Public Servant Lifestyle

Simple seat exercises can help long-distance air travellers avoid the potentially fatal condition deep vein thrombosis (DVT).

Government advice on avoiding DVT - deep vein thrombosis, where blood clots develop in the deep veins of the legs - places a strong emphasis on the value of doing simple seat exercises, whilst flying.

What Is DVT?

One in every 100 people who develop DVT dies. The cause of death is usually a blood clot, travelling from the legs, to the lungs. This is called a pulmonary embolus, or PE. When PE is severe, it causes the lungs to collapse, and heart failure.

New guidance - issued by the Department of Health (DoH) - explains that, with DVT, "you may get swelling, pain, tenderness and redness, especially at the back of the leg below the knee. This is different from the mild ankle swelling, that many people get during long haul flights, and DVT usually, though not always, affects only one leg.

"These complaints may develop during the journey, but, more commonly, hours, or even days, later. The pain may be made worse by bending the foot upward, towards the knee. In some cases, there may be no signs, or symptoms, of DVT at all, in the legs, and problems only become obvious when a pulmonary embolus, or PE, develops from the clots in the legs.

"Fortunately PE is rare. PE can cause breathlessness, chest pain and in severe cases, collapse. Both DVT and PE, whatever the cause, are serious conditions, and need urgent investigation and treatment."

The government says that, every year, DVT occurs in about one in 2,000 people in the general population, ranging from less than one in 3,000 in people under the age of 40, up to one in 500, in those over 80.

The risk of DVT, and PE, says the government, is greater in people:

Over 40 years of age

Who have had blood clots already

With a family history of blood clots

Suffering from, or who have had treatment for, cancer

With certain blood diseases

Being treated for heart failure, and circulation problems

Who have had recent surgery, especially on the hips or knees

Who have an inherited clotting tendency

DVT is also more common in women, who:

Are pregnant

Have recently had a baby

Are taking the contraceptive pill

Are on hormone replacement therapy, or HRT

These two groups make up 90 to 95% of all those who get DVT, and/or PE

The Link Between Long-Haul Travel and DVT

New advice has been published by the Government outlining how travellers can avoid DVT on long haul flights.

The public can access the information through NHS Direct.

Although the link between long haul travel and DVT is still uncertain, the advice identifies certain groups of people who may be at risk. Those who have had DVT before, suffered a stroke or undergone recent major surgery all fall into this category. DVT is also more common in pregnant women and those who are taking the pill.

The advice places a strong emphasis on the value of doing simple seat exercises whilst flying.

The Government’s deputy chief medical officer Dr Pat Troop said: "We take the health of aircraft passengers and crew members very seriously. Although further research needs to be carried out into the links between DVT and long distance travel, we have today issued the most up to date information and advice to the airlines and the public about minimising the risk of DVT during long journeys."

"Although the link between long haul travel and DVT is still uncertain," says the new guidance, "the advice identifies certain groups of people who may be at risk. Those who have had DVT before, suffered a stroke, or undergone recent major surgery, all fall into this category. DVT is also more common in pregnant women, and those who are taking the contraceptive pill."

The guidance says that a possible link between deep vein thrombosis, and long haul air travel, was first suggested by reports in medical journals in the 1950s. These early reports of DVT, and the evidence about the causes of DVT, in general, pointed to immobility as the common underlying risk factor.

Despite this, says the guidance, information is still unclear on:

How common travel-related DVT really is

What the risk factors are

How it can be prevented

"What is known, however, is that DVT may be associated with any form of long distance travel, whether by air, car, coach or train. In particular long-haul air travel (flights lasting longer than five hours) where passengers remain immobile, in the seated position, for long periods of time, may be associated with an increased risk."

"The important point to remember," says the guidance," is that the vast majority of air passengers do not need to take any medication, on long haul flights, to prevent DVT. All air passengers, even those at greatest risk, can reduce the chances of getting DVT, by doing the simple exercises set out in this advice."

Long-haul

The guidance says that there is some evidence that long-haul flights, especially when passengers have little or no exercise, may increase the risk of developing DVT. Information on the proportion of people who develop DVT related to air travel is limited, but the experts suggest this is small.

Also, it is not easy to decide whether the flight itself caused the DVT/PE, or whether these people were at risk for other reasons. This is because DVT and PE are relatively common conditions anyway, and more people than ever now travel by air, every year.

While it is difficult to be certain what the exact causes of travel-related DVT are, experts agree that lack of exercise or immobility are major underlying risks. They have also identified that people at increased risk of DVT/PE in general are those more likely to develop travel-related DVT/PE.

Before Your Journey

The new guidance says that, before any long-distance trip, we should consult our doctor, if we have:

Ever had a DVT, or PE

A family history of clotting conditions

An inherited tendency to clot (thrombophilia)

Cancer, or had treatment for cancer, in the past

Undergone major surgery, in the last three months

Had hip or knee replacement, within the last three months

Ever suffered from a stroke

Some experts advise that people who have had hip or knee replacements should postpone long haul flights, for three months, after surgery. If you have had this kind of surgery, the new guidance suggests you should talk to your family doctor, travel clinic staff, or a member of the surgical team.

"You may also need to discuss treatment with blood-thinning drugs or the use of elastic stockings if you are in a high-risk group," says the guidance. "While there is some evidence that elastic stockings may be useful, there is no evidence that aspirin is effective in preventing travel-related DVT or PE.

Elastic Stockings

"Elastic stockings are widely available from pharmacies, and pharmacists can provide advice, on use and fitting. Because aspirin can have serious side effects, like bruising, bleeding from the gut, and allergies, you should consult your doctor, before deciding to take this drug. People taking aspirin already, should not increase the dose.

"Women taking the 'pill', or on hormone replacement therapy (HRT) should undertake the described exercises , to help reduce the risk. They should also discuss, with their community pharmacist, the use of elastic stockings. Women who are pregnant, or have recently had a baby, should seek advice from the antenatal team, or the health visitor."

The guidance stresses that we should make sure we have good medical insurance for our trip.

During Your Journey

During our trip, we are advised to:

Be comfortable in our seat

Press the balls of our feet, down hard against the floor, or foot-rest (this will also help increase the blood flow in our legs, and reduce clotting)

Take upper body and breathing exercises, which can further improve circulation

Take occasional short walks, when in-flight advice suggests this is safe

Take advantage of refuelling stopovers, where it may be possible to get off the plane, and walk about

Drink plenty of water

Be sensible about alcohol, which, in excess, leads to dehydration and immobility

Be bending, and straightening our legs, feet and toes, while seated, every half-hour, or so, during the flight

Avoid taking sleeping pills, which also cause immobility

After Your Journey

After the trip, says the guidance, "for the vast majority of air passengers there will be no problem. If, however, you do develop swollen painful legs, especially where one is more affected than the other, or breathing difficulties, see a local doctor urgently, or go to the nearest accident and emergency department."

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