title: Upper body exercise increases lower extremity venous blood flow in deep venous thrombosis.
abstract: OBJECTIVE
  Sequential compression devices or ambulation prevent deep venous thrombosis (DVT) by enhancing venous blood flow in the lower extremity. However, compression therapy or ambulation may not be possible in patients with lower extremity surgery or trauma. We therefore determined whether upper body exercise increases venous blood flow in the lower extremities as a potential means for preventing DVT.
  
  
  METHODS
  We determined blood volume flow and velocity responses in the common femoral veins to low-intensity (5 W, 75 rpm) upper body cycle ergometry in healthy individuals. Six protocols of single and intermittent bouts of exercise were tested. Upon determination of the most efficacious protocol in these participants, we verified the effects of upper body exercise in patients with acute DVT. Measurements were made before, during, and after exercise using duplex ultrasound imaging.
  
  
  RESULTS
  The study enrolled 15 healthy volunteers (10 men, 5 women; aged 20-40 years) with no history of DVT and 10 patients (aged 31-86 years) with acute DVT. In healthy participants, a single 30-second bout of upper body exercise increased volume flow up to 39% for up to 10 minutes after exercise (P < .05). A single 3-minute bout increased flow to a lesser extent (23% increase; P = .05) for nearly 5 minutes, but a single 1-minute bout did not increase flow. An intermittent protocol of three 30-second bouts of exercise resulted in an increase of 34% to 57% in venous flow (P < .05) for an average increase of 179 ± 53 mL/min. Intermittent 1-minute bouts of exercise tended to increase flow 10% to 40% (P = .06-.08) for an average increase of 149 ± 64 mL/min. Intermittent 3-minute bouts of exercise increased flow 21% to 45% (P < .05) for an average increase of 120 ± 42 mL/min. In patients with acute DVT, the intermittent 30-second upper body exercise protocol increased venous blood flow by 45% to 83% (P < .05) for an average increase of 250 ± 63 mL/min, an effect lasting >13 minutes.
  
  
  CONCLUSIONS
  We report the novel finding that upper body exercise increases lower extremity venous blood flow in healthy volunteers and in acute DVT patients. Three intermittent 30-second bouts of low-intensity upper body exercise elicited the highest response for the least amount of effort and may represent an alternative or adjunct for prophylaxis of DVT in patients with restricted ambulation.
authors.affiliation: Center for Vascular Diagnostics, Division of Vascular Surgery, the University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Kevin
authors.initials: K
authors.lastname: Caldwell
authors.affiliation: Department of Medicine, Division of Gerontology and Geriatric Medicine, the University of Maryland School of Medicine, Baltimore, Md; Veterans Affairs Geriatric Research, Education and Clinical Center, Baltimore, Md.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Prior
authors.affiliation: Center for Vascular Diagnostics, Division of Vascular Surgery, the University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Meghan
authors.initials: M
authors.lastname: Kampmann
authors.affiliation: Center for Vascular Diagnostics, Division of Vascular Surgery, the University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Limin
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Center for Vascular Diagnostics, Division of Vascular Surgery, the University of Maryland School of Medicine, Baltimore, Md.
authors.forename: Sue
authors.initials: S
authors.lastname: McEvoy
authors.affiliation: Department of Medicine, Division of Gerontology and Geriatric Medicine, the University of Maryland School of Medicine, Baltimore, Md; Veterans Affairs Geriatric Research, Education and Clinical Center, Baltimore, Md.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Goldberg
authors.affiliation: Center for Vascular Diagnostics, Division of Vascular Surgery, the University of Maryland School of Medicine, Baltimore, Md; Veterans Affairs Medical Center, Baltimore, Md. Electronic address: blal@smail.umaryland.edu.
authors.forename: Brajesh K
authors.initials: BK
authors.lastname: Lal