A waterfall pouring over mossy rock into a clear pool

Swimming and water exercise with lymphedema

Swimming with lymphedema: why water pressure helps, what the slow aqua-lymphatic trials showed, a 30-minute pool routine, water temperature, skin care.

By The Renu lymphatic and massage team · 7 min read

Water is one of the friendliest places to exercise a swollen limb. Macmillan says swimming or moving around in water is good for lymphoedema and that you do not need to wear a compression garment in the pool because the water creates enough pressure. Trials of slow, deliberate movement in warm water found an immediate drop in arm volume that faded within about an hour, with no infections or flare-ups during the studies. The rules are intact skin only, warm rather than hot water, a slow pace, and a shower and moisturiser straight afterward because chlorine and salt dry the skin.

The pool is a good place for a swollen limb, and it is the one form of exercise where the compression garment comes off. Macmillan’s advice is plain: swimming or moving around in water is good for lymphoedema, and you do not need a compression garment while swimming because the water creates enough pressure. Three small trials of water exercise in women with arm lymphedema reported no infections or flare-ups, an immediate (if short-lived) drop in arm volume after slow movement, and better shoulder range of motion after eight weeks. What follows is how to use that, and the skin rules that go with shared water.

Why water helps a swollen limb

Two reasons, one physical and one practical. The physical one is pressure: the water itself creates enough of it, which is Macmillan’s explanation for why the garment is not needed in the pool. The practical one is that the joints are unloaded; Macmillan says swimming and aqua aerobics are helpful if you have problems with your joints because they put less strain on them, and Cancer Research UK lists both among suitable exercises.

The National Lymphedema Network’s exercise paper is candid that aquatic exercise has not been adequately studied in people with lymphedema and asks you to apply the general safety principles of exercise instead. Those principles are the same ones that run through every page in this series: start gradually, increase cautiously, stop for pain, increased swelling or discomfort.

What the aqua-lymphatic trials showed

Small studies, honest results. Here is what each one did and found, from the published abstracts.

Study	What was tested	What happened
Tidhar and Katz-Leurer, 2010 (48 women)	Weekly aqua lymphatic therapy for 3 months, in a hydrotherapy pool 1.2 m deep at 32 to 33 °C, added to self-management, versus self-management alone	No episode of arm infection or increase in limb volume during the study; a positive, clinically significant immediate effect on limb volume but no long-term effect; adherence was higher than for self-management at home; quality of life improved
Johansson, Hayes, Speck and Schmitz, 2013 (29 women)	Water-based exercise at least twice a week for 8 weeks, supervised at first then independent	No effect on lymphedema status; shoulder flexion improved by a median of 6 degrees, with clinically relevant gains in flexion and external rotation years after treatment
Deacon, de Noronha, Shanley and Young, 2019 (18 women)	One 50-minute slow session of modified Ai Chi versus one 50-minute conventional, faster aquatic session, a week apart	Arm volume fell 140 mL more after the slow session, measured immediately; the difference was gone an hour later; 72 percent of participants had a volume drop after the slow session versus 28 percent after the fast one

The pattern is consistent: water exercise is safe for the limb, the volume change is immediate and temporary, slowness beats speed, and the lasting gains are mobility, adherence and how people feel. The 2019 authors made a useful point in reverse: when faster exercise raised arm volume, that increase also subsided within an hour.

A 30-minute pool routine

Our routine, built from the trials’ two consistent features: slow, controlled movement and warm (not hot) water. Compression stays off in the water per Macmillan.

Check the skin before you leave home. Any cut, rash, bite or cracked patch on the limb means a dry-land day instead; see the stop-and-call list below.
Rinse off, then walk in to chest depth. Five minutes of walking forward, backward and sideways through the water, arms moving, at a conversational pace.
Slow limb circuits, ten minutes. For an arm: shoulder circles under the surface, slow elbow bends, wrist circles, fist and spread, each 5 to 10 times, moving as if through honey. For a leg: marching, slow knee bends, ankle circles and heel raises holding the pool edge. These are the same movements as the remedial sequences on land, slowed down by the water; the dry versions are on remedial exercises for arm lymphedema and for leg lymphedema.
Easy swimming or floating, ten minutes. Any stroke that is comfortable. The 2019 trial’s finding argues for an unhurried pace rather than lengths against the clock.
Breathing to finish, five minutes. Standing in the water, slow breaths in through the nose and out through the mouth, the way Cancer Research UK describes deep breathing for lymphoedema; it changes the pressure in the abdomen and chest and encourages lymph to flow back into the blood.
Out, shower, moisturise, garment on. Macmillan: shower and put moisturiser on your skin, because sea salt and chlorine make the skin extra dry. Dry carefully between fingers or toes, then put the garment back on once the skin is dry.

