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Objective:
The incidence of pulmonary embolism (PE) and leg deep vein thrombosis (DVT) has increased in recent years in association with aging and an increase in the number of bedridden individuals. We developed an active in-bed leg exercise apparatus labeled the Leg Exercise Apparatus (LEX) for DVT prevention. We compared the effect of leg exerci...
Citations
... This finding is consistent with the study findings of Zhe Wang et al. proved that active ankle movement is effective in preventing the formation of DVT after lower limb surgery by enhancing the maximum venous outflow and venous capacity and alleviating the swelling [25]. Kenta Tanaka et al. also proposed that the leg exercise protocol may serve as a new DVT prevention tool as it increases vessel diameter and venous blood flow of lower legs [26]. Similarly, Ye Li et al. also found that active ankle movements maximize the maximum venous outflow (MVO) and maximum venous capacity (MVC), which prevents the formation of lower-extremity DVT after orthopedic surgery and helps to quicken postoperative recovery [27]. ...
Introduction: The clinical conditions of bedridden patients are most closely associated with deep vein thrombosis. Prevention with appropriate detection and prophylaxis of deep vein thrombosis is an essential indicator of the quality of care. The aim of the study to evaluate the effectiveness of active ankle exercise in preventing deep vein thrombosis. Methods: An experimental research design was
adopted to conduct the study with 30 bedridden patients who met the inclusion criteria and were assigned on to experimental group (n=15) and control group (n=15) by simple random sampling technique. Active ankle exercise was administered to the experimental group for 7 days with 5 cycles in the morning and 5 cycles in the evening. The control group received routine hospital care services. The study's primary outcome was risk of deep vein thrombosis, measured by modified Well’s Probability Scale impairment scale before the intervention and at the end of the intervention. Results: Within-group analysis, paired t test showed a significant improvement comparing the modified well’s score before (6.93±0.91) and after (4.80±0.56) the intervention in the experimental group (p<0.001). Between-group
analysis, experimental and control group post-test mean score of modified well’s score before (4.80±0.56 & 7.03±0.43) showed significant difference (p<0.001). Conclusion: The study findings concluded that active ankle exercise effectively prevents deep vein thrombosis among bedridden patients. Hence this interventional strategy may include the prevention of DVT protocol in the hospital and may be taught to the caregivers of bedridden patients as part of home care management
... Physical activity also increased anterograde blood flow and decreased oscillatory shear rate in arteries [26]. Increased venous flow was recorded within 30 min of exercise cessation [27]. Resting blood flow was reported to be higher in trained individuals than in untrained individuals [28]. ...
Previous studies have shown conflicting results about the impact of moderate to vigorous physical activity on the risk of venous thromboembolism (VTE). Using Mendelian randomization, we assessed whether moderate to vigorous physical activity causally affects VTE from genetic level. Genetic instruments associated with moderate to vigorous physical activity at the genome-wide significance level (P < 5×10− 8) were selected from the UK Biobank. Summary-level data for VTE were obtained from the FinnGen consortium. Univariable and multivariable Mendelian randomization analyses were conducted. Genetically predicted moderate to vigorous physical activity had no effect on VTE [odds ratio (OR) = 1.08; 95% confidence interval (CI) 0.66–1.78; P = 0.75] under a multiplicative random-effects inverse-variance weighted model. MR-Egger (OR = 0.20; 95% CI 0.01–4.70; P = 0.33), weighted median (OR = 1.08; 95% CI 0.52–2.25; P = 0.84), simple mode (OR = 2.53; 95% CI 0.59–10.92; P = 0.23), weighted mode (OR = 2.21; 95% CI 0.50–9.74; P = 0.31), and multivariable Mendelian randomization (OR = 0.74; 95% CI 0.46–1.19; P = 0.22) also yielded no significant association. The overall estimate was not influenced by individual single nucleotide polymorphism. No evidence of heterogeneity or horizontal pleiotropy was observed. Therefore, moderate to vigorous physical activity had no causal association with VTE in the general population.
... OR=2.286; 95% C.I =1.062-4.919).These results agreed with the study findings done by [15], which reported the exercises were protective factors for VTE in lower extremity fractures. Several studies have found that vigorous ankle exercises increase femoral vein blood flow, resulting in a lower risk of VTE in the rehabilitation group [16]. In the present study there was no significant association between pregnancy and VTE (P-value > 0.05). ...
