Hello, I'm Doctor Alexandre Amato, vascular surgeon at Instituto Amato and today I'm going to talk about physical exercise and lipedema. Lipedema is a subject that I really like and I talk about it a lot here on the channel and exercise is part of the pillars of lipedema treatment. So how can we do this?
How are we going to combine exercise as a therapeutic tool? How can we improve symptoms? How can we improve, reduce the volume of lipedema using physical exercise.
I wrote this book, the exercise method for lipedema exactly because of this. It all started, I started writing some ideas, I was thinking about making a small E-book and in the end it was so much that it ended up becoming a complete book here. I'm going to talk about the main aspects, what we need to remember, because not just any exercise works for lipedema and I keep getting messages here on Instagram, on YouTube, oh, I do this exercise, this exercise is good for lipedema?
And the answer is not that simple, because some exercises need to be adapted, modified, it depends on the patient's stage of the disease, it also depends on the patient's goals. You want to gain muscle, you want to grow, you want aerobics. So, all of this varies greatly depending on the stage of the disease and each person’s goals.
Lipedema pain itself, pain in the lower limbs that may just be due to increased sensitivity to touch, occurs due to inflammation and also occurs due to hypoxia. So you see, exercise can both increase and decrease inflammation and it can also cause hypoxia. So what can we do to increase or decrease each of these factors.
Just out of curiosity, see that there is work showing that patients with lipedema have up to thirty percent less strength in their thigh muscles. This is significant, we cannot apply the same strategy as we would apply to someone who does not have lipedema, to someone with lipedema in a super painful inflammatory phase, many times I get the patient here who is suffering, is doing a lot of exercise, is doing the wrong exercise and You're not seeing results. So the first aspect that is very important and that I talk about a lot is inflammation.
So inflammation is the main part of lipedema, it is what will cause the worst symptoms and physical exercise alone can, in a certain range of intensity, reduce this inflammation, in other words, have an anti-inflammatory effect, as if it is too intense it can even increase this. inflammation. Any exercise for the purpose of muscle gain, for example, ends up causing micro-lesions in the muscles, these are the small injuries that occur as the scarring occurs, which leads to muscle strength.
However, these microlesions also increase inflammation. So, we have to get this intensity right so that the exercise has an anti-inflammatory effect, especially in a phase of high inflammation, high symptoms. Still regarding inflammation, if we start trying to gain muscle mass, exactly at this stage, you will end up increasing inflammation and then you won't get the results you want.
In the absence of inflammation, it is very difficult to lose fat and gain muscle, so we first need to correct our metabolism to then achieve better results in physical exercise. After the disease is more controlled, and there is no longer all this inflammation, then it is possible and easy to gain muscle mass. So, that's why the exercise cannot be the same for the person themselves, right?
But at different stages of the disease. The other thing is the stage of lipedema, so if we take a patient in an early stage, a stage one or a final stage of lipolymphedema who has associated lymphedema. Obviously the daily difficulties will be different and obviously the exercises will also be different.
Someone who is at an early stage, in stage one, for example, will not have difficulty getting in and out of the car or difficulty getting in a ladder, now those who are at an advanced stage four may already have these difficulties and then physical exercise can try to help improve exactly these aspects, while in the initial stages the objective may be entirely different, it may be more aesthetic, it may be to gain muscle mass , it could be well-being, a healthy lifestyle , so we have to evaluate each patient and understand what each patient needs at each moment of their life. There's no point in taking someone in the final stage of the disease and saying, initially you have to gain muscle mass. No, there are a lot of things to improve first.
You have to improve lymphatic return , improve the lymphatic and venous return pump, you have to reduce inflammation, there are a lot of things before achieving aesthetics. And, obviously, this has to be constant adaptation. So, you're not going to start with an exercise that currently works well for lipedema, maybe it won't work well forever, both because you can improve your aspects of the disease and you may want a little more and then you'll have to adapt these exercises, but You have to know exactly which variables you are going to change, so the main one will be the intensity, the type of exercise and with that you will direct yourself to the result you want.
There are many diseases that are accompanied by lipedema, so they are called exactly because lipedema has this deposition of fat in the legs, thighs, there is a change in gait and with this change in gait comes some orthopedic injuries and injuries that end up hindering the execution of certain exercises. So, a very common injury is knee valgus, right? The X-shaped knee.
In extreme cases, it even makes walking difficult. So, we have to consider this and strengthening the thigh can even improve this injury. So physical exercise can not only improve the symptoms of lipedema but, if well targeted, can help correct other changes that come with lipedema.
Another example is flat foot. So the flat foot is the way you step and it will alter the venous pump. Therefore, venous return is impaired.
The drop in the plantar arch and all this also makes some movements difficult. So, there are exercises that can improve this. Hypermobility also has a higher frequency in lipedema, so these are people who can have greater joint mobility , so I don't have any joint mobility.
But they are people who can place the palm of their hand on the ground, who can even put their leg behind their head, or at least managed to do so at some point in their lives. This hypermobility gives a greater range of motion to the joints and this may seem interesting, but in reality it ends up forcing these joints, tendons, muscles, and can cause other injuries. So, physical exercise has to be aimed at strengthening the core muscles , the muscles to maintain the body structure.
