Monday, August 31, 2015

Low impact exercise – Aqua Lymphatic Therapy & Rebounding

By Tatjana van der Krabben

Recently an invitation landed in my inbox for a meeting called ‘Lipedema on the move’, specifically going into suitable exercise options with the opportunity to try these under supervision. The timing was impeccable. I had just cancelled my gym membership, because both going there and the training itself had become a bit of a burden. Draining, really, when I have zero energy to spare. Well, at least not to toss it out the window. But what then? I do want to exercise. What is safe? Where to begin? This clinic was an excellent starting point. Plus, many of my lipedema friends would be there. What more reasons do you need to go?!
Divided into small groups we tried Aqua Lymphatic Therapy (ALT) and rebounding on a mini trampoline. We had a lot of fun, which meant trouble for our instructors, but I think I managed to take in most for my and your benefit.

Aqua Lymphatic Therapy

ALT is very gentle. It doesn’t even come close to regular aquatic exercise. Like manual lymphatic drainage is a very gentle massage to get the lymph moving, so are these exercises very easy and slow-paced. Benefitting from the additional pressure of the water, we did exercises in comfortably warm water in which – most of us – could properly stand.

We started out with self-lymphatic drainage (SLD) and deep breathing to specifically aid lymphatic flow. After that we did very easy exercises to very relaxed music to enforce that easy pace. We walked in water, added alternately extending our arms and gently turned up the pace. The walking was paired with making a swimming motion one arm at the time, first palm down, then palm up. Little by little the pace went up. We strutted in the water, hands in our sides and circled the pool with small jumps.

The more energetic part we did with pool noodles. We used the noodles for stability and support while turning sideways, for instance. We also placed it between our legs to push ourselves higher in the water and make cycling motions (this is Holland people, we Dutch cycle everywhere) and after that horse-like jumps. Giggles all around!

Then the pace went down again. We made the water whirl around us with our hands, adding to the massaging effect of water and did more elaborate SLD. It’s quite impossible to explain this properly without showing it. A very sketchy impression: we massaged ourselves by stroking the skin from just beneath the buttock, up your side right to your armpit where we finished by making a scoop-like motion to pump the lymph. We repeated this twice and then started a little lower, mid upper leg, still from the back and then repeated the same procedure from the knee up, doing each stretch three times. We then massaged the back of our knees. We finished with a type of jumping jacks while pressing down on the groin area where the lymph nodes are. Then massaging the little dimple at the clavicles and deep breathing. That little dimple matters: it’s where all lymphatic massage begins and ends.
I must say, the total package got the lymph moving all right. For lack of time one side got more attention than the other. We all expressed our right side was feeling significantly lighter than our untreated left side. I was surprised the effect was this strong!


The little trampolines we used for rebounding are smooth in use because they use elastic bands for the bounce, not so much a metal coiled spring. The idea behind it is that it’s the easiest on the knees. Also important: these can support quite some weight and the elastic bands come in different strengths. The deeper the bounce (no jumping!) the bigger the effect on the lymph. This effect has recently been tested with a lymphoscintigraphy. The dye, injected between the toes, was administered twice: once prior to similar floor exercises and once more, after clearing all the residual dye from the first test by MLD, to measure again with rebounding. Judging by the path of the dye, the lymph was moving twice as fast when doing the same exercise/motions on the mini trampoline. Only one test subject, yes, but it gives you an idea.

I feared a little for my poor sense of balance, but I didn’t even need a support, just a little hand getting on and off the mini trampoline. We received instruction on the value of a nice, deep bounce, like described above, the proper posture and some basic moves. Best part: it’s not only good for you, it’s fun! I’m a sucker for exercise that is also fun. We all know that sticking with something is the hard part. The element of fun is a huge help in this.

Got a trampoline that matched my dress, uhuh!

A sturdy, quality trampoline like this is costly. I’m sold and getting one, but I’m well aware it’s not for everyone. So I was super pleased to hear NLNet, the Dutch lymphedema and lipedema foundation and the driving force behind this afternoon of exercise, will also be making YouTube clips with simple exercises you can do around the house. Accessible and safe, because the clips will be made by people with knowledge of lipedema. I will keep you posted on that development.

All in all it was a great afternoon. I met old friends and made a few new ones. For some it was the first time in years they got into a pool. It was a great idea to have this privacy and strictly be among ourselves with knowledgeable therapists. Not only that, the lymph actually started moving and I could tell the difference until well into the following day, despite driving back for over an hour after the training. I would say that this type of exercise is really worth looking into.
Do note that the primary focus of these exercises is to keep the lymph flowing and maintain body strength. This offers no promise of weight-loss. As discussed that afternoon healthy fat cells may be present in your legs, which could shrink, but there's no telling in advance whether a reduced circumference of your legs is feasible through exercise and/or a change of diet in your particular case.

Be healthy & be safe. Consult your doctor and/or therapist first if you want to make changes in your exercise regime and/or diet.


  1. Excellent description of the movements.

    1. Thank you. A film clip would be best, of course, but hopefully this can provide a starting point.

  2. Fantastic, thank you for posting this wonderful blog. Wish there were more therapists offering these classes all over the world!

    1. I wish and I dream. Some day This should be the case. Some day...

  3. This is really nice because it well informative for me and hope for others also keep it continued so that we can get benefits.
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  4. How wonderful! Thanks for sharing! As a therapist, it helps to discover what patients enjoy and find beneficial!