New research presented at VAM 2026 showed how structured aerobic exercise combined with standard anticoagulation in patients with acute lower extremity deep vein thrombosis (DVT) may help significantly reduce the risk of developing post-thrombotic syndrome (PTS). The study was funded by the Veterans Affairs Research and Development Department.
“We all understand and appreciate the most important short-term consequence of acute lower extremity DVT, which is pulmonary embolism,” said Brajesh Lal, MD, senior author on the study. “We’ve learned a lot about how to treat DVT in order to prevent pulmonary embolism. Increasingly, we’ve become aware that the long-term consequences of DVT in the form of PTS are very important and can lead to a lot of morbidity.”
Research estimates that PTS impacts 25% to 50% of patients within two years of DVT and can cause chronic pain, leg ulcers and severe disability. Several studies have evaluated endovascular interventions aimed at preventing PTS, but Lal noted they are primarily indicated in a small number of patients with severe DVT. “The vast majority of DVTs that occur are not in that category,” he said. “We don’t really have anything other than anticoagulation to prevent those long-term complications and we know that does not help much.”
For the study, 102 patients with acute lower extremity DVT within the past 30 days randomly received standard anticoagulation or anticoagulation combined with aerobic exercise. The exercise consisted of 30 minutes on a treadmill each day for three months. Patients were encouraged to exercise at roughly 50% of their maximum tolerated effort.
Using the Villalta scale to measure PTS severity, the study found significantly lower average scores in the exercise group. Importantly, no patients in the exercise arm developed moderate or severe PTS, compared to roughly 15% of patients treated with anticoagulation alone.
Lal said the findings challenge long-standing concerns about ambulation after DVT. “We’ve come a long way in our understanding of DVT,” he said. “Twenty years ago, if somebody developed a DVT, the traditional approach was that they were put on bed rest for anywhere from three days to a couple of weeks. Even after we realized that bed rest is not absolutely necessary, there was still a great deal of reticence in ambulating these patients to any major degree.”
According to Lal, vascular surgeons have generally become more comfortable encouraging early ambulation after DVT over the last decade, though that hesitation still persists in other specialties. “People worry about a risk of dislodging clots and causing pulmonary emboli if you ambulate patients too much,” he said. “This study confirms that we need to ambulate our patients after DVT. The more consistent and sustained the ambulation, the better the long-term outcomes are going to be.”
Lal suggested that the intervention could be incorporated relatively easily into routine care because of its simplicity and low cost. While reimbursement for exercise programs remains limited for this particular indication, he said the study provides a practical framework clinicians can implement even now.
“My hope is that these results provide reassurance to all physicians, but in particular non-vascular surgeons, that ambulating patients with DVT is not harmful and in fact is therapeutically beneficial,” he said. “We need to engage in spreading the word so that we can begin to incorporate structured exercise as a standard adjunct to anticoagulation or an endovenous intervention that we may offer these patients.”
