Comparison of reduction of edema after rest and after muscle exercises in treatment of chronic venous insufficiency

Belczak Cleusa Ema Quilici1, Cavalheri Gildo2, Jose Maria Pereira de Godoy3, Belczak Sergio Quilici4, Caffaro Roberto Augusto1
1Vascular Surgery Service, Santa Casa Medicine School, São Paulo, FCMSCSP-Brazil
2Maringá Vascular Center, Brazil
3Department of Cardiology and Cardiovascular Surgery, São Jose do Rio Preto Medicine School -FAMERP, Brazil
4Vascular Surgery Service, University of São Paulo, USP-Brazil

Tóm tắt

The aim of this work was to compare the reduction in edema obtained in the conservative treatment of phlebopathies after resting and after performing a muscle exercise program in the Trendelenburg position. Twenty-eight limbs of 24 patients with venous edema of distinct etiologies and classified as between C3 and C5 using CEAP classification. Volumetric evaluation by water displacement was carried out before and after resting in the Trendelenburg position and after performing programmed muscle exercises 24 hours later under identical conditions of time, position and temperature. For the statistical analysis the paired t-test was used with an alpha error of 5% being considered acceptable. The average total volume of the lower limbs was 3,967.46 mL. The mean reduction in edema obtained after resting was 92.9 mL, and after exercises it was 135.4 mL, giving a statistically significant difference (p-value = 0.0007). In conclusion, exercises are more efficient to reduce the edema of lower limbs than resting in the Trendelenburg position.

Tài liệu tham khảo

Belczak Neto J, Belczak CEQ: Reabilitação cinesiofisiátrica do flebopata crônico. Tratado de Flebologia e Linfologia (Edited by: Thomaz JB, Belczak CEQ). Rio de Janeiro: Rubio 2006, 469–84. Dormandy JA: Microcirculation and Venous leg Ulcers. Phlebolymphology 1997, 11:3. Pereira de Godoy JM, Braile DM, de Fatima Guerreiro Godoy M: Lymph drainage in patients with joint immobility due to chronic ulcerated lesions. Phlebology 2008,23(1):32–4. Godoy JMP, Godoy MFG: Manual lymph drainage: a new concept. J Vasc Br March 2004,03(1):77–80. Artíbale MES, Godoy JMP, Godoy MFG, Braile DM: A new option for compression in the treatment of lymphedema in children. J Vasc Br 2005,4(3):311–3. Brizzio EO: Le pompe Impulse-Aspirative degli arti inferiori. Libro. Tratatto di Flebologia e Linfologia (Edited by: Mancini S). Torino: Edizioni UTET 2001, 67–87. Brizzio EO: Propellent Suction Pumps of the Lower Limbs. Angiologia. 1988,40(6):197–202. Cavalheri G Jr, de Godoy JM, Belczak CE: Correlation of haemodynamics and ankle mobility with clinical classes of clinical, aetiological, anatomical and pathological classification in venous disease. Phlebology 2008,23(3):120–4. Belczak CEQ, Godoy JMP, Seidel AC, Silva JA, Cavalheri Junior G, Belczak SQ: Influência da atividade diária na volumetria dos membros inferiores medida por perimetria e pela pletismografia de água. J Vas Br 2004,3(4):304–10. Eklof B: CEAP classification and implications for investigations. Acta Chir Belg 2006,106(6):654–8. Partsch H: Classificação da Insuficiência Venosa Crônica- CEAP. Tratado de Flebologia e Linfologia (Edited by: Thomaz JB, Belczak CEQ). Rubio: Rio de Janeiro 2006, 86–89. Nilsson S, Bjerknes Haugen G: Volumetry in the evaluation of swelling and foot. J Oslo City Hosp 1981, 31:11–15. Belczak CEQ, Belczak Neto J: Importância da ativação das bombas impulso-aspirativas no tratamento da hipertensão venosa crônica. Rev Bras Fleb e Linf 2001,6(2):16–19. Perrin M, Guex JJ: Edema and Leg Volume: Methods of Assessment. Angiology 2000,51(1):9–12. Nigg BM, Frederik V, Allinger TL, Ronsky JR, Engsberg JR: Range of motion of the foot as a function of age. Foot & Ankle 1992, 13:336–43. Briele HA, Schneebaum S, Barnicle M, Briele C: Method of measurement for volume of an extremity. Surg Gynecol Obstet. 1989,169(4):349–351. NHI consensus statement: Physical activity and cardiovascular health: a national consensus (Edited by: Leon AS). Champaign IL: II human kinetics 1997, 3–13. Fleming P, Fitzgerald P, Devitt A, Rice J, Murray P: The effect of the position of the limb on venous impulse foot pumps. Journal of Bone and Joint Surgery 2000, 82:433–34. Kahn SR, Azoulay L, Hirsch A: Acute effects of exercise in patients with previous deep venous thrombosis. Chest 2003,123(3):399–405. Mackinnon JL: Study of Doppler ultrasonic peripheral vascular assessments performed by physical therapists. Physical Therapy 1983, 63:30–34. McNally MA, Cooke EA, Mollan RA: The effect of active movement of the foot on venous blood flow after total hip replacement. J Bone Joint Surg Am. 1997,79(8):1198–1201. Stick C, Grau II, Witzleb E: On the edema-preventing effect of the calf muscle pump. Eur J Appl Physiol Occup Physiol 1989, 59:39–47. Ramelet AA, Kern P, Perrin M: Lifestyle, physical therapy and prevention. Varicose veins and telangiectasias (Edited by: Ramelet AA, Kern P, Perrin M). Paris: Elsevier SAS 2004, 139–48. Belczak CEQ, Belczak Neto J: Reabilitação cinesioterápica da bomba muscular da panturrilha na insuficiência venosa crônica. Reabilitação Linfovenosa (Edited by: Godoy JMP, Belczak CEQ, Godoy MFG). DiLivros: Rio de Janeiro 2005, 187–201. Yang GD, Vandongen YK, Stacey MC: Variability and reliability of air plethysmographic measurements for the evaluation of chronic venous diseases. J Vasc Surg 1997,26(4):638–42. Quist M, Rorth M, Zacho M, Andersen C, Moeller T, Midtgaard J, Adamsen L: High-intensity resistance and cardiovascular training improve physical capacity in cancer patients undergoing chemotherapy. Scand J Med Sci Sports 2006,16(5):349–57. Sjogren T, Nissinen KJ, Jarvenpaa SK, Ojanen MT, Vanharanta H, Malkia EA: Effects of a physical exercise intervention on subjective physical well-being, psychosocial functioning and general well-being among office workers: a cluster randomized-controlled cross-over design. Scand J Med Sci Sports 2006,16(6):381–90. Jawień A, Szewczyk M, Kornatowska K, Mościcka P, Cierzniakowska K, Cwajda J, Polak A, Grzeszak I: Functional and biopsychosocial restrictions among patients with a venous ulcer. Arch Med Sci 2006,2(1):36–41. Christensen U, Stovring N, Schultz-Larsen K, Schroll M, Avlund K: Functional ability at age 75: is there an impact of physical inactivity from middle age to early old age? Scand J Med Sci Sports 2006,16(4):245–51. Pereira De Godoy JM, Miquelin D, Braile DM, Menezes Da Silva A: Association of deep venous thrombosis with neoplasms in different age groups. Int Angiol 2009,28(2):144–6.