The occurrence of varicose veins is common among adults, with some studies revealing that upwards of one in three individuals suffer from moderate to severe vein problems as they age. Varicose veins are defined as enlarged sections of a vein, typically found in the legs or feet, just below the surface layer of the skin that cause unsightly and, in some cases, uncomfortable bulges. Although this condition can be linked back to a family history of vein issues, being overweight and pregnancy also play a part in developing weakened veins. Prolonged periods of standing may also be a factor despite being in otherwise exemplary health.
For most patients the development of varicose veins is mainly down to bad luck – there is not much one can do to prevent their development. For those who have already experienced the cosmetic woes or physical discomfort of varicose veins, questions about the effect of exercise are very common. The good news is that exercising is not off the table completely, although there is some physical activity that benefits varicose veins and some that has the potential to make the veins worse. First, let’s focus on the dos of exercise.
Exercise does not cause varicose veins:
As far as we know exercise will not make you develop varicose veins. Some people worry about this because they see pictures of athletes with bulging veins on their legs or arms – these are not varicose veins, however – they are normal veins which are just larger than those seen in non athletes and are a normal response to the effect of heavy and sustained physical training. You can exercise as much as you want – it won’t make you develop varicose veins. On the other hand it won’t protect you from them either ! In any event the beneficial aspects of exercise far outweigh the downsides – so if you have varicose veins it is no reason not to exercise – it’s just useful to figure out ways to reduce the negative consequences.
Compression is Key
Varicose veins are caused by malfunctioning valves in the veins which causes the blood to flow the ‘wrong way’ down the leg instead of up. Any activity which increases blood flow through already damaged veins will stretch and damage them further. At rest, about one litre of blood per minute will flow through the veins of each leg. During heavy exercise this can increase to five litres or more per minute. Normal veins will cope with this increase in flow – already damaged veins will not.
Any activity that increases blood flow through the veins will make existing varicose veins worse. This is a bit of a nuisance as virtually all exercise makes blood flow increase through the leg veins – especially running and cycling. The harder you work, the more blood flows through the veins and the more they will bulge out – if you suffer with varicose veins you will probably have noticed this already at the end of your workouts.
Elevation of the legs is helpful:
Swimming probably works better than running or cycling because, although blood flow in the legs does increase as with other activities, the legs are elevated and supported by the water, so the gravitational effect of the legs being dependant (ie lower than the heart) will reduce the degree to which they swell during periods of intense activity.
Can I Still Run with varicose veins?
Yes you can, but if your veins are very bad, you may find it helpful to use a decent pair of compression stockings. These garments squeeze the calf and prevent the veins from swelling excessively during periods of high blood flow. You may have noticed that elite athletes use below knee compression stockings during distance races for the same reason – to prevent blood pooling in the superficial veins and increase the rate at which the blood returns to the heart and lungs to be re-oxygenated. In this case they are seeking to gain a tiny fraction of advantage by enhancing the return of blood, rather than to prevent varicose veins from getting worse, but the principle remains the same.
Fixing the veins is better than compression
Wearing a compression stocking to control varicose veins does work pretty well, but it can’t be said to be a comfortable experience for active people. These days with the improvement in surgical techniques such as the use of EVLT laser surgery for veins, the majority of cases can be fixed quickly and successfully under local anaesthetic – not much worse than going to the dentist.
Surgery with EVLT for varicose veins can produce a radical improvement in exercise performance, particularly in the case of runners or cyclists, where varicose veins can impede performance due to the poor return of blood to the heart. I recall one memorable case of a patient I operated on who was a keen runner. Following successful EVLT treatment to the veins on both legs, he improved his personal best time for the marathon by 30 minutes!
