Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun 3;6(6):CD015669.
doi: 10.1002/14651858.CD015669.

Exercise interventions for the treatment of lower limb lymphoedema after treatment for gynaecological cancers

Affiliations

Exercise interventions for the treatment of lower limb lymphoedema after treatment for gynaecological cancers

Takashi Mimura et al. Cochrane Database Syst Rev. .

Abstract

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of load exercise therapy with complex decongestive therapy compared with complex decongestive therapy alone for lower limb lymphoedema after gynaecological cancer treatment.

PubMed Disclaimer

Conflict of interest statement

TM: nothing to declare

TH: nothing to declare

TM: nothing to declare

YO: nothing to declare

HN: received a research fund from GlaxoSmithKline and consulting fees from Kyowa Kirin, GlaxoSmithKline, Ono Pharmaceutical, Sony, and Terumo, outside the submitted work

EO: nothing to declare

EB: nothing to declare

References

Additional references

Addis 2009
    1. Armer AD, Billinham J, Brorson R, Campisi H, Damstra C, Daroczy RJ, et al. Best Practice for the Management of Lymphoedema: An International Consensus. Medicak Education Partnership (MEP) Ltd, London, 15 October 2009. Available from https://woundsinternational.com/consensus-documents/best-practice-for-th....
Aggithaya 2015
    1. Aggithaya MG, Narahari SR, Ryan TJ. Yoga for correction of lymphedema's impairment of gait as an adjunct to lymphatic drainage: a pilot observational study. International Journal of Yoga 2015;8(1):54-61. [DOI: 10.4103/0973-6131.146063] - DOI - PMC - PubMed
Ahmed 2006
    1. Ahmed RL, Thomas W, Yee D, Schmitz KH. Randomized controlled trial of weight training and lymphedema in breast cancer survivors. Journal of Clinical Oncology 2006;24(18):2765-72. [DOI: 10.1200/JCO.2005.03.6749] - DOI - PubMed
Balaya 2022
    1. Balaya V, Guani B, Morice P, Querleu D, Fourchotte V, Leblanc E, et al. Long-term oncological safety of sentinel lymph node biopsy in early-stage cervical cancer: a post-hoc analysis of SENTICOL I and SENTICOL II cohorts. Gynecologic Oncology 2022;164(1):53-61. [DOI: 10.1016/j.ygyno.2021.10.074] - DOI - PubMed
Brouillard 2021
    1. Brouillard P, Witte MH, Erickson RP, Damstra RJ, Becker C, Quéré I, et al. Primary lymphoedema. Nature Reviews. Disease Primers 2021;7(1):77. [DOI: 10.1038/s41572-021-00309-7] - DOI - PubMed
Brown 2013
    1. Brown JC, John GM, Segal S, Chu CS, Schmitz KH. Physical activity and lower limb lymphedema among uterine cancer survivors. Medicine and Science in Sports and Exercise 2013;45(11):2091-7. [DOI: 10.1249/MSS.0b013e318299afd4] - DOI - PMC - PubMed
Carl 2017
    1. Carl HM, Walia G, Bello R, Clarke-Pearson E, Hassanein AH, Cho B, et al. Systematic review of the surgical treatment of extremity lymphedema. Journal of Reconstructive Microsurgery 2017;33(6):412-25. [DOI: 10.1055/s-0037-1599100] - DOI - PubMed
Carlson 2020
    1. Carlson JW, Kauderer J, Hutson A, Carter J, Armer J, Lockwood S, et al. GOG 244-The lymphedema and gynecologic cancer (LEG) study: Incidence and risk factors in newly diagnosed patients. Gynecologic Oncology 2020;156(2):467-74. [DOI: 10.1016/j.ygyno.2019.10.009] - DOI - PMC - PubMed
Carter 2010
    1. Carter J, Raviv L, Appollo K, Baser RE, Iasonos A, Barakat RR. A pilot study using the Gynecologic Cancer Lymphedema Questionnaire (GCLQ) as a clinical care tool to identify lower extremity lymphedema in gynecologic cancer survivors. Gynecologic Oncology 2010;117(2):317-23. [DOI: 10.1016/j.ygyno.2010.01.022] - DOI - PMC - PubMed
Cella 1993
    1. Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, et al. The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. Journal of Clinical Oncology 1993;11(3):570-9. [DOI: 10.1200/JCO.1993.11.3.570] - DOI - PubMed
Chan 2010
    1. Chan DN, Lui LY, So WK. Effectiveness of exercise programmes on shoulder mobility and lymphoedema after axillary lymph node dissection for breast cancer: systematic review. Journal of Advanced Nursing 2010;66(9):1902-14. [DOI: 10.1111/j.1365-2648.2010.05374.x] - DOI - PubMed
