Table 1. The-Optimal-Lymph-Flow Program Strategies and Rationales^**.

	**Risk Reduction Strategies	Rationales	Frequency & Situations
Promoting lymph Flow	Muscle-Tightening Deep Breathing	The whole body lymph fluid has to be drained through the lymphatic ducts above the heart. Muscle-tightening-deep-breathing stimulates lymphatic ducts and help lymph fluid drain. 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.	At least twice a day in the morning & at night before brushing teeth or as much as the patient wants throughout the day. Air-Travel: before take-off and after landing Sedentary life-style: At least every 4 hours
	Muscle-Tightening Pumping	Muscle-tightening pumping exercises create arm muscle pumping. This helps lymph fluid flow and decreases the fluid build-up in the arms. Muscle-tightening pumping exercises build the arm muscle that helps lymph fluid flow and drain.	At least twice a day in the morning & at night before brushing teeth or as much as the patient wants throughout the day. Air-Travel: before take-off and after landing Sedentary life-style: At least every 4 hours
	Large Muscle Exercises: Walking, Marching at home, Dancing, Swimming, Yoga, Tai Chi.	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 hours. Sedentary life-style: Get up and walk at least every 4 hours.
Improving Limb Functional Status	Shoulder Exercises	Improved limb mobility after surgery facilitates local muscle movements that create muscle milking and pumping to promote local limb lymph fluid flow and drain.	One week after surgery if there is no surgical drains or after the surgical drains are removed. At least twice a day until limb functions are returned to normal. Whenever limb mobility is limited throughout the recovery.
Optimizing BMI	Large Muscle Exercises	Daily large muscle exercises, such as walking, running, swimming, help to achieve optimal weight and body mass index.	At least 30-minutes 3 times a week or daily
	Nutrition-balanced (i.e. more vegetables and fruits) and portion - appropriate diet (feeling 75% full for each meal)	Overweight or obesity is an important risk factor for lymphedema. Having extra weight makes it difficult for lymph flow and drain. This can lead to extra lymph fluid build-up.	Each meal daily It is important to talk to the nutritionist who can help to find a proper weight reduction programs. Although there are a lot of weight reduction programs, each person may respond differently to each program.

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