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Am Fam Physician. 2003;68(6):1183-1184

Deep venous thrombosis (DVT) occurs in approximately one in 1,000 persons per year. Approximately 20 to 50 percent of persons with DVT develop post-thrombotic syndrome. This chronic condition involves leg edema, pain, venous ectasia, skin induration, and ulceration. Post-thrombotic syndrome is thought to worsen with physical activity and when the patient is in an upright position. Little is known about the impact of exercise on the development of post-thrombotic syndrome or its signs and symptoms in patients with DVT. Kahn and associates studied whether previous DVT and post-thrombotic syndrome limit the ability to exercise and whether exercise increases the severity of venous symptoms.

The study population included patients who were being seen in a hospital-based thrombosis clinic with an established diagnosis of unilateral DVT at least one year earlier. Patients were excluded from the study if they had some medical reason for being unable to exercise on a treadmill. Using a published scale that measured five symptoms and six signs with a score from zero (not present or minimal) to 3 (severe), the participants were assessed for post-thrombotic syndrome. Of the 41 patients in the study, 19 had post-thrombotic syndrome.

Physical activity, leg muscle fatigability, calf muscle flexibility, and leg volume also were measured at the start of the study. Study participants then exercised on a treadmill for up to 30 minutes, after which they were reassessed for calf muscle flexibility and leg volume, and completed the same symptoms and signs scale.

At baseline, patients had significantly more symptoms of heaviness, aching, swelling, and throbbing in their affected leg versus the unaffected leg. Exercise did not worsen venous symptoms compared with baseline symptoms, despite the fact that there was a higher gain in leg volume in the affected leg versus the unaffected leg. Post-exercise assessment also demonstrated that patients with post-thrombotic syndrome significantly improved their calf muscle flexibility.

The authors conclude that exercise does not increase symptoms in patients with post-thrombotic syndrome and improves flexibility in the affected leg. Treadmill or similar exercise is not likely to worsen symptoms related to post-thrombotic syndrome. Physicians can recommend exercise for patients with DVT and post-thrombotic syndrome.

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