Covidence [Computer program]
    1. Covidence. Version 15 January 2025. Melbourune, Australia: Veritas Health Innovation, 2025. Available at https://www.covidence.org.
Deeks 2024
    1. Deeks JJ, Higgins JPT, Altman DG, McKenzie JE, Veroniki AA, editor(s). Chapter 10: Chapter 10: Analysing data and undertaking meta-analyses (last updated November 2024). In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.5. Cochrane, 2024. Available from www.training.cochrane.org/handbook.
DerSimonian 1986
    1. DerSimonian R, Laird N. Meta-analysis in clinical trials. Controlled Clinical Trials 1986;7(3):177-88. [DOI: 10.1016/0197-2456(86)90046-2] - DOI - PubMed
Devoogdt 2011
    1. Devoogdt N, Van Kampen M, Geraerts I, Coremans T, Christiaens MR. Lymphoedema Functioning, Disability and Health questionnaire (Lymph-ICF): reliability and validity. Physical Therapy 2011;91(6):944-57. [DOI: 10.2522/ptj.20100087] - DOI - PubMed
EndNote 2023 [Computer program]
    1. EndNote. The EndNote Team, Version EndNote 21. Philadelphia, PA, USA: Clarivate Analytics, May 2023. Available at www.endnote.com.
Executive Committee 2016
    1. Executive Committee. The diagnosis and treatment of peripheral lymphedema: 2016 consensus document of the International Society of Lymphology. Lymphology 2016;49(4):170-84. - PubMed
Eyding 2010
    1. Eyding D, Lelgemann M, Grouven U, Harter M, Kromp M, Kaiser T, et al. Reboxetine for acute treatment of major depression: systematic review and meta-analysis of published and unpublished placebo and selective serotonin reuptake inhibitor controlled trials. BMJ 2010;341:c4737. [DOI: 10.1136/bmj.c4737] - DOI - PMC - PubMed
Fayers 2002
    1. Fayers P, Bottomley A, Group Eortc Quality of Life, Quality of Life Unit. Quality of life research within the EORTC—the EORTC QLQ-C30. European organisation for research and treatment of cancer. European Journal of Cancer 2002;38(Suppl 4):S125-33. [DOI: 10.1016/s0959-8049(01)00448-8] - DOI - PubMed
Frost 2017
    1. Frost JA, Webster KE, Bryant A, Morrison J. Lymphadenectomy for the management of endometrial cancer. Cochrane Database of Systematic Reviews 2017, Issue 10. Art. No: CD007585. [DOI: 10.1002/14651858.CD007585.pub4] - DOI - PMC - PubMed
Goncalves 2010
    1. Goncalves V. Long-term quality of life in gynecological cancer survivors. Current Opinion in Obstetrics & Gynecology 2010;22(1):30-5. [DOI: 10.1097/GCO.0b013e328332e626] - DOI - PubMed
Gordon 2020
    1. Gordon K, Varney R, Keeley V, Riches K, Jeffery S, Van Zanten M, et al. Update and audit of the St George's classification algorithm of primary lymphatic anomalies: a clinical and molecular approach to diagnosis. Journal of Medical Genetics 2020;57(10):653-9. [DOI: 10.1136/jmedgenet-2019-106084] - DOI - PMC - PubMed
GRADEpro GDT  [Computer program]
    1. GRADEpro GDT. Hamilton (ON): McMaster University (developed by Evidence Prime), 2025. Available at http://www.gradepro.org.
Harter 2019
    1. Harter P, Sehouli J, Lorusso D, Reuss A, Vergote I, Marth C, et al. A randomized trial of lymphadenectomy in patients with advanced ovarian neoplasms. New England Journal of Medicine 2019;380(9):822-32. [DOI: 10.1056/NEJMoa1808424] - DOI - PubMed
Hayes 2017
    1. Hayes SC, Janda M, Ward LC, Reul-Hirche H, Steele ML, Carter J, et al. Lymphedema following gynecological cancer: results from a prospective, longitudinal cohort study on prevalence, incidence and risk factors. Gynecologic Oncology 2017;146(3):623-9. [DOI: 10.1016/j.ygyno.2017.06.004] - DOI - PubMed
Higgins 2024a
    1. Higgins JPT, Eldridge S, Li T. Chapter 23: Including variants on randomized trials (last updated October 2019). In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.5. Cochrane, 2024. Available from www.training.cochrane.org/handbook.
Higgins 2024b
