Manual and Self-Lymphatic Drainage Combined With Exercise in Women With Lipedema

Lipedema is a chronic and progressive adipose tissue disorder that predominantly affects women and is characterized by bilateral and symmetrical disproportionate accumulation of subcutaneous adipose tissue, most commonly in the extremities. Pain, tenderness, swelling, easy bruising, and impaired mobility are common features of the condition and may negatively affect physical function and quality of life. Conservative management of lipedema aims to reduce symptoms, maintain mobility, support lymphatic drainage, and improve quality of life. Exercise, manual lymphatic drainage, self-management strategies, and physical activity are among the conservative approaches used in lipedema management.

This randomized controlled study aims to compare the effects of two combined physiotherapy approaches in women with lipedema. A total of 34 women with lipedema are planned to be included. Eligible participants will be allocated to one of two groups: manual lymphatic drainage combined with supervised aerobic exercise or self-lymphatic drainage combined with physical activity guidance.

Participants in the manual lymphatic drainage plus aerobic exercise group will receive supervised treatment twice weekly for six weeks. The aerobic exercise program will include warm-up and cool-down periods and treadmill-based aerobic exercise. Exercise intensity will be prescribed at a moderate intensity corresponding to 64-76% of maximum heart rate and will also be monitored using the Borg Rating of Perceived Exertion Scale, with a target rating of 11-13. Manual lymphatic drainage will be administered by a physiotherapist for approximately 30 minutes during each treatment session.

Participants in the self-lymphatic drainage plus physical activity group will be instructed by a physiotherapist in self-lymphatic drainage and will receive recommendations for moderate-intensity physical activity. Physical activity intensity will be guided using the Talk Test, with participants encouraged to walk at an intensity at which they can talk but not sing. Participants will be followed throughout the six-week intervention period.

Assessments will be performed at baseline and at the end of the six-week intervention. Pain intensity will be assessed using the Visual Analog Scale. Additional assessments will include health-related quality of life using the 36-Item Short Form Health Survey (SF-36), lower extremity functional status using the Lower Extremity Functional Scale, mobility using the Timed Up and Go Test, depressive symptoms using the Beck Depression Inventory, and anthropometric and limb circumference measurements. Limb circumference measurements will also be used to estimate lower extremity volume.

The study is designed to determine whether the two combined conservative physiotherapy approaches differ in their effects on pain and other clinical outcomes, including lower extremity function, mobility, limb volume, quality of life, and depressive symptoms, in women with lipedema.

Inclusion criteria

Female sex. Aged 18 to 65 years. Diagnosed with lipedema. Diagnosed with Stage I, II, III, or IV lipedema. No participation in any physiotherapy program within the previous 3 months. No previous liposuction surgery. Not currently following a weight-loss diet. No change in body weight greater than 10% within the previous 6 months. Willing to participate in the study and provide informed consent.

Exclusion criteria

Severe visual or cognitive impairment. Severe cardiovascular disease. Musculoskeletal conditions or injuries affecting the lower extremities, including osteoarthritis, contracture, or osteoporosis, that may interfere with participation in the study.

Skin conditions that may interfere with the intervention, such as pressure ulcers.

Uncontrolled endocrine disorders, including type 1 or type 2 diabetes mellitus or hypothyroidism.

Obesity secondary to endocrine disorders or medication-induced obesity. Use of estrogen-progestin therapy within the previous 2 months. Pregnancy or a positive pregnancy test. Breastfeeding. Concurrent participation in another clinical trial.