Combined manual lymphatic drainage and exercise for lymphedema in breast cancer survivors: A randomised controlled trial

Background: Breast cancer–related lymphedema (BCRL) is a common and disabling complication of breast cancer treatment. Although exercise is recommended for BCRL management, the additional benefit of manual lymphatic drainage (MLD) remains unclear. This study compared the effectiveness of combined MLD and exercise versus exercise alone in reducing limb circumference and improving quality of life (QoL) among breast cancer survivors. Methods: A randomised controlled trial was conducted between January 2022 and December 2023 at the Department of Physical Medicine and Rehabilitation, Khwaja Yunus Ali Medical College and Hospital, Enayetpur, Sirajganj, Bangladesh. Forty-two women with Stage I and II unilateral BCRL were randomly assigned to an exercise-only group (Group A, n=21) or a combined MLD and exercise group (Group B, n=21). Limb circumference at four anatomical sites and QoL, using the Bangla Lymphedema Life Impact Scale Version 2, were measured at baseline and after six weeks. Effects were evaluated using two-way repeated measures of analysis of variance. Adjusted mean differences between groups were further estimated using analysis of covariance, controlling for age, overweight, duration of oedema, chemotherapy, and radiotherapy. Results: Both groups demonstrated significant improvements in limb circumference and QoL after six weeks; however, reductions were significantly greater in the combined MLD and exercise group (Group B), P<0.001. The largest mean difference in limb circumference was observed above the elbow (6.6 cm) in Group B. For QoL, the greatest improvement was noted in the physical domain, with a mean reduction of 5.2 points in Group B. Conclusion: Combining MLD with exercise provides greater reduction in limb swelling and greater improvement in QoL compared with exercise alone in patients with BCRL.