Venous thromboembolism (VTE), a term referring to blood clots in the veins, is an underdiagnosed and dangerous, yet avoidable, medical illness that can result in disability and mortality. When a blood clot develops in a deep vein, commonly in the lower leg, thigh, or pelvis, it is referred to as a deep vein thrombosis (DVT). To evaluate the risk factors of VTE between cases and controls in the hospital Imam Sadiq Teaching in Babylon City and to predict variables that contribute to the risk factors of VTE among the studied samples. The study was conducted in a hospital, Imam Sadiq Teaching in Babylon, Iraq, and was designed as a case control. There were 165 participants (55 cases and 110 controls). Data was collected during a four-month period. The findings show that there are no significant sociodemographic risk factors for VTE, with the most significant being obstructive sleep apnea syndrome (p. value < 0.05) among patients. The frequency of exercise in patients with VTE and the control group was 20.0%, 36.4% respectively, at a significant level (P. value < 0.05). There was no significant association between risk factors for females and VTE (P. value > 0.05) except for used contraceptive pills and a history of a cesarean operation. There was no significant link between medical history and the outcome of this investigation (hypertension, diabetes, heart disease, and lung diseases) ... except kidney disease was likely at a higher risk of VTE than participants who had no kidney disease. Although there is no significant relationship between sociodemographic and VTE, the study found that there was a very high correlation between the risk of obstructive sleep apnea syndrome, caesarean sections, oral contraceptives, and renal disease with VTE.
... Therefore, we developed a novel leg exercise apparatus (LEX) to facilitate active leg movement during the early postoperative period [18][19][20][21]. A previous study on healthy adults found that exercising with an LEX was more effective than using IPC alone for improving blood flow [18]. ...
... A previous study on healthy adults found that exercising with an LEX was more effective than using IPC alone for improving blood flow [18]. Moreover, other studies conducted by our team have shown that exercising the lower extremities with the LEX was significantly more effective in activating the muscles of the lower limbs and improving blood flow than performing in-bed exercises without an assisting device [19]. ...
... The LEX [18][19][20][21] is a novel device originally developed to perform in-bed lower extremity exercises in patients with impaired mobilization. The device has been designed to enable the performance of exercises in a supine position without diminishing the positive effect of ankle plantar flexion and dorsiflexion on blood flow. ...
Venous thromboembolism (VTE) is a severe complication in orthopedic surgeries. Herein, we developed a novel leg exercise apparatus (LEX) to encourage postoperative limb movement in bedridden patients to prevent VTE. We aimed to evaluate its feasibility and safety in individuals at risk of VTE. Twenty patients (four men, 16 women) who underwent total joint arthroplasty in the lower extremity were enrolled in this prospective study. Exercise using the LEX was performed for 5 min at 30 cycles/min, four times/day during postoperative days 1-7. Clinical assessments included the evaluation of vital signs, venous ultrasonography, and blood tests within seven days postoperatively, and adverse events (pulmonary embolism and cerebral hemorrhage) were monitored. Overall, 16/20 (80%) patients completed the 7-day exercise regimen. There were no cases of severe adverse events, changes in vital signs, or lower-extremity deep vein thrombosis in patients who performed exercises with the LEX. Thus, the results of this pilot study show that this novel apparatus may be a safe and feasible tool for VTE prophylaxis after joint arthroplasty of the lower extremities.
... Although we recommend voluntary lower extremity exercises to prevent VTE, patients with spinal disease rarely perform leg exercises voluntarily. Therefore, we developed a novel leg exercise apparatus (LEX) that helps patients move their lower extremities voluntarily [11][12][13][14]. We found that a brief period of exercise using the LEX increased venous flow in the lower extremities compared with the continuous use of IPCD [12]. ...
... The LEX is a device developed to facilitate active lower extremity exercise and consequently prevent VTE. Patients can perform leg exercises effectively using the LEX as it was designed to perform leg exercises in the supine position ( Figure 1) [11][12][13][14]. The device is made up of right and left pedals and a motion control mechanism, which can be placed on the bed and fixed to the backboard of the bed by hooks. ...
