Chapter: Consultation hour
Article: 6 of 12
Update: Feb 24, 2021
Author(s): Wohlgemuth, Walter A.
Vascular malformation patients with extensive involvement of a limb are often advised to totally avoid sports and exercise. This is wrong. The only exception here is an acute infection situation or an acute exacerbation of the disease.
Full participation in exercise and sports is even desirable in the long run, if this is at all possible.
The intense muscle movement, with simultaneous wearing of a compression garment, leads to an increase in the flow rate of lymph and venous blood from peripheral to proximal via the muscle pump. Both phlebedema and lymphedema are thus reduced and the tissue fluid pressure decreases.
In situations of increased venous pressure due to chronic venous hypertension or chronic venous insufficiency, the muscle pump increases the reflux of venous blood to the heart during physical exercise and leads to a feeling of relief in the affected leg.
At the same time, the dilated, irregular vascular spaces of the venous malformation, filled with stagnant blood, are “pumped out” and refilled. This increases the blood flow through the venous malformation, which decreases the local intravascular coagulation, helps to prevent the development of thrombophlebitis and larger clots within the malformation.
The combination of movement and compression is particularly valuable, as it supports the muscle pump by providing additional external counterpressure.
However, problems associated with intensive exercise exist. These concern bony involvement of the vascular anomaly, with an increased risk of fracture or an increased risk of bleeding. This may be due to accompanying bone dysplasia (venous malformation) or direct bone involvement with dysplastic vascular channels (arteriovenous malformation), leading to reduced mechanical stability of the bone. Contraindications to exercise are also the presence of open or ischemic wounds (e.g., in patients with AVM) or acute bacterial inflammation or erysipelas.
In principle, participation in sports lessons at school or performance-intensive sports as a hobby are also possible and even desirable. Many patients with even extensive venous malformations do competitive sports or fitness training in the gym.
An important aspect is the wearing of suitable, adaptable footwear (e.g., light linen sports shoes) during sports activities. Poorly fitted orthopedic shoes are often too hard and lead to pressure points. Pay attention to the rapid growth of children's feet; the shoe should not pinch.
Swimming, including competitive swimming, is generally not contraindicated. Special attention should be paid to skin hygiene and infection protection. The disinfection of feet and toes is of central importance here.
Even team sports that involve a certain risk of injury, such as soccer, are usually quite possible after consultation with an appropriate doctor.
Sports that combine frequent rapid changes of direction and fast sprints with standing (e.g., tennis, badminton) are possible, but usually somewhat painful (especially for patients with venous malformations in the legs). Typically the pain sets in the next morning after overexertion.
Equestrian sports are also a very good way of training the whole body. As with other sports, only patients with skin wounds or a fracture risk due to bony involvement of the vascular anomaly should be excluded.
Full-contact or martial arts sports are also possible in principle in many cases, depending on the exact type, extent and location of the vascular defect and after appropriate medical advice from a specialist.
The often well-meaning suggestion of relieving the extremity affected by a visible vascular defect does much more harm than good, especially during growth and in adolescents.
Immobility or conversely a disproportionately invasive surgical therapy can lead to secondary contractures that are not directly caused by the disease, but by inadequate therapeutic means. The degree of exercise that is still possible varies from one individual to another, especially in terms of pain intensity. Therefore, the affected children or adolescents can only be encouraged to work out their individual limits themselves by trying them out.