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

Results

Of the 1004 potential patients approached from April 2001 to July 2002, 645 were excluded for the following reasons: refusal or inability to provide informed consent (308 patients), incapable of responding to a questionnaire in English or French (138 patients), estimated life expectancy less than 3 months (116 patients), geographic inaccessibility for follow-up (80 patients), and other (3 patients). Of the remaining 359, there were 301 patients with data on the variables of interest recorded at all three time points. Compared with enrolled patients, those excluded were older (mean age 65 vs 56 yr, P < 0.001), more likely to be female (60 vs 50%, P = 0.003), and to have proximal DVT (70 vs 55%, P < 0.001).

The baseline measures of our patients are shown in Table 1 . The population is mostly middle aged. Twenty-five percent of our population was inactive (Godin score = 0), and another 25% only mildly to moderately active (Godin score < 20). Approximately half of the patients had a proximal DVT, and almost all patients were symptomatic.

Figure 1 illustrates the results from the univariate comparison. When the clinically unchanged category was defined as PTS = 0, the proportion of individuals whose PTS score worsened from 1 month to 4 months was very similar between each of the 1-month habitual physical activity categories ( P = 0.42). When the clinically unchanged category was defined as PTS between -1 and 1 inclusive, there was still no statistical difference between habitual physical activity categories (data not shown, P = 0.11).

A stacked bar diagram illustrating the change in the PTS score between 1 and 4 months post-DVT for patients according to their 1-month physical activity (Godin score: none, = 0; mildly to moderately active, 1—20, highly active, > 20). The black bar represents patients who worsened between 1 and 4 months ( PTS > 0), the striped bar represents patients who remained unchanged between 1 and 4 months ( PTS = 0), and the open bar represents patients who improved between 1 and 4 months ( PTS < 0). The univariate chi-square P value = 0.42.

Table 2 shows the association between increasing levels of habitual physical activity at 1 month and the dichotomized PTS score after adjusting for potential confounders, sex, disease severity at 1 month (VEINES-QOL), pre-DVT physical activity (baseline Godin score), and age. Physical activity did not worsen symptoms and signs. Furthermore, although the results did not achieve statistical significance, there was an apparent clinically relevant dose-dependent beneficial effect of increasing habitual physical activity at 1 month on change in symptoms and signs from 1 month to 4 months.

Our results are robust. The results were similar when disease severity was modeled using disease-specific QOL (VEINES-QOL) at baseline or at 1 month. In addition, the results were similar if we replaced the outcome PTS (a measure of change in symptoms and signs) with VEINES-QOL (a measure of change in venous disease-related health status), although the dose-dependent effect was no longer present (OR ˜ 0.63 (0.30, 1.3) for both mildly to moderately active and highly active groups).

We also examined change in physical activity levels among those patients who were active before their DVT (Godin scores > 0 pre-DVT ( N = 220)). At 4 months post-DVT, 55.5% of patients had returned to their previous or higher level of activity (42.3% ( N = 93) had the same physical activity level and 13.2% ( N = 29) had increased their physical activity level), and 44.5% ( N = 98) had decreased their physical activity level. Of the 98 patients who stated that their level of physical activity had decreased, 43.9% were for reasons unrelated to the DVT (e.g., rheumatoid arthritis, seasonal activities, or no reason given).

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