Purpose:
Venous thromboembolism (VTE) is a complication in patients with a spinal disease requiring bedfast for conservative therapies. We previously developed a novel leg exercise apparatus (LEX) to encourage patients to exercise their lower extremities during bed rest. The purpose of this study was to evaluate the feasibility and safety of the LEX for the prevention of VTE in patients on bed rest due to spinal disease.
Methods:
Patients with spinal diseases requiring bed rest were included in the study. Exercise using the LEX was performed for ≥5 minutes. The exercises were performed three or more times per day during the bed rest period. In addition, we evaluated adverse events, such as symptomatic VTE and changes in vital signs, using venous ultrasonography, blood tests, and measurement of vital signs.
Results:
In total, 31 patients were enrolled (11 men, 20 women), with mean age, height, weight, and body mass index of 72.4 years, 155.2 cm, 55.0 kg, and 22.6 kg/m2, respectively. Twenty-four subjects had spinal fractures. Twenty-nine patients continued exercising until they could leave their beds. No symptomatic VTE was observed in any patient, and no other severe adverse events were observed. There were no significant changes in vital signs. The average number of exercise days with LEX and length of hospitalization were 11 and 31 days, respectively.
Conclusions:
This is the first study regarding mechanical thromboprophylaxis through in-bed exercise for patients with bedridden spinal disease. The LEX exercise protocol, in addition to mechanical prophylaxis with graduated compression stockings and intermittent pneumatic compression devices, for the prevention of symptomatic VTE may be feasible and safe for patients with bedridden spinal disease.
... Therefore, we developed a novel leg exercise apparatus (LEX) to facilitate active leg movement during the early postoperative period [18][19][20][21]. In a previous study on healthy adults, we found that LEX exercising is more effective than IPC alone for improving blood ow [18]. ...
... In a previous study on healthy adults, we found that LEX exercising is more effective than IPC alone for improving blood ow [18]. Moreover, other studies of our authorship have shown that LEX exercising of the lower extremities is signi cantly more effective in activating muscles of the lower limbs and improving blood ow than performing in-bed exercises without an assisting device [19]. ...
... The LEX [18][19][20][21] is a novel device originally developed to perform in-bed lower extremity exercises in patients with impaired mobilization. The device has been designed so that exercises can be performed in a supine position without diminishing the positive effect of ankle plantar exion and dorsi exion on blood ow. ...
Background: Venous thromboembolism (VTE) is a severe complication of orthopedic surgeries. Although mechanical measures such as graduated compression stockings and intermittent pneumatic compression are widely used for VTE prevention, complications (e.g. lower limb pain or skin disorders) may result from prolonged usage. Early postoperative ambulation and active ankle movements are recommended but have low patient acceptance due to surgical pain and the lack of motivation. To overcome these limitations, we developed a novel leg exercise apparatus (LEX) to encourage limb movement in bedridden patients in the early postoperative period in order to prevent VTE. Here, we aimed to evaluate the feasibility and safety of the LEX in individuals at high risk of deep vein thrombosis (DVT) postoperatively.
Methods: Twenty subjects (4 men, 16 women) who underwent total joint arthroplasty in the lower extremity were enrolled in this prospective study. Exercise using LEX was performed for 5 minutes at 30 cycles/min, four times per day from postoperative days 1 to 7. Clinical assessments included the evaluation of vital signs before and after exercise with LEX, venous ultrasonography and blood tests within 7 days postoperatively, and evaluation of adverse events, including pulmonary embolism and cerebral hemorrhage.
Results: Overall, 16/20 (80%) patients completed the exercise regimen of 7 days, while 4 dropped out. All four subjects who dropped out had undergone total hip arthroplasty; three of them refused to start exercises with LEX because of leg pain related to surgery. No severe adverse events occurred. There were no severe changes in vital signs. No DVT of the lower extremities was confirmed during postoperative week 1. The average preoperative D-dimer level was 0.85 µg/mL (range, 0.4-2.2), whereas the corresponding value in postoperative week 1 was 7.93 µg/mL (range, 2.0-13.8).
Conclusions: In this study, no DVT cases or severe adverse events occurred postoperatively in patients undergoing total joint arthroplasty of the lower extremities who performed exercises with LEX. A study protocol analyzing the efficacy of this tool to prevent VTE after joint arthroplasty of the lower extremities may be safe and feasible.
