Best Evidence for the Exercise-Based Management of Lower Limb Lymphedema After Gynecological Cancer: A Systematic...

Lower limb lymphedema after gynecological cancer treatment significantly impairs quality-of-life, increases care needs, and escalates costs. Despite exercise benefits, evidence-based guidance on optimal interventions is lacking. This study addresses this gap by conducting a systematic review and evidence synthesis of current guidelines and high-quality studies.

A systematic search was conducted based on the hierarchical "6S" evidence model to retrieve high-quality evidence. Searches in PubMed, CINAHL, Embase, Web of Science, Ovid, BMJ Best Practice, UpToDate, Cochrane Library, major guideline repositories, and PEDro identified guidelines, systematic reviews, recommended practices, evidence summaries, clinical decisions, and expert consensuses on exercise therapy (inception to February 2025). Two reviewers independently screened, evaluated, extracted, and synthesized evidence using the JBI system.

Seventeen publications were included. Synthesis across nine domains yielded 32 recommendations. Key findings: recommendations related to patients without active infections or lymphatic leakage only; conduct pre-exercise assessments by qualified professionals; recommend combined aerobic and resistance training. Aquatic therapy, low-impact exercises, and moderate-to-vigorous intensity exercise were beneficial/safe with individualized guidance; use appropriate compression garments during exercise; provide tailored supervision to enhance compliance. Evidence levels and grades specified.

This review provides a structured synthesis of the best available evidence for exercise management of lower limb lymphedema in gynecological cancer survivors, covering nine critical aspects. Findings offer a practical guide for clinicians designing interventions.