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High-Sensitivity C-Reactive Protein is a Predictor of Subsequent Atrial High-Rate Episodes in Patients with Pacemakers and Preserved Ejection Fraction

Fluid Shifts Induced by Physical Therapy in Lower Limb Lymphedema Patients

Physiology Division, Otto Loewi Research Center, Gravitational Physiology and Medicine Research Unit, Medical University of Graz, 8036 Graz, Austria
Physical Medicine and General Rehabilitation Department, KABEG, Wolfsberg Site, 9400 Wolfsberg, Austria
Wolfsberg Clinical Center for Lymphatic Disorders, Wolfsberg State Hospital, KABEG, 9400 Wolfsberg, Austria
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(11), 3678;
Received: 18 September 2020 / Revised: 18 October 2020 / Accepted: 12 November 2020 / Published: 16 November 2020
(This article belongs to the Section Vascular Medicine)
Complete decongestive therapy (CDT), a physical therapy including manual lymphatic drainage (MLD) and compression bandaging, is aimed at mobilizing fluid and reducing limb volume in lymphedema patients. Details of fluid shifts occurring in response to CDT are currently not well studied. Therefore, we investigated fluid shifts before, during and after CDT. Thirteen patients (3 males and 10 females, aged 57 ± 8.0 years, 167.2 ± 8.3 cm height, 91.0 ± 23.4 kg weight) diagnosed with stage II leg lymphedema participated. Leg volume, limb and whole-body fluid composition (total body water (limbTBW/%TBW), extracellular (limbECF/%ECF) and intracellular (limbICF/%ICF fluid), as well as ECF/ICF and limbECF/limbICF ratios were determined using perometry and bioelectrical impedance spectroscopy. Plasma volume, proteins, osmolality, oncotic pressure and electrolytes were assessed. Leg volume (p < 0.001), limbECF (p = 0.041), limbICF (p = 0.005) and limbECF/limbICF decreased over CDT. Total leg volume and limbTBW were correlated (r = 0.635). %TBW (p = 0.001) and %ECF (p = 0.007) decreased over time. The maximum effects were seen within one week of CDT. LimbICF (p = 0.017), %TBW (p = 0.009) and %ICF (p = 0.003) increased post-MLD, whereas ECF/ICF decreased due to MLD. Plasma volume increased by 1.5% post-MLD, as well as albumin and the albumin-to-globulin ratio (p = 0.005 and p = 0.049, respectively). Our results indicate that physical therapy leads to fluid shifts in lymphedema patients, with the greatest effects occurring within one week of therapy. Fluid shifts due to physical therapy were also reflected in increased plasma volume and plasma protein concentrations. Perometry, in contrast to bioelectrical impedance analysis, does not seem to be sensitive enough to detect small fluid changes caused by manual lymphatic drainage. View Full-Text
Keywords: lymph; lymphatic flow; complete decongestive therapy; lymphatic drainage lymph; lymphatic flow; complete decongestive therapy; lymphatic drainage
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MDPI and ACS Style

Brix, B.; Apich, G.; Roessler, A.; Ure, C.; Schmid-Zalaudek, K.; Hinghofer-Szalkay, H.; Goswami, N. Fluid Shifts Induced by Physical Therapy in Lower Limb Lymphedema Patients. J. Clin. Med. 2020, 9, 3678.

AMA Style

Brix B, Apich G, Roessler A, Ure C, Schmid-Zalaudek K, Hinghofer-Szalkay H, Goswami N. Fluid Shifts Induced by Physical Therapy in Lower Limb Lymphedema Patients. Journal of Clinical Medicine. 2020; 9(11):3678.

Chicago/Turabian Style

Brix, Bianca, Gert Apich, Andreas Roessler, Christian Ure, Karin Schmid-Zalaudek, Helmut Hinghofer-Szalkay, and Nandu Goswami. 2020. "Fluid Shifts Induced by Physical Therapy in Lower Limb Lymphedema Patients" Journal of Clinical Medicine 9, no. 11: 3678.

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