... In a retrospective study of consecutive patients undergoing total hip arthroplasty, 126 patients underwent manual calf massage and passive ankle motion, and 138 patients underwent total hip arthroplasty using the same surgical approach without this mechanical prophylaxis, Imai and colleagues found the incidence of deep vein thrombosis was 6.52% and 0.79% in the control and rehabilitation groups, respectively, indicating performing this mechanical prophylaxis reduced the incidence of venous thromboembolism after total hip arthroplasty. 20 Many reports showed an increase in femoral vein blood flow during active ankle exercises 21 , which lead to a reduced rate of DVT in the rehabilitation group. In the current study, although the included patients were different, but the mechanism of rehabilitation exercises for prevention of DVT are identical. ...
Objectives
To determine the clinical characteristics and risk factors of Deep Venous Thrombosis (DVT) in patients with gynecological malignant tumor, facilitating gynecologists better prevent the fatal complication.
Methods
The patients with gynecological malignant tumor treated in department of gynecology of our hospital between May 2013 and May 2018 were reviewed retrospectively. The clinical data of patients including gender, age, tumor staging, adenocarcinoma, surgery, operation time, hypertension, hyperlipemia, diabetes, coronary heart disease, radiotherapy, chemotherapy, hospital stay, and postoperative rehabilitation exercise were collected to analyze the clinical characteristics of patients and determine the risk factors of DVT.
Results
In the current study, 67 patients were included in DVT group, and 554 patients were included in Non-DVT group. There were significant differences in age, hypertension, hyperlipemia, operation time, adenocarcinoma, tumor staging, radiotherapy and postoperative rehabilitation exercises between DVT and non-DVT groups (p<0.05). However, there was no significant differences in gender, coronary heart disease, diabetes, surgical treatment and hospital stay (p>0.05). In multivariate analysis, the factors including age, hypertension, adenocarcinoma, radiotherapy, and hyperlipemia were independent risk factors, while rehabilitation exercise was protective factor for DVT.
Conclusion
In cases of gynecological malignant tumor, DVT screening should be given due importance, especially for those patients with old age, hypertension, hyperlipemia, adenocarcinoma, or history of radiotherapy. Rehabilitation exercise should be encouraged in these patients.
... 8,9 Exercise strategies exist, with lower extremity exercises appearing more effective at increasing lower extremity venous flow for up to 30 minutes after exercise completion. [16][17][18][19][20] The increased blood flow volume and velocity will potentially decrease the chance of clot formation, especially in the venous valve pockets. 21 However, the lack of a standardized method of lower extremity exercise, duration, and frequency and the inability to coach the exercises have limited the efficacy and application of exercise therapy to research purposes only. ...
... The amount of immediate increase in blood flow parameters was comparable to that in previously reported studies examining the effect of calf muscle exercise on venous return. [17][18][19][20] The immediate increase is due to activation of the calf muscle pump as has been described previously. [1][2][3][4][5][6][7] The improvement in venous flow parameters lasted for approximately 10 minutes. ...
Objective:
Current prophylactic protocols fail to prevent deep venous thrombosis (DVT) in a significant minority of patients, and it remains one of the leading causes of preventable death. We therefore quantified the efficacy of novel game-based exercises (exergaming) to augment femoral venous parameters relative to ankle movement and muscle flexion.
Methods:
Healthy volunteers were recruited to perform a series of ankle and foot exercises using a wireless foot sensor (LEGSys; BioSensics LLC, Watertown, Mass) to navigate a computer cursor sequentially on a screen to the center of 200 circular targets. A single ultrasound technician (W.A.M.) measured each patient's mean flow volume, peak flow velocity, mean flow velocity, and cross-sectional area of the right femoral vein at baseline and obtained immediate postexercise (PEX), 5-minute PEX, and 15-minute PEX measurements. Electromyography (EMG) was performed at baseline and during the exercise. Baseline demographics and medical and surgical comorbidities were also recorded. The primary end point was the difference between baseline and immediate PEX mean flow volume estimates. We secondarily explored the association of baseline characteristics and EMG measurements with femoral vein parameters.
