Exercise's Role in the Prevention of DVT & PE

Bill Kelley, EP

If you have never heard of a DVT or PE, that's good news because it means that you have probably not encountered these potentially deadly medical conditions.  However, as a bariatric patient – especially in the early postoperative period - you are at a much greater risk for this disorder.

DVT or deep vein thrombosis is a medical condition that occurs when a blood clot forms in one of the large deep veins in the body, usually in the lower extremities. This condition may lead to the development of a pulmonary embolism or PE.  A pulmonary embolism can occur when a fragment of a blood clot breaks loose from the wall of the vein and migrates to the lungs.  In the United States up to 200,000 people per year die from pulmonary embolism –more than die from AIDS, breast cancer and highway fatalities combined.

Despite these startling statistics, most Americans are unaware of this condition and the risk factors that can lead to a DVT and the risk for a PE.  Obesity is a major risk factor for both cardiovascular disease and the formation of blood clots.  Excessive body fat slows circulation and often limits activity levels.  Low levels of activity and prolonged periods of immobilization can lead to blood pooling in the extremities and the formation of blood clots.  Surgery and even sitting for long periods of time can slow down blood flow substantially and lead to clot development.  Other risk factors include a history of blood clots, cancer, congestive heart failure, stroke, respiratory failure, varicose veins, inflammatory bowel disease, pregnancy and post-menopausal hormone replacement.

Prevention is the best defense against the formation of DVT's and deadly PE's.  Identifying high-risk individuals and then utilizing effective preventive measures is the best strategy to minimize DVT risk.  Traditional non-pharmacological treatments include early mobilization and the use of pneumatic compression boots and stockings to help facilitate circulation.  Anti-coagulant drugs are also generally prescribed prior to surgery and for a period thereafter to help thin blood and reduce the chance for stasis or blood pooling.

Exercises, such as walking and repetitive lower body movements, enhance blood velocity and greatly reduce the chance for clot formation.   Even one hour of inactivity greatly slows blood flow to the deep veins in the lower body and increases the risk for a DVT and PE.  Airline travelers are frequently given simple leg exercises that can be performed while sitting in a limited space and are advised to perform such exercises every 15 to 30 minutes to help facilitate lower limb circulation during trips.  Post surgery and other bedridden patients need to be walking as soon as they are able to get out of bed.  The more time a person spends in bed or immobile, the greater the chances of developing a DVT and PE.

Bariatric patients need to be particularly aware of their risk factors.  According to data from the International Bariatric Surgery Registry (IBSR), pulmonary embolism is the number one cause of death post-surgery.  According the IBSR findings, 32% of deaths that occur within the first 30 days after surgery are due to the occurrence of a PE.

This is a completely unacceptable situation; DVT and PE are medical conditions that are largely preventable.  All bariatric patients need to be educated about the necessity for early ambulation, frequent walking and given a lower limb extremity exercise program. These 'anti-clot' leg exercises should be given to the patient prior to surgery to ensure that the patient is familiar with the movements and can begin them with greater ease following surgery.

Outlined below is a very simple but extremely effective post-surgery exercise protocol:

Post Surgery DVT Prevention Protocol
Get up and moving within the first 4 hours post-surgery
Walk at least 5 minutes each waking hour

Lower body movements or exercises
Ankle Circles – slowly rotate foot and ankle clockwise & then counterclockwise repeat 25-30 times. Do 2 sets per session.
Alphabet Tracing – outline with your foot and toes each letter of the alphabet on the floor and repeat with the other leg.
Bilateral Heel Raise – simply rise up on the balls of your feet and repeat 15 – 20 times.  Do 3 sets per session.
Do all the above exercises 3 times per day or 3 sessions per day

Upon release from the hospital, patients should add a 30 minute daily walk in addition to the above protocol.  In cases where orthopedic conditions limit walking and mobility, frequent movement (5 minutes every hour) and performing the lower body movements are even more critical to do every day.

On a last note, risk of DVT and PE increase significantly during prolonged periods of inactivity.  Frequent movement and performing anti-clot exercises where movement is limited is your best defense against blood clot formation.  Also a regular exercise regime will greatly enhance your cardiovascular fitness resulting in enhanced blood velocity and an overall more efficient circulatory system.

Bill Kelley is an exercise physiologist and founder of the Exercise Right Program at Florida Hospital Celebration Health.  He can be reached through email at William.kelley@flhosp.org