Research progress on the hemodynamic mechanism and application of ankle pump exercise in preventing deep vein thrombosis_West China Medical Journal

Authors：

GU Siqi ¹ , KONG Dan ¹ , LI Jiahui ¹ , SONG Mi ² , LI Xiaofang ² ,  GAO Yuan ³

1. Department of Orthopaedic, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, P. R. China;
2. Medical School of Chinese PLA, Beijing 100853, P. R. China;
3. Department of Nursing, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, P. R. China;

Corresponding author：

GAO Yuan, Email: gaoyuanzd@163.com

Keywords：

Ankle pump exercise; deep venous thrombosis; hemodynamics; hemorheology; frequency; position

DOI：

10.7507/1002-0179.202302022

Video：

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Ankle pump exercise (APE) is one of the basic measures to prevent the formation of deep vein thrombosis, which has been widely recognized for its advantages of simplicity, safety, and ease of perform. However, there is still controversy regarding the frequency, duration, angle, position, and adjunctive exercise of APE. This article will review the hemodynamic and hemorheological effects of APE for the prevention of DVT, the current status of clinical application, and new advances in adjunctive APE, in order to provide methods and guidance for clinical staff.

Citation： GU Siqi, KONG Dan, LI Jiahui, SONG Mi, LI Xiaofang, GAO Yuan. Research progress on the hemodynamic mechanism and application of ankle pump exercise in preventing deep vein thrombosis. West China Medical Journal, 2023, 38(7): 1096-1099. doi: 10.7507/1002-0179.202302022 Copy

