Table 1.

The-Optimal-Lymph-Flow program: self-care strategies, rationales, and actions

Strategies		Rationales	Actions
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.	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 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.	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 arm muscle that helps lymph fluid flow and drain.	Air-travel: before take-off and after landing.
			Sedentary lifestyle: 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 lifestyle: 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.
Keep a healthy weight
	Eat nutrition-balanced diet (ie, more vegetables and fruit as well as quality proteins); Maintain portion-appropriate diet (feeling 75% full for each meal)	Overweight or obesity is an important risk factor for lymph fluid accumulation.	Each meal daily
		Having extra weight makes it difficult for lymph flow and drain. This can lead to extra lymph fluid build-up.	It is important to talk to the nutritionist who can help to find proper weight reduction programs.
		There are numerous weight management programs available to assist with weight loss.
		Although there are a lot of weight reduction programs, each person may respond differently to each program.
		The core of the weight management is to eat a nutrition-balanced, portion-appropriate diet. It is also important to stay hydrated, exercise, and get adequate sleep.
	Stay hydrated	People may actually be thirsty, not hungry.	Drink 6 to 8 glasses of water daily; in the morning, before and during meals, and throughout the day.
			Avoid drinks with calories (eg, juices).
			Drink green tea to boost metabolism.
	Large muscle exercises	Daily large muscle exercises (eg, walking, running, swimming, Yoga) help to burn more calories.	At least 30-minutes 3 times a week or daily.
		Daily large muscle exercises also promote lymph flow by creating muscle pumps.
	Get enough sleep	Lack of sleep increases the production of the stress hormone cortisol, creates hunger, and leads to overeating.	At least 7-8 hours of sleep per night.
		Getting just one more hour of sleep per night reduces belly fat accumulation.