When we’re trying to find the “best” exercise, are we sometimes missing the point?
I saw a post recently about exercise for lymphoedema and lipedema.
It was talking about swimming pools and something rather clever that happens when we get into water.
Hydrostatic pressure.
Immediately my anatomy-and-movement brain went:
Ooh. That’s interesting.
Because water doesn’t just give us somewhere to exercise.
It changes the environment in which we’re exercising.
And inevitably that sent me down a rabbit hole.
Is exercising in water actually better than exercising on land?
So I went looking.
And somewhere between the research papers, hydrostatic pressure, buoyancy, muscle pumps, lymphatics and exercise guidelines, I found myself asking a rather different question:
If it gets you moving… who cares how?
Bear with me.
Because I’m absolutely not saying the physiology doesn’t matter.
It does.
💦 What’s so clever about water?
When you stand in water, the water exerts pressure against your body.
That’s hydrostatic pressure.
And it increases with depth.
So if you’re standing upright in a pool, the pressure acting on the tissues around your feet and lower legs is greater than it is higher up your body.
That’s interesting when we’re thinking about oedema.
But water gives us something else too:
buoyancy.
The deeper you’re immersed, the more your body weight is supported by the water.
And suddenly someone who finds walking, squatting or stepping difficult on land may find those same movements considerably easier.
Then we add movement itself.
Muscles contract and relax.
Joints move.
Breathing changes.
Cardiovascular demand changes.
The muscle pump contributes to venous return, while movement and changing tissue pressures are among the mechanical influences supporting lymph transport.
So:
Water + pressure + buoyancy + movement.
There’s a perfectly reasonable physiological argument for aquatic exercise.
But physiological plausibility and evidence of superiority aren’t quite the same thing.
And that’s where this gets interesting.
🔎 So what does the evidence say about lymphoedema?
Here’s where my rabbit hole became slightly less tidy.
A 2025 systematic review specifically examining exercise in people with lower-limb lymphoedema found just 12 eligible studies involving 367 participants.
Exercise appeared to have small positive effects on quality of life, physical function, pain and lower-limb volume.
Sounds great.
Except there was substantial variation between the studies and a high risk of bias. The researchers therefore concluded that the evidence wasn’t strong enough to produce an evidence-based prescription telling us precisely what exercise people with lower-limb lymphoedema should do. PubMed Central (PMC)
That distinction matters.
It isn’t:
“Exercise doesn’t work.”
It’s:
“We don’t yet know enough to prescribe one optimum exercise formula.”
And I think those are two very different messages.
🌊 But surely water is better?
Maybe for some things and some people.
But “better” is a surprisingly difficult word to prove.
A review of water-based exercise for upper- and lower-limb lymphoedema identified eight randomised controlled trials and one clinical study.
Aquatic exercise showed potential benefits for things including range of movement, strength, pain and quality of life. Some studies reported reductions in limb volume, particularly in the short term, while others did not.
And importantly, most of the available studies involved breast-cancer-related lymphoedema, rather than lower-limb lymphoedema.
The authors’ conclusion?
Promising — but we need better research and clearer exercise protocols. ScienceDirect
Which leaves us in a rather familiar place:
Water looks useful.
Land exercise looks useful.
We don’t have compelling evidence that everybody with lymphoedema should get themselves into a swimming pool.
And perhaps they don’t need to.
💗 And what about lipedema?
This is possibly where I think the conversation about exercise becomes even more important.
Lipedema can be associated with pain, heaviness and reduced mobility, and lipedema tissue itself is recognised as being difficult to reduce through conventional diet and exercise. Read Lipoedema vs Lymphoedema.
Unfortunately, “exercise won’t get rid of lipedema tissue” can sometimes get translated into:
“Exercise doesn’t work for lipedema.”
Those are absolutely not the same thing.
A 2025 systematic review found only six studies involving 115 women with lipedema.
Again — tiny evidence base.
But exercise interventions showed promising improvements in pain and other symptoms, quality of life, functional performance and limb measurements. Some effects appeared greater when exercise was combined with ongoing compression.