1.	Manfredi VM, Machado MB, Barbato NG, et al. Effectiveness of deep venous thrombosis prevention in total hip arthroplasty. Acta Ortop Bras, 2021, 29(6): 293-296.
2.	Chopard R, Albertsen IE, Piazza G. Diagnosis and treatment of lower extremity venous thromboembolism: a review. JAMA, 2020, 324(17): 1765-1776.
3.	Tamowicz B, Mikstacki A, Urbanek T, et al. Mechanical methods of venous thromboembolism prevention: from guidelines to clinical practice. Pol Arch Intern Med, 2019, 129(5): 335-341.
4.	Sochart DH, Hardinge K. The relationship of foot and ankle movements to venous return in the lower limb. J Bone Joint Surg Br, 1999, 81(4): 700-704.
5.	Li Y, Guan XH, Wang R, et al. Active ankle movements prevent formation of lower-extremity deep venous thrombosis after orthopedic surgery. Med Sci Monit, 2016, 22: 3169-3176.
6.	Staubesand J, Heisterkamp T, Stege H. Use of duplex sonography to investigate the effect of active and passive movement at the ankle joint for promoting venous return. Clin Anat, 1995, 8(2): 96-101.
7.	Meissner MH, Moneta G, Burnand K, et al. The hemodynamics and diagnosis of venous disease. J Vasc Surg, 2007, 46(Suppl S): 4S-24S.
8.	Westrich GH, Specht LM, Sharrock NE, et al. Venous haemodynamics after total knee arthroplasty: evaluation of active dorsal to plantar flexion and several mechanical compression devices. J Bone Joint Surg Br, 1998, 80(6): 1057-1066.
9.	Suehiro K, Morikage N, Harada T, et al. Effects of leg compression and calf muscle contraction by active ankle motion on venous hemodynamics in sitting individuals. Phlebology, 2022, 37(5): 361-366.
10.	Kropp AT, Meiss AL, Guthoff AE, et al. The efficacy of forceful ankle and toe exercises to increase venous return: a comprehensive Doppler ultrasound study. Phlebology, 2018, 33(5): 330-337.
11.	Hu X, Li Y, Li J, et al. Effects of altered blood flow induced by the muscle pump on thrombosis in a microfluidic venous valve model. Lab Chip, 2020, 20(14): 2473-2481.
12.	Walker MA, Hoier B, Walker PJ, et al. Vasoactive enzymes and blood flow responses to passive and active exercise in peripheral arterial disease. Atherosclerosis, 2016, 246: 98-105.
13.	Iba T, Shin T, Sonoda T, et al. Stimulation of endothelial secretion of tissue-type plasminogen activator by repetitive stretch. J Surg Res, 1991, 50(5): 457-460.
14.	Wang X, Tang R, Zhang H, et al. What frequency of ankle pump exercise is optimal to improve lower limb hemodynamics? A systematic review and network meta-analysis. Asian Nurs Res (Korean Soc Nurs Sci), 2023, 17(2): 53-60.
15.	Shimizu Y, Kamada H, Sakane M, et al. A novel exercise device for venous thromboembolism prophylaxis improves venous flow in bed versus ankle movement exercises in healthy volunteers. J Orthop Surg (Hong Kong), 2017, 25(3): 2309499017739477.
16.	Li H, Zhang W, Lu Q, et al. Which frequency of ankle pump exercise should be chosen for the prophylaxis of deep vein thrombosis?. Inquiry, 2022, 59: 469580221105989.
17.	Li T, Yang S, Hu F, et al. Effects of ankle pump exercise frequency on venous hemodynamics of the lower limb. Clin Hemorheol Microcirc, 2020, 76(1): 111-120.
