Chest
Volume 123, Issue 2, February 2003, Pages 399-405
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Clinical Investigations
EXERCISE
Acute Effects of Exercise in Patients With Previous Deep Venous Thrombosis*: Impact of the Postthrombotic Syndrome

https://doi.org/10.1378/chest.123.2.399Get rights and content

Background:

The postthrombotic syndrome (PTS) occurs frequently after deep venous thrombosis (DVT) and is believed to worsen with upright posture and physical activity. However, the effects of exercise in patients with previous DVT have not been studied.

Study objectives:

To determine whether previous DVT and PTS limit the ability to exercise, and whether exercise increases the severity of venous symptoms and signs.

Design and setting:

A repeated-measures cohort study that was conducted at a university-affiliated teaching hospital, 1999–2000.

Participants:

Subjects with a first episode of unilateral DVT at least 1 year earlier were recruited from the Thrombosis Clinic (total, 41 subjects; with PTS, 19 subjects).

Intervention:

Treadmill exercise session.

Measurements and results:

Venous symptoms, calf muscle fatigability, flexibility, and leg volume before and after treadmill exercise were measured and compared. Exercise did not worsen venous symptoms, despite a higher gain in affected leg volume in subjects with PTS vs subjects without PTS (mean difference: affected leg, 53 mL; unaffected leg, −15 mL; p = 0.018). Calf flexibility significantly improved after exercise in subjects with PTS (gastrocnemius: affected-unaffected, PTS vs no PTS + 4.5°, p = 0.0029; soleus: affected-unaffected, PTS vs no PTS + 5.7°, p = 0.0011).

Conclusions:

Exercise did not acutely exacerbate symptoms and, in subjects with PTS, resulted in improved flexibility in the affected leg. Our findings suggest that treadmill or similar exercise is unlikely to make symptoms of PTS worse, and may improve flexibility. Further study is indicated to determine whether a regular exercise-training program might have a role in the management of patients with PTS, since, to date, the treatment options for this condition are limited.

Section snippets

Subjects

Study subjects were recruited from the Thrombosis Clinic of our hospital, a clinic that observes all patients in whom venous thromboembolism had been diagnosed. Sequential patients with a first diagnosis of unilateral DVT established by objective testing at least 1 year prior were approached for participation in the study. Subjects were excluded if they had bilateral DVT, had experienced more than one episode of DVT, had symptomatic pulmonary embolism, had any medical condition that precluded

Study Population

Forty-three patients were recruited over a 1-year period (1999 to 2000). Two patients were excluded (one had a history of bilateral DVT and one was not able to follow the research assistant’s instructions), leaving a study population of 41 subjects. PTS, as defined as a Villalta score of ≥ 5, was present in 19 patients (46.3%) in the study group, and the PTS was categorized as mild/moderate in 17 subjects and as severe in 2 subjects. The mean (SD) PTS score was 2.1 (1.3), 6.4 (1.3), and 19.0

Discussion

DVT and its chronic sequela, PTS, affect adults of all age groups, many of whom are active and eager to exercise. The effects of exercise on patients with DVT and PTS have not been studied previously. From a physiologic point of view, exercise could either help or worsen PTS. During exercise, muscle contraction increases the pressure outside of the veins and propels blood back to the heart (calf muscle pump), reducing the hydrostatic pressure gradient required for edema formation.16 However,

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    Drs. Kahn and Shrier are Chercheurs Boursier Clinicien (Clinical Research Scholars) supported by the Fonds de Recherche en Santé du Québec. This study was supported by an unrestricted grant-in-aid from the Beiersdorf-Jobst Research Program of the American College of Phlebology.

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