The authors were appropriately cautious because studies were small and heterogeneous. PubMed
Another recent review looking at objectively measured physical activity and capacity in lipedema found just six eligible studies. Women with lipedema generally demonstrated reduced walking capacity and muscle strength compared with controls, while structured exercise — particularly combinations of aerobic and resistance exercise — was associated with improvements in walking distance, strength and pain.
Again, though, the researchers emphasised how limited the evidence remains. PubMed Central (PMC)
That makes me think we need to be careful about what we’re asking exercise to achieve.
What if getting smaller isn’t the only outcome?
This matters.
If somebody with lipedema exercises for twelve weeks and their legs aren’t dramatically smaller, has the exercise failed?
What if she can walk further?
What if she’s stronger?
What if stairs are easier?
What if her pain is better?
What if she can get herself off the floor?
What if she has more confidence?
What if she’s protecting her cardiovascular health?
What if she’s maintaining muscle as she gets older?
What if she simply feels better in her body?
Those aren’t consolation prizes.
They’re health outcomes.
And a 2024 consensus statement specifically addressing physical exercise in lipedema supports exercise as part of management, including aquatic exercise and strength training, while also acknowledging the lack of standardised exercise prescription and the need for much more research. PubMed Central (PMC)
🏊 So should I exercise in water or on land?
Now we get to my favourite bit.
Let’s imagine two people.
One loves swimming.
In water her joints feel comfortable, her legs feel lighter and she can move for 30 minutes when walking for 10 minutes on land is uncomfortable.
Put her in the pool.
Someone else hates swimming.
She doesn’t like changing rooms. She’s self-conscious in a swimsuit. Getting into and out of a pool is difficult and she knows perfectly well that the expensive swimming membership will sit unused in her purse.
But she loves walking with her friend.
Let her walk.
Another person discovers resistance training and loves seeing herself getting stronger.
Brilliant.
Someone else dances around the kitchen.
That counts too.
And somebody currently doing almost nothing manages five minutes around the block.
That absolutely counts.
Because the evidence about general physical activity is considerably stronger than our evidence about the perfect lymphoedema or lipedema exercise.
⏱️ How much movement are we actually talking about?
The newly updated 2026 UK Chief Medical Officers’ physical activity guidelines recommend adults work towards at least 150 minutes of moderate-intensity activity each week, or 75 minutes vigorous activity (or a combination), together with muscle-strengthening activity on at least two days each week. GOV.UK
WHO recommends 150–300 minutes of moderate aerobic activity, or 75–150 minutes vigorous activity, plus muscle strengthening on at least two days. NCBI
But here’s the sentence I think matters more than any of those numbers:
Any activity is better than none.
The UK guidance says health benefits are measurable even at relatively low levels of activity. It also specifically recognises that activity accumulated in bouts of any duration can contribute — we don’t have to achieve exercise in neat 10-, 20- or 30-minute chunks. GOV.UK
WHO similarly recommends that people living with chronic conditions who cannot meet the full recommendations should be active according to their abilities and build up gradually. NCBI
So 150 minutes isn’t the entry requirement for exercise.
It’s something we might work towards.
If five minutes is your starting point, start with five.
🤔 Which brings me back to my rabbit hole.
I started out wondering:
Land versus water — which is better?
And I’ve ended up thinking that for many people I’ve asked the wrong question.
Yes, hydrostatic pressure is fascinating.
Yes, buoyancy may make movement considerably more comfortable.
Yes, compression, lymphatic physiology and appropriate exercise prescription matter.
And yes, I’d love to see much better research comparing different exercise environments and prescriptions in both lymphoedema and lipedema.
But meanwhile, there’s an actual person in front of us.
And I want them to move.
Not because movement will magically cure lymphoedema.
Not because somebody can exercise lipedema away.
Not because every body needs to become smaller.
But because human beings need movement.
We need muscle.
We need cardiovascular capacity.
We need joints that move.
We need balance.
We need enough physical reserve to get out of a chair, climb stairs, carry shopping, get off the floor and continue doing the things that make our lives ours.
And preferably, we need to find some way of achieving that which we don’t absolutely hate.