18.	Nakayama T, Tsukada S, Hiyama T, et al. Impact of active ankle movement frequency on velocity of lower limb venous flow following total hip arthroplasty. Adv Orthop, 2016, 2016: 7683272.
19.	张雅芝, 王颖, 褚彦香, 等. 踝泵运动预防成人围手术期下肢深静脉血栓最佳证据总结. 中华现代护理杂志, 2022, 28(1): 15-21.
20.	Toya K, Sasano K, Takasoh T, et al. Ankle positions and exercise intervals effect on the blood flow velocity in the common femoral vein during ankle pumping exercises. J Phys Ther Sci, 2016, 28(2): 685-688.
21.	Guo M, Lu L, Sun Y, et al. Comprehensive functional exercises with patient education for the prevention of venous thrombosis after major gynecologic surgery: a randomized controlled study. Thromb Res, 2019, 178: 69-74.
22.	刘建丽, 张瑞英, 陈玉屏. 骨科病房指导患者不同踝泵运动频率强度的护理实践研究. 中国医药科学, 2018, 8(21): 78-81.
23.	谌艳, 吴俞萱, 江伟, 等. 踝泵运动对下肢静脉血流动力学影响的研究. 创伤外科杂志, 2020, 22(1): 52-56.
24.	路孝美, 王吉昌, 孙静岚, 等. 踝泵运动预防深静脉血栓的研究进展. 中华现代护理杂志, 2021, 27(4): 447-450.
25.	毕如云. 体位干预结合踝关节运动预防下肢静脉曲张术后患者深静脉血栓的价值研究. 河北医药, 2022, 44(4): 546-549.
26.	Kiss G, Faludi B, Szilágyi B, et al. Effect of active and passive mechanical thromboprophylaxis and consensual effect on the venous blood flow velocity among hemiparetic patients. Clin Appl Thromb Hemost, 2019, 25: 1076029619832111.
27.	Li T, Yang S, Dou C, et al. Effects of different exercise methods of calf muscles on the hemodynamics of lower extremity vein. Phlebology, 2022, 37(6): 432-438.
28.	Shimizu Y, Kamada H, Sakane M, et al. A novel apparatus for active leg exercise improves venous flow in the lower extremity. J Sports Med Phys Fitness, 2016, 56(12): 1592-1597.
29.	Yonezawa T, Nomura K, Onodera T, et al. Evaluation of venous return in lower limb by passive ankle exercise performed by PHARAD. Annu Int Conf IEEE Eng Med Biol Soc, 2015, 2015: 3582-3585.
30.	Low FZ, Lim JH, Yeow CH. Design, characterisation and evaluation of a soft robotic sock device on healthy subjects for assisted ankle rehabilitation. J Med Eng Technol, 2018, 42(1): 26-34.
31.	Sakai K, Takahira N, Tsuda K, et al. A novel device for lower leg intermittent pneumatic compression synchronized with active ankle exercise for prevention of deep vein thrombosis. Phlebology, 2022, 37(7): 507-515.
32.	Sakai K, Takahira N, Tsuda K, et al. Effects of intermittent pneumatic compression on femoral vein peak venous velocity during active ankle exercise. J Orthop Surg (Hong Kong), 2021, 29(1): 2309499021998105.
33.	Tateiwa T, Ishida T, Masaoka T, et al. Does intraoperative mechanical prophylaxis prevent venous thromboembolism in total knee arthroplasty? - effectiveness of passive-assisted ankle motion in surgical/non-surgical side. Arthroplasty, 2021, 3(1): 35.
34.	Zhuang Z, Ai D, Yao Y, et al. The changes of the calf-vein deformation and femoral vein peak velocity during ankle pump exercise with or without graduated compression stockings. BMC Musculoskelet Disord, 2022, 23(1): 435.
35.	Kwon OY, Jung DY, Kim Y, et al. Effects of ankle exercise combined with deep breathing on blood flow velocity in the femoral vein. Aust J Physiother, 2003, 49(4): 253-258.
36.	Tsuda K, Takahira N, Ejiri M, et al. Effect of resistance of the exercise band on the peak femoral vein velocity during active ankle flexion. Phlebology, 2020, 35(3): 176-183.