    1. Higgins JPT, Savović J, Page MJ, Elbers RG, Sterne JAC. Chapter 8: Assessing risk of bias in a randomized trial (last updated October 2019). In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ,et al, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.5. Cochrane, 2024. Available from www.training.cochrane.org/handbook 2022.
International Society of Lymphology 2003
    1. International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema. Consensus document of the International Society of Lymphology. Lymphology 2003;36(2):84-91. - PubMed
Kampmeier 1958
    1. Kampmeier OF. On the lymphatic system of Ascaphus; its evolutionary significance. Anatomical Record 1958;132(3):343-63. [DOI: 10.1002/ar.1091320309] - DOI - PubMed
Katz 2010
    1. Katz E, Dugan NL, Cohn JC, Chu C, Smith RG, Schmitz KH. Weight lifting in patients with lower-extremity lymphedema secondary to cancer: a pilot and feasibility study. Archives of Physical Medicine and Rehabilitation 2010;91(7):1070-6. [DOI: 10.1016/j.apmr.2010.03.021] - DOI - PMC - PubMed
Kawai 2015
    1. Kawai Y, Ajima K, Nagai T, Yokoyama Y, Kaidoh M, Seto E, et al. Abdominal respiration induces hemodilution and related reduction in ADH concentration of blood. Lymphatic Research and Biology 2015;13(3):202-7. [DOI: 10.1089/lrb.2015.0017] - DOI - PubMed
Keeley 2010
    1. Keeley V, Crooks S, Locke J, Veigas D, Riches K, Hilliam R. A quality of life measure for lmb lymphoedema (LYMQOL). Journal of Lymphoedema 2010;5:26-37.
Kim 2010
    1. Kim DS, Sim YJ, Jeong HJ, Kim GC. Effect of active resistive exercise on breast cancer-related lymphedema: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation 2010;91(12):1844-8. [DOI: 10.1016/j.apmr.2010.09.008] - DOI - PubMed
Kuroda 2017
    1. Kuroda K, Yamamoto Y, Yanagisawa M, Kawata A, Akiba N, Suzuki K, et al. Risk factors and a prediction model for lower limb lymphedema following lymphadenectomy in gynecologic cancer: a hospital-based retrospective cohort study. BMC Women's Health 2017;17(1):50. [DOI: 10.1186/s12905-017-0403-1] - DOI - PMC - PubMed
Lefebvre 2024
    1. Lefebvre C, Glanville J, Briscoe S, Featherstone R, Littlewood A, Metzendorf M-I, et al. Chapter 4: Searching for and selecting studies [last updated March 2025]. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.5.1. Cochrane, 2025. Available from www.training.cochrane.org/handbook.
Lim 2022
    1. Lim P, Li H, Neoh D, Ng SK. Health-related quality of life measurement tools for lymphedema: a review of the literature. Plastic and Reconstructive Surgery, Global Open 2022;10(4):e4276. [DOI: 10.1097/GOX.0000000000004276] - DOI - PMC - PubMed
Mantel 1959
    1. Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. Journal of the National Cancer Institute 1959;22(4):719-48. - PubMed
Markkula 2019
    1. Markkula SP, Leung N, Allen VB, Furniss D. Surgical interventions for the prevention or treatment of lymphoedema after breast cancer treatment. Cochrane Database of Systematic Reviews 2019, Issue 2. Art. No: CD011433. [DOI: 10.1002/14651858.CD011433.pub2] - DOI - PMC - PubMed
McNeely 2010
    1. McNeely ML, Campbell K, Ospina M, Rowe BH, Dabbs K, Klassen TP, et al. Exercise interventions for upper-limb dysfunction due to breast cancer treatment. Cochrane Database of Systematic Reviews 2010, Issue 6. Art. No: CD005211. [DOI: 10.1002/14651858.CD005211.pub2] - DOI - PubMed
Moher 2009
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Medicine 2009;6(7):e1000097. [DOI: 10.1371/journal.pmed.1000097] - DOI - PMC - PubMed
Morgan 2005
    1. Morgan PA, Moody M, Franks PJ, Moffatt CJ, Doherty DC. Assessing community nurses' level of knowledge of lymphoedema. British Journal of Nursing 2005;14(1):8-13. [DOI: 10.12968/bjon.2005.14.1.17365] - DOI - PubMed
Nakamura 2017
    1. Nakamura K, Masuyama H, Ida N, Haruma T, Kusumoto T, Seki N, et al. Radical hysterectomy plus concurrent chemoradiation/radiation therapy is negatively associated with return to work in patients with cervical cancer. International Journal of Gynecological Cancer 2017;27(1):117-22. [DOI: 10.1097/IGC.0000000000000840] - DOI - PubMed
