BACKGROUND: Lymphedema is a chronic, progressive condition characterized by an accumulation of lymphatic fluid in the interstitial compartment. This disorder is the results of impaired lymphatic drainage; it is classified as primary lymphedema when due to congenital lymphatic dysplasia, and secondary when acquired following other conditions such as trauma, surgery, radiotherapy, or infections. Lymphedema can lead to major morphological and functional impairment of the affected area, with psychological consequences and reduced quality of life. No curative treatment is currently available; however, the reference conservative approach is Complex Decongestive Therapy (CDT), which includes multiple components such as manual lymph drainage (DLM), skin care, multilayer bandaging, and exercise. Within this framework, physical activity is an essential therapeutic tool, even if its optimal modalities remain uncertain. OBJECTIVE: This study stems from both scientific interest and practical need to identify which type of exercise (endurance training or resistance training) is more appropriate for patients with lymphedema involving lower limb lymphedema. Exploring this comparison may help address a persisting gap in the current evidence. Identifying the most effective type of training would allow treatment time and resources in rehabilitation settings to be allocated more efficiently, enabling a more targeted intervention. METHODS: A literature research on the current evidence regarding the most effective exercise modalities in lymphedema was conducted, highlighting a gap in the available literature. A semi-experimental study was therefore carried out on patients with LLL admitted to the RRF unit of Ospedale di Asiago. Recruited patients were offered a strength program three times per day, consisting of the following bodyweight exercises (sets × repetitions): calf raises (3×20), sit-to-stand/squat (3×12), and step-ups (3×15 per limb). Exercises were performed with 1–2 minute rest intervals between sets, and were progressed and individualized. To compare this program with an endurance training regimen, retrospective data were retrieved from previous admissions to the same facility in which patients had performed three sessions per day on the NuStep Recumbent Cross Trainer for 20 minutes, progressively increased up to a maximum of 40 minutes. In both groups, exercise sessions were performed after application of multilayer bandaging. To assess the reduction of lymphedema, the primary outcomes were reduction in the volume of the affected limb, expressed by changes in standardized segmental circumferences, and reduction in body weight, both measured at the end of the hospitalization. RESULTS: Both groups achieved clinically relevant decongestion within two weeks from admission. For lower limb circumferences, the between-group difference was -3.64% in favor of resistance training, without statistical significance. For body weight, the difference between groups is minimal and non-significant (Δ = 0.76%). CONCLUSION: In CDT for LLL, both resistance and endurance training performed in association with multilayer bandaging proved to be safe, feasible and effective interventions, without statistically significant differences. The small sample size, patient heterogeneity, the use of retrospective data and some variability in compression protocols call for caution in interpreting the results, which should be regarded as primarily exploratory.
BACKGROUND: Il linfedema è una patologia cronica e progressiva che porta ad un accumulo di liquido linfatico nel compartimento interstiziale. Questa problematica è dovuta ad un’alterazione del drenaggio linfatico; si parla di linfedema primario se è dovuto a una displasia linfatica congenita oppure secondario se è acquisito in seguito ad altre cause come traumi, interventi chirurgici, radioterapia e infezioni. Questa patologia può portare ad importanti compromissioni morfologiche e funzionali della zona colpita, inficiando sull’aspetto psicologico e sulla qualità di vita della persona. Attualmente non esiste un trattamento risolutivo per questa patologia, tuttavia la terapia conservativa di riferimento è la Terapia Decongestiva Complessa (CDT), che comprende diversi tipi di trattamento, tra cui il linfodrenaggio manuale (DLM), la cura della cute, il bendaggio multistrato multicomponente e l’esercizio terapeutico. In questo contesto, l’attività fisica risulta uno strumento fondamentale, anche se ne rimangono incerte le modalità ottimali. OBIETTIVI: Questo studio nasce dalla curiosità e dall’esigenza pratica di identificare quale tipologia di esercizi tra endurance training e resistance training è meglio proporre ai pazienti con linfedema agli inferiori (LLL). Approfondire tale confronto consentirebbe di colmare un gap ancora presente nelle evidenze disponibili. Individuare il tipo di allenamento più efficace permetterebbe di indirizzare il tempo di trattamento e le risorse nelle strutture riabilitative, consentendo un intervento mirato. MATERIALI & METODI: È stata condotta una ricerca bibliografica in merito alle evidenze attuali sulle modalità di esercizio più efficaci nel linfedema, evidenziando una lacuna nella letteratura. È stato quindi condotto uno studio semi-sperimentale utilizzando come campione i pazienti con LLL ricoverati nel reparto RRF dell’Ospedale di Asiago. Ai pazienti reclutati è stato proposto un allenamento di Forza 3 volte al giorno, composto dai seguenti esercizi a corpo libero (con il relativo numero di serie e ripetizioni): - calf-raise (3x20); - sit-to-stand/squat (3x12); - step-up (3x15xAI). Questi esercizi