Reaching consensus on exercise recommendations for individuals living with lower limb lymphoedema: a Delphi study

Existing exercise recommendations primarily focus on upper limb lymphoedema, with limited clarity on the most effective types, frequency, and intensity of exercise for individuals with lower limb lymphoedema. Given the differences observed between the upper and lower limbs, it makes intuitive sense to develop a framework of exercise recommendations for lower limb lymphoedema. We conducted a modified two round e-Delphi during February and March 2025. A draft framework was developed by the research team using relevant documents identified within the literature. . The expert panel considered 68 exercise recommendations and three recommendations regarding compression garments whilst exercising. Over two rounds, panellists rated their level of agreement on whether each recommendation was important when prescribing exercise to individuals living with lower limb lymphoedema. A total of 54 panellists from 10 countries participated in round 1, with a high retention rate of 96% in round 2. The final framework consisted of 26 exercise recommendations across three domains: resistance (n = 7 recommendations); aerobic (n = 15); flexibility (n = 4); and three recommendations regarding compression garment use whilst exercising. This framework outlines a set of exercise recommendations to guide healthcare professionals in prescribing multimodal programs for individuals living by lower limb lymphoedema. Current literature lacks clear guidance on effective exercise, types, frequency, and intensity for lower limb lymphoedema.Clinicians often adapt recommendations designed for upper limb lymphoedema, highlighting the need for tailored guidance for lower limb presentations.The purpose of this framework is not to dictate the way healthcare professionals must prescribe exercise; rather, it is to offer consensus-based exercise recommendations for individuals living with lower limb lymphoedema in the absence of strong scientific evidence. Current literature lacks clear guidance on effective exercise, types, frequency, and intensity for lower limb lymphoedema. Clinicians often adapt recommendations designed for upper limb lymphoedema, highlighting the need for tailored guidance for lower limb presentations. The purpose of this framework is not to dictate the way healthcare professionals must prescribe exercise; rather, it is to offer consensus-based exercise recommendations for individuals living with lower limb lymphoedema in the absence of strong scientific evidence.