Please READ THIS important Blog on Lipedema and Exercise:    Lipese Blog

If you are at risk for blood clots, please see a physician before beginning any new exercise program. 

WE NEED TO MOVE AS MUCH AS POSSIBLE

Although moving may be painful in the short run, the benefits of movement help overall by strengthening your muscles, moving lymph, and boosting your mood and confidence.

Doctor Karen Herbst says, "Exercise in combination with a healthy diet is the cornerstone of treatment for people with fat disorders.  I recommend low impact exercise that does not increase lactic acid, for long periods of time. This includes swimming or any water activity, walking in good shoes and possibly compression, whole body vibration, stationary bike (or street bike if able), elliptical trainer, yoga, stretching, Pilates, dancing and other forms of exercise.  Exercise helps improve blood and lymphatic flow as well as stimulating fitness pathways that help manage stress when it happens.”

In many of the fat disorders, the wrong kind of exercise or treatment may do more harm than good. Exercise that is too strenuous can increase fatigue and pain in people with fat disorders. If your healthcare provider suggests exercise to improve your health, discuss with them what type of exercise would be best for you. People with any of the fat disorders may do well with water exercise, use of a rebounder or whole body vibration. Other non-impact exercise like walking or an elliptical trainer would also be good for those who are able. Stretching or breaking tissue during deep tissue massage or strenuous physical therapy may increase inflammation or damage to the fat tissue.

Eating well and exercising will not make fat disorders go away. But they may help lessen the severity of your symptoms or slow down disease progression.

Supportive evidence

A research paper on lipedema says “Exercise should be tailored to the patient ability and disease status. Compression should be worn during exercise whenever it is possible. Walking, swimming, cycling and low impact aerobics are recommended.” (1)

The Washington Post recently posted The Health Hazards of Sitting, which states that “Sitting for long periods of time slows blood circulation, which causes fluid to pool in the legs.”

Schmeller writes "Women with lipedema report a spontaneously occurring feeling of tension or swelling as well as a noticeable hypersensitivity to touch and pressure in the thighs and lower legs. The complaints generally become worse as the day progresses, particularly after standing or sitting for long periods." [2]

Reich, et al say "Physical activity should be encouraged for patients with in lipedema. Exercise activates the foot and calf muscle pump increasing lymphatic drainage, reducing edema formation in the tissue and reducing the risk of additional obesity. Suitable types of sport are swimming, speed walking and bicycle riding. Sports with a high risk of injury or strong decelerating movements are often unpleasant and associated with subsequent pain. The cause for this is unclear." [3]

About working out

Clearly our workouts must be tailored to our current levels of fitness and capabilities. It is important to push ourselves just a little more than we think we can do.

However, our exercise should not be too intense, like running, intense spin classes, or heavy weight training. Intense activity that deprives muscles of oxygen causes inflammation in our muscles and this in turn aggravates lipedema. An activity is too intense if you can “feel the burn"; see this link. Stretching before working out helps get oxygen to muscles to warm them up. Pay attention to your breath to ensure oxygen reaches your muscles.

Initially you may want to spend a lot of time strengthening - but not aggravating - the areas around your knees and feet. Due to the atypical weight distribution, feet and knee problems are common.

For most people, exercise that is high-impact on the knees is not advised, so if you choose to do it, pay attention to your knees and be very careful.

Recommended exercise forms include swimming and other aquatic aerobics, Tai Chi, Nordic walking, normal cycling and Pilates. If these activities are too much, just walking or standing on a vibration machine may suffice. 

Remember to hydrate before, during and after your workout. Stretching after a workout may reduce the chance and impact of sore muscles, but first check with your doctor to see whether (and what type of) stretching is appropriate for you.

Breathing

Some patients report an improvement in lymph flow just by changing their breathing pattern, so exercise forms that incorporate a focus on breath like Tai Chi, yoga and Pilates may be especially effective.

Eating Well

Exercise works especially well in combination with eating healthier foods. However if you suddenly start working out a lot more than you are used to, your metabolism may increase which can cause you to feel hungrier than normal. To avoid that feeling, ramp up the exercise level slowly, have a small snack 60-90 minutes before working out, and a piece of fruit afterward.

Trainers

Since all exercise must be tailored to meet our capabilities, many people find working in small groups or one-on-one with a trainer is especially helpful. Some qualities to look for in a trainer are:

  • they take an interest in your medical conditions and adapt their routine accordingly
  • they watch you to make sure you are doing each movement correctly
  • they push you just the right amount
  • they are knowledgeable about the human body and can explain how each movement impacts your muscles; some trainers understand tendons and ligaments
  • they are busy and clients recommend them
  • they are healthy and have a good attitude
  • they inspire you to be healthy
  • if you tell them something doesn't feel right, they go slowly or stop

Tell your trainer if you have hypermobility, foot or knee issues, as well as any other conditions.

