TABLE 5. The-Optimal-Lymph-Flow (TOLF) Exercise to Promote Lymph Flow [16].

TOLF Exercise	Rationales	Frequency & Situations
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.
Shoulder Exercises	•Improved limb mobility after surgery facilitates local muscle movements that create muscle milking and pumping that help local limb lymph fluid flow and drain.	•One week after surgery if there are 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.
Large Muscle Exercise: 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 over 4 hours flight. •Sedentary life-style: Get up and walk at least every 4 hours.