Lymphatic circulation has a peripheral origin and, unlike the blood, does not have any upstream pump – like the heart – moving the lymph forward. Inside larger lymphatic vessels, a minor smooth muscle component allows for just enough peristalsis to push on the lymph. However, the muscular system is the actual peripheral drive allowing for a healthy and quick lymph flow through the lymphatic collectors. With its physiological and periodic contractions, the muscular system acts as an external pump moving the lymph forward. For this reason, in all lymphedema patients, moderate, non traumatic, physical exercise is recommended, which is useful to a physiological activation of this centripetal function. Swimming is the best type of sport recommended for this group of patients, since this exercise is the best in meeting drainage needs. Conversely, as mentioned above, no other sport involving excessive muscle fatigue, which is likely to cause peripheral lymph overproduction, nor sports causing repeated traumas and likely to damage already insufficient lymphatic structures, should be recommended.

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