Compression

In general it is good to wear compression while working out. Some people even wear compression while swimming. Do not wear compression when on a vibration machine because the vibration machine is to help loosen things up. Click here to view our Compression Garments page.

Swimming and aqua aerobics

Swimming and aqua aerobics - see link

Walking

Dancing

Dancing can be done in the privacy of your home, right now, so turn on Pandora, find your favorite tunes, stand up, put down the keyboard, and shake it!

Cycling

http://en.wikipedia.org/wiki/Cycling

Even if it's been years since you've been on a bike, well, it's just like riding a bike. Cycle shops can help fit a bicycle to you and will often rent bicycles by the hour or day. Don't forget your helmet!

Nordic Walking

http://en.wikipedia.org/wiki/Nordic_walking

"Compared to regular walking, Nordic walking (also called pole walking) involves applying force to the poles with each stride. Nordic walkers use more of their entire body (with greater intensity) and receive fitness building stimulation not present in normal walking for the chest, lats, triceps, biceps, shoulder, abdominals, spinal and other core muscles that may result in significant increases in heart rate at a given pace." (Wikipedia)

Yoga

http://en.wikipedia.org/wiki/Yoga

Yoga historically combines spiritual and physical activities, but yoga classes often focus on slow, controlled movements and stretching.

Mat Pilates

http://en.wikipedia.org/wiki/Pilates 

Pilates, broadly, is similar to yoga, but with less time spent on any given movement, resulting in more movements per session. And without chanting. There is a focus on stretching, breathing, and core muscle workout. The stretching and movements help move lymph to the core. The focus on breath and core helps the body process lymph.

Mat Pilates takes place on a mat on the floor. Mat Pilates may be more difficult than machine Pilates and some people are more prone to experiencing back or knee pain. 

Machine Pilates

http://en.wikipedia.org/wiki/Pilates 

Pilates, broadly, is similar to yoga, but with less time spent on any given movement, resulting in more movements per session. And without chanting. There is a focus on stretching, breathing, and core muscle workout. The stretching and movements help move lymph to the core. The focus on breath and core helps the body process lymph.

The added use of 'machines' may help reduce the effects of gravity as some exercises can be performed when the person is horizontal. For example, using a 'jump board' can mimic rebounding exercises without quite as much gravity pulling the weight of the body down toward the feet and knees, because the person is horizontal while 'jumping'.

 

Tai Chi

http://en.wikipedia.org/wiki/Tai_chi 

Tai Chi is a martial art with a focus on breath, "The core training involves two primary features: the first being taolu (solo "forms"), a slow sequence of movements which emphasize a straight spine, abdominal breathing and a natural range of motion; the second being different styles of tuishou ("pushing hands") for training movement principles of the form with a partner and in a more practical manner." (Wikipedia)

Vibration

Some doctors recommend standing on a vibration machine (for example the PowerPlate brand) as a form of exercise. Some research on vibration can be found here, but note that since this company sells vibration machines they may only show the supportive research. At least one research paper found that vibration may not be effective and may actually be harmful. Vibration machines can sometimes be found in gyms.

For security, hold onto rails or a stable chair.

Do not wear compression while on the vibration plate so that the adipose tissue to vibrates or jiggles, unless you need to for pain. 

Sit, stand, or do small movements like flexing the knee while standing. To vibrate your arms, kneeling or sit next to the plate and place your hands on the plate. 

Start at small times and slower speeds at the beginning; faster is not always better.

A feeling of flu-like symptoms might happen at first if wastes are being removed.  Please drink plenty of fluid. Always consult your physician before trying anything new. Discontinue with vibrating if you experience pain in your joints. If you use vibration machines, please consult with your physician before doing so with compression garments.

 

References

  1. Gyozo Szolnoky (2012). Lipedema, Physical Therapy Perspectives in the 21st Century - Challenges and Possibilities, Dr. Josette Bettany-Saltikov (Ed.), ISBN: 978-953-51-0459-9, InTech, Available from:
    http://www.intechopen.com/books/physical-therapy-perspectives-in-the-21st-century-challenges-and-possibilities
    http://www.intechopen.com/download/get/type/pdfs/id/35008
  2. Schmeller Chapter 7 Liposuction
  3. 2012_LIP_Reich-Schupke_Thick Legs - Not Always Lipedema
  4. 2010_LIP_Fife_Lipedema A Frequently Misdiagnoed and Misunderstood Fatty Deposition Syndrome