Determination of the effect of physical activity programme in open air by high performance sensors for anthropometric primary lymphedema assessment in clinical environment

Background: Lymphedema, a chronic condition of lymphatic dysfunction and interstitial fluid accumulation, represents a valuable model for testing sustainable, exercise-based therapeutic strategies. The integration of outdoor physical activity and non-invasive monitoring tools may promote person-centered and ecologically responsible healthcare. Methods: This study evaluated the effects of outdoor physical activity in individuals with lymphedema through three non-invasive tools: single-frequency bioimpedance analysis (SF-BIA), segmental indirect volumetry, and Bioelectrical Impedance Vector Analysis (BIVA). A novel two-branch electrical model was also developed to estimate extracellular electrical volume (VE) and tissue resistivity (ρ). The protocols included: 1. A cross-sectional analysis of 55 female Dragon Boat athletes (37 breast cancer survivors, 18 controls); 2. A pre-post intervention study involving 29 individuals with lower-limb lymphedema during 15 minutes of Fitwalking with compression; 3. Validation of the new model in a separate cohort of 40 patients with unilateral lower-limb lymphedema. Results: In Dragon Boat athletes, no differences in segmental composition or vector parameters were observed between groups, but breast cancer-related lymphedema (BCRL, n = 11) showed lower resistance and reactance in affected arms (p < 0.05), suggesting fluid retention despite preserved muscle mass. In the Fitwalking study, limb volume decreased significantly post-exercise (p = 0.016), while segmental resistance decreased and reactance (normalized by limb length) increased (p = 0.006). Height-normalized reactance (Xc/H) was strongly correlated with interlimb volume difference (ρ = −0.890, p < 0.001). The novel model showed high correlations between VE and both geometric volume (ρ = 0.968) and clinical severity (ρ = 0.946). VE and ρ decreased significantly after walking with compression, indicating acute fluid redistribution. Conclusions: Outdoor physical activity—when combined with sustainable compression strategies and supported by bioelectrical monitoring—proves safe and effective for lymphedema management. The new electrical model offers enhanced sensitivity over traditional volumetry, enabling more accurate classification and real-time evaluation of therapeutic response. These findings support the adoption of ecologically sustainable, bioelectrically informed care models in both clinical and home-based settings.