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Mobility and exercise after deep-vein thrombosis
Explains what is known about becoming active and exercising after being diagnosed with deep-vein thrombosis (DVT).


Introduction
Is early mobility safe?
Is early mobilization appropriate for me?
What level of activity is OK?
Summary

Introduction
Immobility and lack of exercise are well known risk factors for developing deep-vein thrombosis (DVT) – the blood flow in your veins will be slower if you are not active, increasing the chance of a clot forming. But what if you have just been diagnosed with DVT and have begun treatment? Is it OK then to move around and even exercise to some degree, or should any activity be avoided completely for the time being?

In the past, patients diagnosed with DVT were often strictly advised to rest in bed, usually in hospital, for periods of up to 7–10 days. This was because it was assumed that any movement might cause the blood clot (usually in the leg) to dislodge and travel to the lungs, causing a potentially life-threatening blockage – a pulmonary embolism (PE). Now, however, there is evidence that the chances of this happening are no higher in appropriately treated patients who are mobile (taking a daily walk, for example), than in those resting in bed. What's more, early mobilization may also help reduce symptoms in the affected leg, and speed up recovery.
 
 
Is early mobility safe?
In several studies looking at early mobility after DVT, selected patients began supervised walking exercise either immediately after being diagnosed and starting anticoagulants and compression therapy (bandages or stockings), or on the second day after beginning treatment. These patients were no more likely to develop PE in the subsequent days and months than patients who were initially told to stay immobilized in bed.

Pain and swelling have also been found to clear up more quickly in patients encouraged to be mobile. For more on pain and swelling, see the in-depth article, Reducing pain and swelling. General well-being and DVT-related quality of life also improved. The use of knee-high elastic compression stockings (pressure 30–40 mm) on the affected leg may also relieve discomfort and prevent post-thrombotic syndrome (the long term effects of DVT). Stockings are worn except when bathing or sleeping.

It is thought that mobility can help prevent persistent calf symptoms after DVT, and reduce the risk of further DVT, by improving circulation in the affected limb.

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Is early mobilization appropriate for me?
It should be emphasized here that many factors will determine whether early mobilization is appropriate. If, for example, you already have signs of PE, or you cannot take anticoagulants for some reason, then early mobilization is unlikely to be advised. Before attempting any kind of activity after DVT, you should discuss with your treating physician whether or not early activity is appropriate for you – and if it is appropriate, how much activity is to be recommended, and how soon you can begin.


The following issues are likely to be among those considered:
  •   Are you receiving adequate anticoagulant therapy for DVT?
  •   If a PE does occur, what effect would this have on you?
  •   Will continued bed rest put you at increased risk of progressive DVT or other complications of bed rest?
  •   Is there any evidence that you have PE?

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    What level of activity is OK?
    In the studies discussed above, the mobile patients (all receiving treatment and compression therapy) were doing nothing more strenuous than walking normally. Some were encouraged to remain mobile for at least 4 hours a day, under supervision, while others were advised to move around as much as possible, walking between about 600 and 12,000 metres (between about 650 yards and 7.5 miles) per day.

    At present it is not possible to advise on the safety of more vigorous or aggressive exercise after DVT, as there are no clinical data available on this. The clinical judgement of the treating physician is even more critical than usual in this instance.

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    Summary:
  •   There is evidence that early walking exercise can be started in patients with uncomplicated DVT within the
            first 24 hours after appropriate anticoagulant treatment and use of compression garments.
  •   Average daily walking distances of 600–12,000 metres have been associated with improvements in pain and
           swelling, and no increased risk of PE, compared with bed rest.
  •   There is currently a lack of data on the safety of vigorous or aggressive exercise after DVT.
  •   Do not attempt exercise of any kind without first seeking the advice of your treating physician. Their clinical
           judgement is vital in determining whether early mobilization is appropriate for you.

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    References
    Partsch H and Blättler W. Compression and walking versus bed rest in the treatment of proximal deep venous thrombosis with low molecular weight heparin. Journal of Vascular Surgery 2000;volume 32:pages 861–9.

    Aschwanden M et al. Acute deep vein thrombosis: early mobilization does not increase the frequency of pulmonary embolism. Journal of Thrombosis and Haemostasis 2001;volume 85:pages 42–6.

    Partsch H. Therapy of deep vein thrombosis with low molecular weight heparin, leg compression and immediate ambulation. Vasa - Journal of Vascular Diseases 2001;volume 30:pages 195–204.

    Schellong SM, et al. Bed rest in deep vein thrombosis and the incidence of scintigraphic pulmonary embolism. Journal of Thrombosis and Haemostasis 1999;volume 82 Suppl 1:pages 127–9.

    Blättler W and Partsch H. Leg compression and ambulation is better than bed rest for the treatment of acute deep vein thrombosis. International Angiology 2003;volume 22:pages 393–400.

    Aldrich D and Hunt DP. When can the patient with deep venous thrombosis begin to ambulate? Physical Therapy 2004;volume 84:pages 268–73.

    Prandoni P, Lensing A, Prins MH et al. Below-knee elastic compression stockings to prevent the post-thrombotic syndrome. Ann Intern Med 2004;volume 141:pages 249–56.
     

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