Respiratory and Relaxation Training in Lower Extremity Lymphedema

Lower extremity lymphedema is a chronic condition characterized by impaired lymphatic drainage, limb swelling, pain, reduced physical function, and decreased quality of life. Complex decongestive therapy (CDT) is considered the gold standard treatment; however, additional interventions that may improve physiological and functional outcomes remain under investigation.

Respiratory exercises may facilitate lymphatic return through changes in intrathoracic pressure, whereas relaxation training may reduce sympathetic activation and improve exercise tolerance. Despite these theoretical benefits, there is limited evidence regarding their combined effect on muscle oxygenation in patients with lower extremity lymphedema.

Therefore, this randomized controlled study will evaluate whether adding respiratory and relaxation training to CDT improves muscle oxygenation measured by wearable near-infrared spectroscopy (MOXY), functional capacity assessed with the Six-Minute Walk Test, and limb volume compared with CDT alone.

Inclusion criteria

• Female patients aged 18 years or older.
• Clinically diagnosed with secondary lower extremity lymphedema.
• Presence of lower extremity lymphedema for at least 3 months.
• Able to stand and walk independently to complete the Six-Minute Walk Test.
• Willing and able to provide written informed consent.

Exclusion criteria

• Acute cellulitis or other active infection within the previous 2-4 weeks.
• Current or recent deep vein thrombosis (DVT) or uncontrolled peripheral vascular disease.
• Severe cardiovascular, pulmonary, orthopedic, or neurological conditions that could interfere with participation or outcome assessments.
• Pregnancy.
• Skin lesions or irritation preventing placement of the near-infrared spectroscopy (MOXY) sensor.
• Inability to comply with the study protocol or follow-up assessments.