My Fi thought
Perhaps we’re occasionally guilty in healthcare and exercise of searching so hard for the perfect intervention that we create another barrier to doing anything at all.
Should I swim?
Yes, if you enjoy swimming.
Should I walk?
Yes, if walking works for you.
Can I lift weights?
With appropriate progression and individual considerations, resistance training can absolutely be part of the picture.
Does Pilates count?
Of course movement counts.
Does five minutes count?
Yes.
And if painful, heavy legs become easier to move when you’re supported by water?
Get in the water.
Not because I’ve found a paper proving that the swimming pool is universally superior to dry land.
But because it got you moving.
And ultimately…
if it gets you moving, who cares how?
Maybe that is the outcome we should have been measuring all along.
Need some help finding your way into movement?
You don’t need to find the perfect exercise. You need to find movement that works for your body, your health and your life.
Whether that’s walking, Pilates, strength work, exercising in water or simply starting with five minutes more movement than you’re doing now, the important bit is finding somewhere you can begin — and something you can build on.
If lymphoedema, lipedema, cancer treatment, pain, reduced mobility or simply a long time away from exercise is making you unsure where to start, I can help you find a way forward that’s realistic for you.
Because movement doesn’t have to look impressive to make a difference.
Walk it. Swim it. Strengthen it. Move it.
If it gets you moving… who cares how?
Fiona Palmer — Pilates Therapy & Bodywork
Clinical exercise • Cancer rehabilitation • Lymphoedema support • Movement & wellbeing
pilatestherapyandbodywork.com
📚 Fi’s Reading List — if you fancy following me down the rabbit hole
1. Wittenkamp et al. (2025) — Exercise in lower-limb lymphoedema
A systematic review of 12 studies and 367 participants. Exercise appeared to have small positive effects on quality of life, function, pain and limb volume, but the quality and heterogeneity of the evidence prevented the authors making a specific evidence-based exercise prescription. PubMed Central (PMC)
💭 Fi thought:
This may be my favourite paper for this article precisely because it doesn’t give us a tidy answer. Exercise looks useful; we just don’t yet know the perfect recipe. Don’t confuse “we need better evidence” with “don’t exercise.”
2. Water-based exercise for upper- and lower-limb lymphoedema (2022)
This review included eight RCTs and one clinical study. Water exercise showed potential benefits for movement, strength, pain and quality of life, with mixed findings for limb volume. Most research was in breast-cancer-related lymphoedema, so we should be cautious about applying all of it directly to lower limbs. PubMed
💭 Fi thought:
This is exactly why I like water — the physiology makes sense and the research is encouraging. But “promising” isn’t the same as “proven better”. That’s an important distinction.
3. Exercise training in women with lipedema — 2025 systematic review
Only six studies involving 115 women met the inclusion criteria. Exercise showed promising effects across symptoms, quality of life, function and some limb measures; effects appeared greater when exercise was combined with compression. But small samples and differing exercise programmes mean much more research is needed. PubMed
💭 Fi thought:
115 women. That’s worth stopping over. We need to be very careful about making sweeping claims about the “best exercise for lipedema” when the evidence base is still this small.
4. Objective physical activity and capacity in lipedema — recent scoping review
After screening more than 5,000 records, only six studies met the criteria for objective measurement. The evidence suggests reduced walking capacity and strength can be important issues in lipedema and that structured activity may improve function, strength and pain, but again the research base is limited. PubMed Central (PMC)
💭 Fi thought:
This brings me straight back to function. I don’t only want to know whether someone’s leg circumference changed. Can she walk further? Is she stronger? Can she live her life more easily?
5. UK Chief Medical Officers’ Physical Activity Guidelines — 2026 update
The updated UK guidance retains the target of at least 150 minutes of moderate activity per week for adults, alongside strength work, but importantly emphasises that any activity is better than none, health benefits occur below 150 minutes, and activity can be accumulated in bouts of any duration. GOV.UK
💭 Fi thought:
This may actually be the most useful prescription of the lot: if you’re doing nothing, do something. If you’re doing something, gradually do a bit more. We sometimes make movement far more complicated than it needs to be.