Another injury that is very common is chondromalacia or knee cartilage damage. If you put your hand on your knee and move your leg and feel a crepitus, you feel your knee popping, right? It feels like it's crunchy, right?
There's a patient who says it's crunchy, right? This chondromalacia is often precisely because of this change in gait due to lipedema and this can limit some exercises and some exercises can even worsen chondromalacia. So, you have to know exactly what you can do to avoid causing more problems.
I mentioned venous return and lymphatic return. So, they are executed by muscle contraction. So, exactly with physical exercise and muscle contraction, we pump both venous blood and lymph back into the central circulation.
So, if we don't have this adequate contraction and this contraction, it may not be adequate due to the wrong problem, but also due to lower muscle capacity. So, it is very common, exactly because This decrease in muscle strength and muscle efficiency in patients with lipedema has a negative impact on both venous and lymphatic return. So, some exercises are better for improving this return and we have to take advantage of this greater effectiveness of the exercises, for example, in the water.
So, when you are in a swimming pool, the pressure exerted by the water will also facilitate the return of blood and lymph. But there are also other exercises that will, for example, increase the range of motion of the foot and this will contract more the calf, which is the main pump, the peripheral heart, but we also have the plantar pump when we step, the We squeeze the blood that is in the foot and this blood ends up returning to circulation, ending up boosting it, right? A propellant bomb.
Now another aspect is the influence of the mind on exercise, right? Everyone talks about the influence of exercise on the mind, but I see few people talking about the opposite, which is the mind during exercise . So, what does the influence of exercise on the mind mean?
For example, exercise and reduce anxiety. This is information like this, it's common sense, right? Everyone knows that exercising makes you feel calmer and improves various aspects of your life in general, right?
Now how much does the mind influence the choice of exercise, right? Did you know that if you have high anxiety or if you have any impediment, for example, you are afraid of going to the gym to show off your body and if your mind makes it difficult for you to exercise, you will having to find alternatives for this. So, ah, I don't want to show my body, so, that's why I don't go to a swimming pool.
If you don't go to the pool, you won't do the best water exercise for lipedema. And in the end, if we trace it back, all of this started with a problem in the mind, you know, a fear of showing one's body. Okay, this came from an anti-obesity bias or from a negative impact it had on the environment you create to exercise is very important, but also the search for dopamine, we are always our life is an incessant search for dopamine , this small daily dose of pain from our addiction, right?
And this addiction can be in food, it can be in even more harmful addictions like drugs, like smoking, shopping, there are several things that can cause a small release of dopamine in our brain, but if we know that there is dopamine in exercise, We have to know how to extract this dopamine as much as possible from exercise. We often compete with someone else or compete with ourselves. Always trying to improve this means we end up getting daily micro doses of dopamine.
And the medicines, right? Those who have started lipedema treatment are often taking several medications. Will this influence the exercise?
It wo n't , is there anyone that can make it difficult? So, for example, there are some medications that can lower blood sugar, does this prevent you from doing any physical exercise? So, we need to evaluate each patient's situation and understand how this can affect their physical exercise.
Remembering that most patients who are undergoing the correct treatment for lipedema are on some type of diet or change in eating habits. So, there are several, right? But it can be anything from intermittent fasting, a ketogenic diet, an anti-inflammatory diet, I talk a lot about anti-inflammatory diets, ketogenic diets, which are excellent for lipedema.
So, what is the impact of this on physical exercise, right? I've seen people saying that people on a ketogenic diet can't exercise. Even though there are many scientific studies published on athletes doing physical exercise.
So, it is not a limitation. Just like in a ketogenic diet there is greater dehydration, you have to drink more fluids, you have to be very concerned about hydration, we have to know the individual aspects of each diet and apply this to physical activity. So, my main message here in this video is to remember bioindividuality, an exercise that works for one person, does not necessarily work for another person, it is important for us to evaluate, understand each person's objective, what each person wants to achieve with with this exercise.
Most exercises can be adapted. So, ah, I really like doing this exercise here. But they told me that this exercise cannot be used for lipedema.
Actually, that's not it. In fact, you need to understand your body and adapt this exercise to your body's needs. Maybe you can't do it like you're doing right now, maybe you need a small adjustment or a bigger adjustment, but there really are few exercises that absolutely cannot be done in case of lipedema.
Now there are exercises that have a better chance of working, if I say it here the chance of making a mistake is small and when I'm making a video here for a larger audience, I have to be very careful about saying it. That's what's going to work, because even if it works for the public and the other half doesn't work, I'm hurting the half that didn't work. So, what are these exercises that have the chance of working for a larger audience.
It's exercises in the water, so swimming, water aerobics, there's a huge chance of not making a mistake. So, I'm very comfortable saying go this way and the chance is great, but that doesn't mean that this is the only thing that can be done. This means that there is less chance of making a mistake in this regard.
A walk for example, it's difficult to make a mistake with a walk at the intensity, you may not achieve your biggest goals of gaining muscle mass, but the chance of making a mistake and ending up getting inflamed during a walk is very small, now you have to remember that the exercises change according to the phase of treatment and stage of the disease and even within the stage with the phase, right? Whether it is inflamed, whether it is not inflamed. At the beginning you need a medical evaluation for this, we were not born with a manual for our body, there is a phase of understanding, of self-knowledge so you can understand when you are inflamed, when you are not inflamed, when you can do a certain exercise.
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