sono stati proposti con delle pause di 1-2 minuti dopo ogni serie, in modo progressivo e personalizzato. Per confrontare questa tipologia di allenamento con un Endurance training, sono stati recuperati dei dati retrospettivi di precedenti ricoveri nella stessa struttura, durante i quali i pazienti avevano eseguito 3 allenamenti al giorno utilizzando il macchinario "NuStep Recumbent Cross Trainers" per 20 minuti incrementali (fino ad un massimo di 40 minuti). In entrambe le casistiche, l’allenamento è stato svolto in seguito al bendaggio multistrato multicomponente. Per verificare la riduzione del linfedema, sono stati selezionati come outcome la riduzione del volume dell’arto coinvolto, espressa tramite variazione delle circonferenze segmentarie, e la riduzione del peso corporeo, rilevate alla dimissione. RISULTATI: Entrambi i gruppi hanno ottenuto una decongestione clinicamente rilevante a due settimane dall’ingresso. Per le circonferenze degli arti inferiori, la differenza tra gruppi è risultata di -3,64% a favore del Resistance training, senza significatività statistica. Per il peso corporeo, la differenza è minima e non significativa (Δ = 0,76%). CONCLUSIONI: Nella CDT intensiva per il LLL, sia il Resistance che l’Endurance training svolti in associazione al bendaggio multistrato si sono dimostrati interventi sicuri, fattibili ed efficaci, senza differenze statisticamente significative. Il campione ridotto, l’eterogeneità dei pazienti, l’uso di dati retrospettivi e alcune variabilità nei protocolli di compressione impongono cautela nell’interpretazione dei risultati, che hanno valore principalmente esplorativo.
Confronto tra Endurance training e Resistance training in associazione al bendaggio multistrato multicomponente nella riduzione del volume degli arti e nella perdita di peso corporeo in pazienti con linfedema agli AAII nel medio termine: uno studio sperimentale
ZORZI, ANDREA
2024/2025
Abstract
BACKGROUND: Lymphedema is a chronic, progressive condition characterized by an accumulation of lymphatic fluid in the interstitial compartment. This disorder is the results of impaired lymphatic drainage; it is classified as primary lymphedema when due to congenital lymphatic dysplasia, and secondary when acquired following other conditions such as trauma, surgery, radiotherapy, or infections. Lymphedema can lead to major morphological and functional impairment of the affected area, with psychological consequences and reduced quality of life. No curative treatment is currently available; however, the reference conservative approach is Complex Decongestive Therapy (CDT), which includes multiple components such as manual lymph drainage (DLM), skin care, multilayer bandaging, and exercise. Within this framework, physical activity is an essential therapeutic tool, even if its optimal modalities remain uncertain. OBJECTIVE: This study stems from both scientific interest and practical need to identify which type of exercise (endurance training or resistance training) is more appropriate for patients with lymphedema involving lower limb lymphedema. Exploring this comparison may help address a persisting gap in the current evidence. Identifying the most effective type of training would allow treatment time and resources in rehabilitation settings to be allocated more efficiently, enabling a more targeted intervention. METHODS: A literature research on the current evidence regarding the most effective exercise modalities in lymphedema was conducted, highlighting a gap in the available literature. A semi-experimental study was therefore carried out on patients with LLL admitted to the RRF unit of Ospedale di Asiago. Recruited patients were offered a strength program three times per day, consisting of the following bodyweight exercises (sets × repetitions): calf raises (3×20), sit-to-stand/squat (3×12), and step-ups (3×15 per limb). Exercises were performed with 1–2 minute rest intervals between sets, and were progressed and individualized. To compare this program with an endurance training regimen, retrospective data were retrieved from previous admissions to the same facility in which patients had performed three sessions per day on the NuStep Recumbent Cross Trainer for 20 minutes, progressively increased up to a maximum of 40 minutes. In both groups, exercise sessions were performed after application of multilayer bandaging. To assess the reduction of lymphedema, the primary outcomes were reduction in the volume of the affected limb, expressed by changes in standardized segmental circumferences, and reduction in body weight, both measured at the end of the hospitalization. RESULTS: Both groups achieved clinically relevant decongestion within two weeks from admission. For lower limb circumferences, the between-group difference was -3.64% in favor of resistance training, without statistical significance. For body weight, the difference between groups is minimal and non-significant (Δ = 0.76%). CONCLUSION: In CDT for LLL, both resistance and endurance training performed in association with multilayer bandaging proved to be safe, feasible and effective interventions, without statistically significant differences. The small sample size, patient heterogeneity, the use of retrospective data and some variability in compression protocols call for caution in interpreting the results, which should be regarded as primarily exploratory.| File | Dimensione | Formato | |
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Tesi CdL Fisioterapia 2024-2025 - Andrea Zorzi.pdf
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https://hdl.handle.net/20.500.12608/102512