1. Manfredi VM, Machado MB, Barbato NG, et al. Effectiveness of deep venous thrombosis prevention in total hip arthroplasty. Acta Ortop Bras, 2021, 29(6): 293-296.
2. Chopard R, Albertsen IE, Piazza G. Diagnosis and treatment of lower extremity venous thromboembolism: a review. JAMA, 2020, 324(17): 1765-1776.
3. Tamowicz B, Mikstacki A, Urbanek T, et al. Mechanical methods of venous thromboembolism prevention: from guidelines to clinical practice. Pol Arch Intern Med, 2019, 129(5): 335-341.
4. Sochart DH, Hardinge K. The relationship of foot and ankle movements to venous return in the lower limb. J Bone Joint Surg Br, 1999, 81(4): 700-704.
5. Li Y, Guan XH, Wang R, et al. Active ankle movements prevent formation of lower-extremity deep venous thrombosis after orthopedic surgery. Med Sci Monit, 2016, 22: 3169-3176.
6. Staubesand J, Heisterkamp T, Stege H. Use of duplex sonography to investigate the effect of active and passive movement at the ankle joint for promoting venous return. Clin Anat, 1995, 8(2): 96-101.
7. Meissner MH, Moneta G, Burnand K, et al. The hemodynamics and diagnosis of venous disease. J Vasc Surg, 2007, 46(Suppl S): 4S-24S.
8. Westrich GH, Specht LM, Sharrock NE, et al. Venous haemodynamics after total knee arthroplasty: evaluation of active dorsal to plantar flexion and several mechanical compression devices. J Bone Joint Surg Br, 1998, 80(6): 1057-1066.
9. Suehiro K, Morikage N, Harada T, et al. Effects of leg compression and calf muscle contraction by active ankle motion on venous hemodynamics in sitting individuals. Phlebology, 2022, 37(5): 361-366.
10. Kropp AT, Meiss AL, Guthoff AE, et al. The efficacy of forceful ankle and toe exercises to increase venous return: a comprehensive Doppler ultrasound study. Phlebology, 2018, 33(5): 330-337.
11. Hu X, Li Y, Li J, et al. Effects of altered blood flow induced by the muscle pump on thrombosis in a microfluidic venous valve model. Lab Chip, 2020, 20(14): 2473-2481.
12. Walker MA, Hoier B, Walker PJ, et al. Vasoactive enzymes and blood flow responses to passive and active exercise in peripheral arterial disease. Atherosclerosis, 2016, 246: 98-105.
13. Iba T, Shin T, Sonoda T, et al. Stimulation of endothelial secretion of tissue-type plasminogen activator by repetitive stretch. J Surg Res, 1991, 50(5): 457-460.
14. Wang X, Tang R, Zhang H, et al. What frequency of ankle pump exercise is optimal to improve lower limb hemodynamics? A systematic review and network meta-analysis. Asian Nurs Res (Korean Soc Nurs Sci), 2023, 17(2): 53-60.
15. Shimizu Y, Kamada H, Sakane M, et al. A novel exercise device for venous thromboembolism prophylaxis improves venous flow in bed versus ankle movement exercises in healthy volunteers. J Orthop Surg (Hong Kong), 2017, 25(3): 2309499017739477.
16. Li H, Zhang W, Lu Q, et al. Which frequency of ankle pump exercise should be chosen for the prophylaxis of deep vein thrombosis?. Inquiry, 2022, 59: 469580221105989.
17. Li T, Yang S, Hu F, et al. Effects of ankle pump exercise frequency on venous hemodynamics of the lower limb. Clin Hemorheol Microcirc, 2020, 76(1): 111-120.
18. Nakayama T, Tsukada S, Hiyama T, et al. Impact of active ankle movement frequency on velocity of lower limb venous flow following total hip arthroplasty. Adv Orthop, 2016, 2016: 7683272.
19. 张雅芝, 王颖, 褚彦香, 等. 踝泵运动预防成人围手术期下肢深静脉血栓最佳证据总结. 中华现代护理杂志, 2022, 28(1): 15-21.
20. Toya K, Sasano K, Takasoh T, et al. Ankle positions and exercise intervals effect on the blood flow velocity in the common femoral vein during ankle pumping exercises. J Phys Ther Sci, 2016, 28(2): 685-688.
21. Guo M, Lu L, Sun Y, et al. Comprehensive functional exercises with patient education for the prevention of venous thrombosis after major gynecologic surgery: a randomized controlled study. Thromb Res, 2019, 178: 69-74.
22. 刘建丽, 张瑞英, 陈玉屏. 骨科病房指导患者不同踝泵运动频率强度的护理实践研究. 中国医药科学, 2018, 8(21): 78-81.
23. 谌艳, 吴俞萱, 江伟, 等. 踝泵运动对下肢静脉血流动力学影响的研究. 创伤外科杂志, 2020, 22(1): 52-56.
24. 路孝美, 王吉昌, 孙静岚, 等. 踝泵运动预防深静脉血栓的研究进展. 中华现代护理杂志, 2021, 27(4): 447-450.
25. 毕如云. 体位干预结合踝关节运动预防下肢静脉曲张术后患者深静脉血栓的价值研究. 河北医药, 2022, 44(4): 546-549.
26. Kiss G, Faludi B, Szilágyi B, et al. Effect of active and passive mechanical thromboprophylaxis and consensual effect on the venous blood flow velocity among hemiparetic patients. Clin Appl Thromb Hemost, 2019, 25: 1076029619832111.
27. Li T, Yang S, Dou C, et al. Effects of different exercise methods of calf muscles on the hemodynamics of lower extremity vein. Phlebology, 2022, 37(6): 432-438.
28. Shimizu Y, Kamada H, Sakane M, et al. A novel apparatus for active leg exercise improves venous flow in the lower extremity. J Sports Med Phys Fitness, 2016, 56(12): 1592-1597.
29. Yonezawa T, Nomura K, Onodera T, et al. Evaluation of venous return in lower limb by passive ankle exercise performed by PHARAD. Annu Int Conf IEEE Eng Med Biol Soc, 2015, 2015: 3582-3585.
30. Low FZ, Lim JH, Yeow CH. Design, characterisation and evaluation of a soft robotic sock device on healthy subjects for assisted ankle rehabilitation. J Med Eng Technol, 2018, 42(1): 26-34.
31. Sakai K, Takahira N, Tsuda K, et al. A novel device for lower leg intermittent pneumatic compression synchronized with active ankle exercise for prevention of deep vein thrombosis. Phlebology, 2022, 37(7): 507-515.
32. Sakai K, Takahira N, Tsuda K, et al. Effects of intermittent pneumatic compression on femoral vein peak venous velocity during active ankle exercise. J Orthop Surg (Hong Kong), 2021, 29(1): 2309499021998105.
33. Tateiwa T, Ishida T, Masaoka T, et al. Does intraoperative mechanical prophylaxis prevent venous thromboembolism in total knee arthroplasty? - effectiveness of passive-assisted ankle motion in surgical/non-surgical side. Arthroplasty, 2021, 3(1): 35.
34. Zhuang Z, Ai D, Yao Y, et al. The changes of the calf-vein deformation and femoral vein peak velocity during ankle pump exercise with or without graduated compression stockings. BMC Musculoskelet Disord, 2022, 23(1): 435.
35. Kwon OY, Jung DY, Kim Y, et al. Effects of ankle exercise combined with deep breathing on blood flow velocity in the femoral vein. Aust J Physiother, 2003, 49(4): 253-258.
36. Tsuda K, Takahira N, Ejiri M, et al. Effect of resistance of the exercise band on the peak femoral vein velocity during active ankle flexion. Phlebology, 2020, 35(3): 176-183.

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