Effect of Physical Activity after Recent Deep Venous Thrombosis: A Cohort Study

Ian Shrier; Susan R. Kahn

Disclosures

Med Sci Sports Exerc. 2005;37(4):630-634. 

In This Article

Abstract and Introduction

Purpose: To determine whether increased physical activity 1 month after deep vein thrombosis (DVT) led to worsening of venous symptoms and signs within the subsequent 3 months.
Methods: By a multicenter prospective cohort study of patients with acute DVT, we used validated questionnaires at baseline, 1 month, and 4 months post-DVT for each exposure, using the Godin Questionnaire to measure physical activity, the VEINES-QOL to measure disease severity, and the postthrombotic syndrome (PTS) scale to measure symptoms and signs usually attributed to sequelae of DVT.
Results: Of 301 patients followed for 4 months, 25% were inactive and 25% were only mildly active before their DVT. In univariate analysis, physical activity at 1 month was not associated with a change in PTS score between 1 month and 4 months ( P = 0.42). After adjusting for the potential confounders of age, sex, pre-DVT physical activity, and disease severity at 1 month, the results suggested that higher physical activity levels at 1 month may be protective against worsening of the PTS score over the subsequent 3 months. Compared with those who were inactive at 1 month, the adjusted OR was 0.93 (95%CI: 0.47, 1.87) for mildly to moderately active persons, and 0.52 (95%CI: 0.24, 1.15) for highly active persons. Among patients who were active pre-DVT ( N = 220), 55.5% had returned to their previous levels of physical activity or greater within 4 months.
Conclusions: For most persons, exercise at 1 month post-DVT does not appear to worsen venous symptoms and signs over the subsequent 3 months, and more than 50% resume their usual level of activity within 4 months.

Deep venous thrombosis (DVT) is a common vascular disorder that occurs in approximately 1 out of 1000 persons per year.[1] Multiple studies over the past 10—15 yr have centered on the diagnosis, prevention, and treatment of DVT, and on outcomes such as mortality, recurrence of thromboembolism, and bleeding. However, two important neglected areas are the impact of DVT on the ability to exercise, and the effects of exercise on recovery after DVT.

Health care professionals may be reluctant to prescribe exercise to patients with DVT because of concerns that exercise increases blood flow, and therefore swelling, in patients who have an abnormal venous circulation. Are such concerns supported by the evidence? Although there is no direct evidence from clinical studies, the evidence from physiological studies suggests that exercise could have both deleterious and beneficial effects in patients with a recent history of DVT. The potential deleterious effects of exercise are mostly due to decreased arteriolar resistance, which leads to increased muscle blood flow.[2,5,20] Although the venous system can easily accommodate increased flow under normal conditions, this may not be the case after a DVT, due either to persistent partial venous obstruction, reflux, or both.[9] The mismatched flow results in an increased volume within the vascular bed, which leads to increased capillary intravascular pressure, promotion of fluid transudation from the capillaries into the interstitial space, and impaired leg muscle perfusion.[4,18] These phenomena promote exercise-induced leg swelling and increased muscle fatigue, which would potentially worsen venous symptoms.

The potentially beneficial effects of exercise relate to the calf muscle pump theory and muscle training. During exercise, muscle contraction increases the pressure outside of the veins and propels blood back to the heart (calf muscle pump), thereby reducing the hydrostatic pressure gradient that is partially responsible for edema formation.[17,21] This would tend to reduce venous symptoms and signs. Further, several of the putative mechanisms by which exercise improves symptoms in arterial insufficiency [14,22] (e.g., enhanced biomechanical efficiency, changes in pain perception, or increased angiogenesis [19]) may also lead to improvements of symptoms and signs in venous insufficiency.

We have shown previously that an acute bout of treadmill exercise did not worsen symptoms or signs in patients who had a DVT for 1 yr or longer before being studied.[8] However, the effects of exercise earlier in the course after DVT have not been determined. Therefore, the objective of this study was to examine whether higher levels of physical activity 1 month after DVT lead to worsening of venous symptoms and signs at 4 months after DVT.

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