Add the Deacon trial’s lesson to any class you join: if the instructor sets a brisk tempo, do the movements at half speed. The faster session in that study raised arm volume for a while in some women; the slow one lowered it.

Water temperature, hot tubs and the sea

Warm is the target, and the Tidhar trial gives a number: 32 to 33 degrees Celsius. Hot is different. Macmillan’s travel advice is to avoid saunas and hot baths in case they increase swelling and to keep the affected area as cool as possible; the NLN’s 2026 risk-reduction paper recommends avoiding saunas; Cancer Research UK says to use hot tubs and saunas only for a short time and to avoid them entirely with open wounds or cuts. The hot tub next to the lane pool is therefore a separate decision, covered on hot tubs and hot baths with lymphedema.

The sea and lakes bring footing into it. Macmillan asks you not to walk barefoot on a beach or around a swimming pool, because a cut on the limb is an infection risk; water shoes solve that. Salt dries the skin as chlorine does, so the shower-and-moisturise step is the same.

Skin rules that do not bend

Lymphedema care is skin care, and shared water tests it. Cancer Research UK asks you to moisturise every day and to avoid perfumed lotions that dry and irritate; after a swim, the moisturiser is not optional. Choose a product your garment maker allows; our page on moisturising when you wear a compression garment explains why that matters. Swim only with intact skin. Protect the limb from sun on the way to and from the water; the full routine is on sun protection for skin at risk of lymphedema.

Stop and call

Stay out of the water, and contact your lymphedema therapist or doctor, if:

The limb has any open skin: a cut, graze, blister, cracked dry patch, bite that has been scratched, or a rash. Cancer Research UK’s rule for hot tubs with open wounds is the one we apply to every shared pool.
Redness, warmth, pain, swelling, fever or chills appear in the limb: the NLN’s infection signs, which it says to treat as an urgent medical event. Macmillan asks you to tell a doctor straight away about any sign of infection.
The limb is heavier, tighter or more swollen the next morning after a session. The NLN’s rule is to stop exercise for increased swelling or discomfort and to report it; the trials showed volume changes should settle within about an hour, so a limb that is still bigger the next day is telling you the pace, the temperature or the duration was wrong.
You felt faint, chilled or unwell in the water. That is a medical question before it is a lymphedema one.

The wider red flags are on when swelling needs medical care.

Where the pool fits

Water exercise is support, not treatment. The Tidhar trial’s immediate volume reduction did not last, and the authors said so; the Johansson trial found no change in lymphedema status at all. What the pool reliably gives is mobility, a safe place to move a heavy limb, and a habit people keep. The treatment that changes the limb over months is complete decongestive therapy, and at Renu that is Meeghan Mackenzie’s work as our Certified Lymphedema Therapist. If you are starting to swim, tell her at your next session; a garment that is being taken off and put back on daily needs to be the right garment, and a compression fitting with Meeghan Mackenzie is 30 minutes for $25. For the ground rules that apply to every form of exercise, start with how to start exercising with lymphedema, safely.

Questions people ask

Do I wear my compression sleeve or stocking in the pool?

Macmillan says you do not need to wear a compression garment while swimming because the water creates enough pressure, and its wider rule is to follow your lymphoedema specialist's instructions about when and how long to wear garments. Put the garment back on once you are dry. If your lymphedema is severe, or is in the trunk, breast or genitals rather than a limb, ask your therapist what they want you to do before the first swim.

Is the sea better than a chlorinated pool?

The sources treat them the same way: Macmillan says sea salt and chlorine both make the skin extra dry, so after either you shower and put moisturiser on. The practical differences are footing and footwear; Macmillan asks you not to walk barefoot on a beach or around a swimming pool, because a cut on the limb is an infection risk.

Can I swim with a cut, a rash or an insect bite on the limb?

Wait until it has healed. Cancer Research UK says to avoid hot tubs and saunas if you have any open wounds or cuts, and we apply the same rule to any shared water; Macmillan asks you to tell a doctor straight away about any sign of infection on the limb. The NLN's 2026 paper treats a suspected infection in the limb as an urgent medical event, and shared water is not where you want broken skin.

Is aqua aerobics safe with lymphedema?

Cancer Research UK lists swimming and aqua aerobics among suitable exercises, and Macmillan says both are helpful if you have joint problems because they put less strain on the joints. The 2019 cross-over trial is worth knowing about: slow, controlled movement produced a larger immediate drop in arm volume than a conventional, faster aqua session, so if a class is brisk, do the moves at your own pace near the back.

How warm should the water be?

The Tidhar aqua lymphatic therapy trial ran in a hydrotherapy pool at 32 to 33 degrees Celsius and 1.2 metres deep, which is warm but not hot. Hot is the line to avoid: Macmillan's travel advice is to avoid saunas and hot baths in case they increase swelling, and the NLN's 2026 position is to avoid saunas. The hot tub beside the pool is covered on its own page.