Nguyen 2017
    1. Nguyen TT, Hoskin TL, Habermann EB, Cheville AL, Boughey JC. Breast cancer-related lymphedema risk is related to multidisciplinary treatment and not surgery alone: results from a large cohort study. Annals of Surgical Oncology 2017;24(10):2972-80. [DOI: 10.1245/s10434-017-5960-x] - DOI - PMC - PubMed
Ohhashi 2005
    1. Ohhashi T, Mizuno R, Ikomi F, Kawai Y. Current topics of physiology and pharmacology in the lymphatic system. Pharmacology & Therapeutics 2005;105(2):165-88. [DOI: 10.1016/j.pharmthera.2004.10.009] - DOI - PubMed
Paramanandam 2014
    1. Paramanandam VS, Roberts D. Weight training is not harmful for women with breast cancer-related lymphoedema: a systematic review. Journal of Physiotherapy 2014;60(3):136-43. [DOI: 10.1016/j.jphys.2014.07.001] - DOI - PubMed
Partsch 2014
    1. Partsch H, Lee B. Phlebology and lymphology—a family affair. Phlebology 2014;29(10):645-7. [DOI: 10.1177/0268355514551514] - DOI - PubMed
Qizilbash 1998
    1. Qizilbash N, Whitehead A, Higgins J, Wilcock G, Schneider L, Farlow M, Dementia Trialists' Collaboration. Cholinesterase inhibition for Alzheimer disease: a meta-analysis of the tacrine trials. JAMA 1998;280(20):1777-82. [DOI: 10.1001/jama.280.20.1777] - DOI - PubMed
RevMan 2025 [Computer program]
    1. Review Manager (RevMan). Version 8.20. The Cochrane Collaboration, 2025. Available at revman.cochrane.org.
Rockson 2008
    1. Rockson SG, Rivera KK. Estimating the population burden of lymphedema. Annals of the New York Academy of Sciences 2008;1131:147-54. [DOI: 10.1196/annals.1413.014] - DOI - PubMed
Rockson 2019
    1. Rockson SG, Keeley V, Kilbreath S, Szuba A, Towers A. Cancer-associated secondary lymphoedema. Nature Reviews. Disease Primers 2019;5(1):22. [DOI: 10.1038/s41572-019-0072-5] - DOI - PubMed
Sagen 2009
    1. Sagen A, Karesen R, Risberg MA. Physical activity for the affected limb and arm lymphedema after breast cancer surgery. A prospective, randomized controlled trial with two years follow-up. Acta Oncologica 2009;48(8):1102-10. [DOI: 10.3109/02841860903061683] - DOI - PubMed
Schmid‐Schonbein 1990
    1. Schmid-Schonbein GW. Microlymphatics and lymph flow. Physiological Reviews 1990;70(4):987-1028. [DOI: 10.1152/physrev.1990.70.4.987] - DOI - PubMed
Schmitz 2009
    1. Schmitz KH, Ahmed RL, Troxel A, Cheville A, Smith R, Lewis-Grant L, et al. Weight lifting in women with breast-cancer-related lymphedema. New England Journal of Medicine 2009;361(7):664-73. [DOI: 10.1056/NEJMoa0810118] - DOI - PubMed
Schmitz 2010
    1. Schmitz KH, Ahmed RL, Troxel AB, Cheville A, Lewis-Grant L, Smith Ret al. Weight lifting for women at risk for breast cancer-related lymphedema: a randomized trial. JAMA 2010;304(24):2699-705. [DOI: 10.1001/jama.2010.1837] - DOI - PubMed
Sterne 2001
    1. Sterne JA, Egger M. Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. Journal of Clinical Epidemiology 2001;54(10):1046-55. [DOI: 10.1016/s0895-4356(01)00377-8] - DOI - PubMed
Sterne 2019
    1. Sterne JA, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019;366:l4898. [DOI: 10.1136/bmj.l4898] - DOI - PubMed
Tada 2009
    1. Tada H, Teramukai S, Fukushima M, Sasaki H. Risk factors for lower limb lymphedema after lymph node dissection in patients with ovarian and uterine carcinoma. BMC Cancer 2009;9:47. [DOI: 10.1186/1471-2407-9-47] - DOI - PMC - PubMed
Todo 2010
    1. Todo Y, Yamamoto R, Minobe S, Suzuki Y, Takeshi U, Nakatani M, et al. Risk factors for postoperative lower-extremity lymphedema in endometrial cancer survivors who had treatment including lymphadenectomy. Gynecologic Oncology 2010;119(1):60-4. [DOI: 10.1016/j.ygyno.2010.06.018] - DOI - PubMed
Wang 2012
    1. Wang PL, Cheng YB, Kuerban G. The clinical characteristic differences between thrombosis-related edema and lymphedema following radiotherapy or chemoradiotherapy for patients with cervical cancer. Journal of Radiation Research 2012;53(1):125-9. [DOI: 10.1269/jrr.11094] - DOI - PubMed

LinkOut - more resources