Table 1.

TOLF-HF program strategies and rationales (16, 18).

Strategies and exercises*	Rationales	Frequency & situations
Muscle-tightening deep breathing exercises	• The whole-body lymph fluid has to be drained through the lymphatic ducts above the heart. Muscle-tightening-deep-breathing stimulates lymphatic ducts and helps lymph fluid drain.	• At least twice a day in the morning & at night before brushing teeth or as much as the patient wants throughout the day
	• Lymph fluid drains when muscles move. Muscle-tightening-deep-breathing creates the whole-body muscle movements that create muscle milking and pumping action and help to drain lymph fluid	• Air-Travel: before take-off and after landing.
		• Sedentary lifestyle: At least every 4 h
Muscle-tightening pumping exercises	• Muscle-tightening pumping exercises create arm muscle pumping. This helps lymph fluid flow and decreases the fluid build-up in the upper and lower extremities.	• At least twice a day in the morning & at night before brushing teeth or as much as the patient wants throughout the day
	• Muscle-tightening pumping exercises build the muscles in upper and lower limbs that helps lymph fluid flow and drain.	• Air-Travel: before take-off and after landing
		• Sedentary lifestyle: At least every 4 h
Large muscle exercises: walking, marching at home, dancing, swimming, yoga, Tai Chi, etc.	• Large muscle exercises create muscle milking and pumping to promote overall body lymph fluid flow and drain.	• At least 10-minutes daily.
		• Air-Travel: get up and walk around for flight over 4 h.
		• Sedentary lifestyle: Get up and walk at least every 4 h.

^*For step-by-step instruction for each exercise, please contact the corresponding author.