August 2016: Cancer

Spotlight on Aquatics, Cancer, & Lymphedema 


An extensive body of literature has developed related to the use of physical therapy techniques in water for the treatment of cancer concerns including lymphedema. One of the chief benefits of aquatic therapy is due to the effect of buoyancy which counterbalances gravity. In addition to the nurturing and relaxation benefits of buoyancy, aquatic programs are often helpful for patients suffering from lymphedema because of the hydrostatic pressure of the water which drives the excess fluid out of the limb and back into circulation. Because the application of warmth to skin surfaces causes vasodilatation and increased skin blood flow, avoidance of hot tubs or excessively warm water has been recommended; as cold water has the contrary effect, the alternation of warmer and colder water temperatures has been recommended for various kinds of hydrotherapy in patients at risk for lymphedema.

Aquatic therapy was first conceived as a pleasurable means of providing patient control of maintenance therapy and combining the mobilizing effects of massage and exercise on interstitial fluid with the enhancement of fluid uptake into lymphatic channels by the hydrostatic pressure of water. The findings of many recent studies suggest that aquatic therapy also provides an effective means of improving the many other outcomes – such as pain -- in patients with breast cancer or the limb lymphedema which can appear after surgery or therapy.


This study was designed to investigate the impact of aquatic exercise on breast cancer survivors with hormone therapy-associated pain conditions. Patients attended two-months of aquatic intervention consisted of 24 sessions 3 days per week. Each session included 5 minutes of warm-up, 15–20 minutes of aerobic exercise, 15 minutes of mobility exercise and 20 minutes of recovery techniques. Their results were compared to controls and the resulting findings seem to say that aquatic exercise may reduce the pain threshold and waist circumference in breast cancer survivors with hormone therapy-associated arthralgia.

Researchers investigated the effectiveness of an 8-week aquatic program on cancer-related fatigue, as well as physical and psychological outcomes in breast cancer survivors. The intervention group attended aquatic exercise sessions 3 times per week for 8 weeks in a heated deep swimming pool. Sessions lasted 60 minutes in duration: 10 minutes of warm-up, 40 minutes of aerobic and endurance exercises, and 10 minutes of cool-down exercises. Their results demonstrated that an aquatic exercise program conducted in deep water was effective for improving cancer-related fatigue and strength in breast cancer survivors.

This study’s aim was to compare the effects of land versus water exercise programs on body composition and breast cancer-specific quality of life in breast cancer survivors. They had mixed results with land exercise produced a greater decrease in body fat and an increase in lean body mass while water exercise demonstrated a better result for improving breast symptoms.

This systematic review aimed to determine the effects of supervised exercise interventions on cancer related fatigue in breast cancer survivors. While the study was not limited to studies about aquatic exercise, the authors did include aquatic studies in their pool. They found that supervised exercise reduces fatigue and must be implemented in breast cancer rehabilitation settings. They also suggested that high-volume exercises are safe and effective in improving cancer related fatigue and overall quality of life in women with breast cancer. 

This study aimed to clarify the effectiveness of hydrotherapy in improving shoulder abduction as well as shoulder pain and disability in post mastectomy female patients. Thirty patients were assigned randomly into two equal groups.  The first group was the control group treated   by   conventional   physical   therapy exercises (range   of   motion exercises) for 6  weeks three sessions  weekly  and  the  session  lasts  up  to  20  minutes.   While   the   second   group (treatment group) was treated   by underwater exercises three times weekly and up to 6 weeks, the session extends to 20 minutes.  The study concluded that underwater exercises have a great role in improving shoulder abduction as well as pain and disability in post mastectomy female patients.

Aquatic physiotherapy has been established as an accepted treatment option for many chronic diseases and this literature  review  attempted to determine if the available evidence supported its use for cancer-related concerns. This review attempted to establish what is currently known to inform safe and effective clinical practice. The author found that while there is limited research available, the initial findings do indicate that the aquatic environment may offer clinicians and cancer survivors a safe and well tolerated environment in which to improve many symptoms.


Cantarero-Villanueva I, Fernández-Lao C, Caro-Moran E, Morillas-Ruiz J, Galiano-Castillo N, Diaz-Rodriguez L & Arroyo-Morales M (2012). Aquatic exercise in a chest-high pool for hormone therapy-induced arthralgia in breast cancer survivors: A pragmatic controlled trial. Clin Rehab, 27(2): 123-132.

Cantarero-Villanueva I, Fernández-Lao C, Cuesta-Vargas AI, Del Morral-Avila R, Fernández-de las Peñas C & Arroyo-Morales M (2013).  The effectiveness of a deep-water aquatic exercise program in  cancer-related fatigue in breast cancer survivors: A randomized controlled trial. Arch Phys Med Rehab, 94(2): 221-230.

Fernández-Lao, C., Cantarero-Villanueva, I., Ariza-Garcia, A., Courtney, C., Fernández-De-Las-Peñas, C., & Arroyo-Morales, M. (2013). Water versus land-based multimodal exercise program effects on body composition in breast cancer survivors: a controlled clinical trial. Supportive Care in Cancer, 21(2), 521-530.

Meneses-Echávez, J. (2015). Effects of supervised exercise on cancer-related fatigue in breast cancer survivors: a systematic review and meta-analysis. BMC Cancer. 15:77. Retrieved from

Mohammed, A. H., Mahran, H. G., & Aboelazm, S. N. (2014). Does Hydrotherapy Improve Shoulder Abduction in Post-mastectomy Patients? International Journal, 2(11), 484-490.

Smith Suzanne. (2016). Aquatic Physiotherapy Level 3 Course Literature Review: Aquatic Physiotherapy and its application to Cancer Rehabilitation: Informing safe and effective practice. Aquatic Physical Therapy Group, p. Epub ahead of print.