The safety and efficacy of early-initiation exercise training after acute venous thromboembolism: a randomized clinical trial.
BACKGROUND
Exercise training after myocardial infarction is the standard of care within a cardiac rehabilitation setting. However, there is scant evidence regarding the safety and efficacy of early exercise training following a venous thromboembolism (VTE).


METHODS
Eligible consenting participants were randomly allocated, on an individual basis, to either a 3-month exercise and behavioral weight loss intervention group or a control group. The primary clinical outcomes were change in health behavior (body weight and physical activity) and objectively measured fitness (Vo2peak ).


RESULTS
From 2013 to 2014, 239 patients presented to a community-based specialty clinic after an acute VTE; 43 (18%) of these met the eligibility criteria for inclusion in the study. Of these, 19 (44%) consented to participate (nine in the intervention group; 10 in the control group). There were no adverse events in either group over a 3-month period. The mean difference in body weight between the intervention and control groups was - 4.6 kg (95% confidence interval [CI] - 11.4 to 2.2) in favor of the intervention. The mean difference in duration of physical activity from baseline to 3 months between the intervention and control groups was 133 min (95% CI 7-248) in favor of the intervention. There was a significant change in fitness over a 3-month period for the intervention group (baseline Vo2peak , 26.1 ± 5.4 mL O2 kg(-1)  min(-1) ; postintervention Vo2peak , 29.8 ± 5.4 mL O2 kg(-1)  min(-1) ).


CONCLUSIONS
Early initiation of exercise training resulted in improvements in physical activity and fitness, and did not result in adverse events while individuals were receiving therapeutic anticoagulation. These are the first data on initiation of an exercise training and behavioral weight loss program in the early post-VTE setting.
Department of Medicine, University of Vermont, Burlington, VT, USA.|Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA.|Division of Cardiology, Cardiac Rehabilitation and Prevention, University of Vermont Medical Center, Burlington, VT, USA.
S G
SG
Lakoski
Division of Cardiology, Cardiac Rehabilitation and Prevention, University of Vermont Medical Center, Burlington, VT, USA.
P D
PD
Savage
Department of Medicine, University of Vermont, Burlington, VT, USA.
A M
AM
Berkman
Department of Medicine, University of Vermont, Burlington, VT, USA.
L
L
Penalosa
Department of Mathematics and Statistics, University of Vermont, Burlington, VT, USA.
A
A
Crocker
Department of Medicine, University of Vermont, Burlington, VT, USA.|Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA.|Division of Cardiology, Cardiac Rehabilitation and Prevention, University of Vermont Medical Center, Burlington, VT, USA.
P A
PA
Ades
Department of Medicine, McGill University, Montreal, QC, Canada.
S R
SR
Kahn
Department of Medicine and Pathology, Cardiovascular Research Institute, University of Vermont, Burlington, VT, USA.
M
M
Cushman
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D031204:Caloric Restriction; D003131:Combined Modality Therapy; D005080:Exercise Test; D005081:Exercise Therapy / Q000009:adverse effects / Q000379:methods*; D017079:Exercise Tolerance; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D010809:Physical Fitness; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D014707:Vermont; D015431:Weight Loss
D000925:Anticoagulants
clinical trial; exercise; pulmonary embolism; venous thromboembolism; venous thrombosis