05). Conclusion Compared to enhancing leg muscle strength, improving respiratory muscle function in addition to MLDB had a greater impact on reducing edema and enhancing functionality and QoL. Trial Registration Number NCT05609526. Registration Date: 14.11.2022.