Tidhar, D., & Katz-Leurer, M. (2010). Aqua lymphatic therapy in women who suffer from breast cancer treatment-related lymphedema: A randomized controlled study. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 18(3), 383–392.

Identify whether aqua lymphatic therapy (ALT) is a safe method of treatment for lymphedema

ALT, which uses the physical properties of water to enable women to perform self-massage and exercises, was performed weekly in the intervention group during 45-minute sessions in a warm (32–33º C) hydrotherapy pool 1.2 m deep. The control group was instructed to continue to perform the self-management measures as usual up to the beginning of the study.

• The study sample was comprised of 48 female patients.
• Mean age was 56 years, with a range of 31–81 years.
• All patients had unilateral lymphedema secondary to breast cancer surgery with axillary node dissection.
• Patients had undergone or completed Intensive complex physical therapy and were at least two weeks in the self-management state.

The study took place in an outpatient setting hydrotherapy pool in Ramet Ga, Israel.

The study used a single-blinded randomized controlled trial design.

• Volume of limbs was measured using water displacement.
• Adherence to treatment was assessed using an adherence diary.
• Quality of life, including physical, psychological, and social withdrawal factors, was assessed using the Upper Limb Lymphedema Questionnaire (ULL 27).
• Safety was determined based on an absence of related infections.

No infections or worsening of limb volume was noted in the post-treatment evaluation. Mean adherence to self-management was 28%. Adherence in the ALT group was 79%, possibly because of the low frequency of therapy and group exercise. The warm temperature environment of the water has an immediate positive influence on limb volume, but no long-term effect was observed. The ALT group showed improved emotional and social dimensions, while the control group demonstrated a worsening quality of life, despite unchanged physical dimensions.

ALT was found to be a safe method for maintenance therapy in patients with mild-to-moderate arm lymphedema. Warm water temperature environment appeared to have an immediate short-term positive influence on limb volume.

• The study sample was small, with less than 100 patients.
• Randomization did not produce two similar groups in all baseline measures, such as breast and chest wall radiation, chemotherapy, and type of surgery; however, these measures were not found to be a factor in the study.

Access to warm water public pools and cleanliness of pools is essential to avoid ear, sinus, and respiratory infections. Staph bacteria, the usual cause of skin infections, is not described in the literature as being present in pool water. Patients should be cautioned to not participate in ALT if they have skin infections, cuts, or wounds. The quality of life improved in the ALT group, while it declined in the control group, despite no physical changes in limb volume between the two groups. This might indicate that offering something, or a different, exercise could positively impact quality of life and potentially adherence.