Randomized Controlled Trial Nurse-Led, Home Lymphatic Exercises on Fluid Overload with Heart Failure

Fluid overload is a major contributor to symptoms and hospitalization in patients with heart failure (HF). Home-based exercise interventions designed to enhance lymphatic drainage may reduce thoracic congestion and fluid overload symptoms, yet limited research has investigated the effectiveness of these exercises using objective measures of thoracic fluid content and body water composition in this population.

To evaluate the effectiveness of The-Optimal-Lymph-Flow (TOLF) intervention, a nurse-led, home-based, and structured exercise program designed to enhance lymphatic drainage and fluid overload, in patients with HF.

A parallel randomized clinical trial design was used. A total of 80 participants were recruited, randomly assigned to either the TOLF intervention or usual care and followed for 4 weeks. Primary outcomes included thoracic fluid content measured by a dielectric sensing device; total body water and extracellular water measured by a bioimpedance device; fluid overload symptom prevalence and burden assessed using a self-reported questionnaire; and hospital readmission rates. Mixed-effects models were used to estimate treatment effects, adjusting for health behaviors.

Compared with the control group, participants receiving the TOLF intervention demonstrated significantly greater reductions in thoracic fluid content at 4 weeks post-intervention. Significant treatment effects were also observed for fluid overload symptom prevalence and symptom burden. These effects remained substantial after adjustment for health behaviors. A sizable reduction in rehospitalization rates was observed in participants receiving intervention. No significant treatment effects were observed for body water composition, although within-group reductions were noted in the intervention arm. In addition, findings also demonstrated feasibility and acceptability with 79% retention, > 80% protocol adherence, and 98% participant satisfaction.

The home-based lymphatic exercise intervention is effective in reducing thoracic congestion, fluid overload symptoms, and hospital readmission. These findings align with the emerging evidence supporting the role of lymphatic system in HF and warrant further evaluation in a larger trial.