Structured exercise training and rehabilitation in patients with acute venous thromboembolism: a systematic review of...

Patients' rehabilitation after acute venous thromboembolism (VTE) may reduce the risk of persistent impairments in patients' functioning and quality of life. This systematic review addresses the safety and efficacy of early initiation of structured exercise training (ET) programmes in the rehabilitation of acute VTE.

We systematically searched MEDLINE, EMBASE, and CENTRAL for randomized controlled trials (RCTs) evaluating structured ET initiated within 3 months after VTE, defined as deep vein thrombosis (DVT) and/or pulmonary embolism (PE). No restrictions were applied to comparator interventions or clinical indications. Two reviewers independently screened and extracted data, and risk of bias was assessed using the Cochrane Risk of Bias 2 tool. In total, 2160 records were identified, of which four RCTs (n = 250) met inclusion criteria. Two studies investigated ET after PE, one after DVT, and one after either condition. Interventions included supervised aerobic or high-intensity interval training, home-based ET programmes, and combined behavioural counselling. Three studies demonstrated improvements in exercise capacity, cardiopulmonary function, or quality of life within ET groups. However, differences between ET and control groups were nonsignificant and limited by small sample sizes and risk of bias. No trial reported safety concerns regarding ET initiated within 3 months after VTE.

Early initiation of structured ET and rehabilitation programmes after VTE appears to be safe. Robust evidence on efficacy of ET and rehabilitation programmes in terms of functional and quality-of-life benefits is limited, and large scale RCTs addressing potential effects of ET to prevent post-thrombotic syndrome and post-PE syndromes are warranted.

Thrombosis of the legs and pulmonary embolism are common conditions associated with long-term consequences for affected patients. These consequences include limitations in daily life, persistent symptoms, and reduced quality of life. Early exercise training and rehabilitation within 3 months of diagnosis might support affected patients in maintaining their physical functioning and preventing such long-term consequences. Therefore, we searched several databases for literature on medical studies evaluating exercise training and rehabilitation in this situation. We only considered medical studies that compared the exercise training and rehabilitation to standard treatment of thrombosis and pulmonary embolism (anticoagulation), with patients being randomly assigned to either treatment strategy. We identified four studies including 250 patients. Overall, patients tolerated the exercise training and rehabilitation very well, without adverse events or worsening of their thrombosis or pulmonary embolism. However, there was no clear benefit of exercise training or rehabilitation. This might be due to the small number of included patients. To summarize, exercise training and rehabilitation appear to be safe in patients with thrombosis of the legs and pulmonary embolism, but it remains to be clarified whether it can prevent long-term consequences.