Results:
Fifteen healthy subjects (53% male; 28.1 ± 4.6 years) completed the exergaming task within a mean of 4 minutes, 2 ± 21 seconds. Immediately after exercise, the femoral vein mean flow volume, mean velocity, and peak systolic velocity increased by 49%, 53%, and 48%, respectively (P < .02 for each). Mean flow volume and velocity remained significantly elevated 5 minutes after exercise (P < .04 for each). Plantar flexion and dorsiflexion velocities and EMG frequency and intensity were not significantly correlated with PEX mean flow volume estimates (P > .05). Subgroup analysis revealed that women (P < .01) and Hispanics (P < .01) exhibited significantly slower PEX responses. Subjects with the largest improvements in mean flow volume had lower peak plantar flexion velocities (P < .01).
Conclusions:
Exergaming increases mean flow volume, mean flow velocity, and peak systolic velocity within the femoral vein by approximately 50% above baseline. Exergaming represents a novel and potentially attractive method of DVT prevention by augmenting femoral vein mean volume flow and capitalizing on biofeedback. Less forceful but more uniform contractions were found to be most effective at augmenting venous blood flow. Exergaming will require further validation in larger study bases, among patients at higher risk of DVT.
... The LEX is designed to be used in the supine position, specifically for postoperative and bedridden patients. [18][19][20][21] We previously reported that a short period of active ankle exercise with the LEX improved femoral venous flow volume compared to continuous intermittent pneumatic compression. 18 The LEX makes combined leg motion possible, which involves ankle dorsiflexion/plantar flexion, ankle inversion/eversion, and knee and hip flexion/ extension. ...
... Another study compared femoral venous flow in healthy participants for a period of 30 min after 1 min of exercise, at a rate of 30 cycles/min, with and without LEX. 20 After 1 min of exercise with LEX, the venous flow volume and vessel diameter at 30 min was higher than that observed at 30 min, after 1 min of exercise without LEX, in the same leg. ...
Purpose:
Venous thromboembolism prophylaxis is crucial. To facilitate active ankle movement in postoperative and bedridden patients, we developed a novel leg exercise apparatus (LEX). We investigated the effect of the LEX by comparing increases in lower extremity venous flow during different modes of exercise using the LEX.
Methods:
In eight healthy participants, we measured venous flow volume and velocity in the femoral vein using duplex ultrasonography at 1, 10, 20, and 30 min after completing three modes of 1-min LEX exercises. The exercises involved (1) rapid single motion (ankle dorsi-plantar flexion; 60 cycles/min); (2) slow single motion (30 cycles/min); and (3) slow combined leg motion.
Results:
Flow volumes after modes 1, 2, and 3 were 1.63-, 1.39-, and 1.53-fold above baseline at 30 min, respectively. Short periods of rapid single motion, with the LEX, improved postexercise lower extremity venous flow volumes at 30 min and mean venous flow velocity at 20 min, compared to slow single motion exercise. Even at slow speeds, combined-motion improved flow volume compared to single motion.
Conclusion:
Short periods of rapid single motion exercise, with the LEX, improved postexercise venous flow volumes in the lower extremities at 30 min and mean venous flow velocity at 20 min. These effects were greater than those produced by slow single motion exercises. However, even at slow speeds, combined-motion exercises improved flow volume compared to single motion. Therefore, LEX may prove effective at preventing thromboembolism in postoperative and bedridden patients.
The device presented here—ABLEFIT—provides customized physical exercises, in active and passive modes, for patients permanently or temporarily bedridden or in a wheelchair. The device incorporates an intelligent platform for control, evaluation and record of the patient's performance during the rehabilitation process, making possible the permanent assessment of the patient's performance and thus contributing for an integrated knowledge of their condition by health professionals. Furthermore, the generation of simulation environments and the creation of interactive models to stimulate and motivate the user is also possible. A feasible contribution is thus expected to counteract the immobility syndrome and the morbidity and mortality associated with the complications resulting from prolonged inactivity or even sedentary lifestyle that can be seen both in elderly population and in adults and young people with some type of restriction of mobility or disability. Additionally, it is expected that the advanced system of physical rehabilitation presented here opens a unique opportunity for technological evolution in: (i) hospitals and clinics; (ii) homes for the elderly and continuing care centers; (iii) physical rehabilitation centers and (iv) home care.
