Exercising Safely After a Blood Clot

If you’ve been diagnosed with a blood clot, you might wonder if it’s safe to exercise. Being active is a great way to get your heart pumping and your blood flowing. When people are inactive, blood flows back to the heart slowly. Staying active prevents blood from pooling in your body, lowering the chance of forming clots.

Is It Safe to Exercise After a Blood Clot?

According to Dr. Ellen Hillegass, a physical therapist and APTA board-certified Cardiopulmonary Clinical Specialist, “People who’ve had a clot are better off increasing their movement instead of being sedentary – as long as they’re being treated with a blood thinner. There are some situations when a person with a clot shouldn’t move—like someone who had a massive clot—but usually, if medication is on board, they can exercise.”

Blood clots can be classified as:

· Provoked: A clot with a clear cause, like surgery or immobility

· Unprovoked: A clot without a clear cause, which can be a sign of another health problem

“If your clot was unprovoked, you want to make sure you’ve seen your doctor for a work-up. Exercise recommendations are the same regardless of whether your clot was provoked or unprovoked,” notes Dr. Hillegass.

Benefits of exercise

Exercise can help the body’s natural system that breaks down blood clots, especially when combined with medications. It does this by lowering the levels of a protein called PAI-1, which stops clots from breaking down, and increasing the levels of another protein called tPA, which helps dissolve clots. Studies show that walking and biking can improve this process.

When Can I Start—or Return to— Exercising?

If you feel ready, you can usually return to exercise after starting your blood thinner unless your clinician advises otherwise. “When clinicians prescribe blood thinners, they aren’t trying to break up the clot. They’re trying to go after the floaters (small clots) that could travel to the lungs. When medication is at a therapeutic level in the blood, it breaks up the floaters. If you break up the floaters and increase mobility, the clot doesn’t build up,” explains Dr. Hillegass.

The therapeutic level of a drug is the amount of medicine in your body that is enough to work properly. If exercising is safe after medications are started, then how long does it take for medications to reach a therapeutic level? “Most medications used to treat blood clots work quickly, within hours,” notes Dr. Hillegass.

Guidelines established by the American Physical Therapy Association (APTA) in 2022 provide the following time frames for when blood thinners reach a therapeutic level:  

Safe Exercises After a Blood Clot

So once a medication is at the therapeutic level, what type of exercises are safe to do after a blood clot? “Movement! Anything that increases blood flow,” recommends Dr. Hillegass. She suggests starting with gentle activities, such as:

· Walking

· Ankle pumps

· Light arm weights

· Swimming

Some people may experience pain from their clot during activity. Sometimes, the pain can linger for a while. The important thing is to keep moving. Dr. Hillegass suggests using an assistive device, such as a cane or walker, if you experience leg pain when trying to move after a blood clot. “It doesn’t mean that you will have to use it forever. Assistive devices help reduce the weight or pressure on the extremity if it’s hurting.”

“Swimming or even walking in the water can also help ease pain. The water creates a compression effect from the hydrostatic pressure,” adds Dr. Hillegass. Compression helps to improve blood flow by gently squeezing the legs. Some people have relief from pain with compression stockings. These stockings can help to ease the aching and swelling in your legs. “Compression stockings can be worn during exercise and may help if pain is felt during mobility,” suggests Dr. Hillegass.

How to Ease into Exercise After a Blood Clot

It’s important to start slow when starting (or restarting) an exercise routine after a blood clot. “Even if you were exercising before you developed a clot, you should start at a lower level when you get back into it. If you were lifting weights before, start with lighter weights and then build back up,” says Dr. Hillegass.

“It’s very important to know that blood thinners increase the risk of bleeding, so when starting or returning to exercise after having a clot, you’ll want to be careful because of the risk of bleeding if you fall or get injured – not because of the blood clot itself,” explains Dr. Hillegass.  “Don’t take up any new exercise you’ve never done before or anything that could put you at high risk of falling. A stationary or recumbent bike can be especially helpful if you have balance issues.”

Signs to Watch for While Exercising

Remember to pay attention to your body when exercising after a blood clot and recognize signs of a problem. Watch for the following warning signs while staying active:

· Sudden pain, swelling, or discomfort in your legs, especially if the pain is different from what you normally feel or starts to get worse. Stop exercising and talk to your doctor.

·  If you experience shortness of breath, lightheadedness, or chest pain, seek medical help immediately.

·  Blood thinners can increase your risk of bleeding. Watch for any signs of unusual or excessive bleeding. If a cut doesn’t stop bleeding, contact your doctor right away.

It’s understandable to have concerns about exercising after having a blood clot. The good news is that exercise is generally safe once you’ve started treatment with blood thinners. However, it's important to talk to your doctor before starting any new exercise program to ensure it's right for your specific situation. Staying active improves blood flow, prevents future clots, and supports your overall health.

Meet the Expert 

Dr. Ellen Hillegass is a physical therapist with APTA board certification in the cardiovascular and pulmonary clinical specialty. Ellen Hillegass was the Chair of the Clinical Practice Guidelines Revision Committee on Venous Thromboembolism (VTE) for the APTA, published in April 2022, and the initial clinical practice guideline on VTE. Dr. Hillegass is also the current Chair of the Oxygen Consensus Guidelines Task Force for the Academy of Cardiovascular and Pulmonary PT of the APTA.

References:

Blood thinners. MedlinePlus. https://medlineplus.gov/bloodthinners.html. Updated June 27, 2024. Accessed September 27, 2024.

Compression stockings. MedlinePlus. https://medlineplus.gov/ency/patientinstructions/000597.htm. Updated July 21, 2022. Accessed September 27, 2024.

Hillegass, E, Lukaszewicz, K, Puthoff, M. Role of physical therapists in the management of individuals at risk for or diagnosed with venous thromboembolism: Evidence-based clinical practice guideline 2022. Physical Therapy. 2022;102(8). https://doi.org/10.1093/ptj/pzac057

Patelis N, Karaolanis G, Kouvelos GN, et al. The effect of exercise on coagulation and fibrinolysis factors in patients with peripheral arterial disease. Exp Biol Med (Maywood). 2016;241(15):1699-1707. doi:10.1177/1535370216660215

Therapeutic drug monitoring. MedlinePlus. https://medlineplus.gov/lab-tests/therapeutic-drug-monitoring/. Updated June 27, 2024. Accessed September 27, 2024.