Bulletin of Rehabilitation MedicineBulletin of Rehabilitation MedicineВестник восстановительной медицины2078-19622713-2625National Medical Research Center for Rehabilitation and Balneology70100110.38025/2078-1962-2026-25-3-103-112ArticlesСтатьиReview ArticlePhysical exercises as a method for correcting dysfunction of the calf muscle-venous pump in patients with post-thrombotic disease: a reviewФизические тренировки как способ коррекции дисфункции мышечно-венозной помпы голени у пациентов с посттромботической болезнью: обзорhttps://orcid.org/0000-0003-3852-2050ApkhanovaTatiana V.АпхановаТатьяна Валерьевна
Russian Federation

D.Sc. (Med.), Chief Researcher, Unit of Physiotherapy and Reflexology

доктор медицинских наук, главный научный сотрудник, отдел физиотерапии и рефлексотерапии

apkhanovatv@nmicrk.ruhttps://orcid.org/0000-0002-8411-8609KaperizKonstantin A.КаперизКонстантин Александрович
Russian Federation

Head of the Vascular Surgery Unit

заведующий отделом сосудистой хирургии

apkhanovatv@nmicrk.ruhttps://orcid.org/0000-0003-3610-8382SapelkinSergey V.СапелкинСергей Викторович
Russian Federation

D.Sc. (Med.), Chief Researcher, Vascular Surgery Unit

доктор медицинских наук, главный научный сотрудник отдела сосудистой хирургии

apkhanovatv@nmicrk.ruNational Medical Research Center for Rehabilitation and BalneologyНациональный медицинский исследовательский центр реабилитации и курортологии Минздрава РоссииNational Medical Research Center for Therapy and Preventive MedicineНациональный медицинский исследовательский центр терапии и профилактической медицины Минздрава РоссииA.V. Vishnevsky National Medical Research Center of SurgeryНациональный медицинский исследовательский центр хирургии им. А.В. Вишневского Минздрава России230620262531031121401202601062026Copyright ©; 2026, Apkhanova T.V., Kaperiz K.A., Sapelkin S.V.Copyright ©; 2026, Апханова Т.В., Капериз К.А., Сапелкин С.В.2026Apkhanova T.V., Kaperiz K.A., Sapelkin S.V.Апханова Т.В., Капериз К.А., Сапелкин С.В.https://creativecommons.org/licenses/by-nc-sa/4.0https://journals.eco-vector.com/2078-1962/article/view/701001

INTRODUCTION. Dysfunction of the calf muscle-venous pump (MVP) associated with venous obstruction contributes to ineffective venous blood emptying from the distal lower extremities and can be considered a therapeutic target in the treatment of chronic venous diseases. Physical exercise (PE) can be an effective method for increasing the hemodynamic efficiency of the MVP.

AIM. A search and analytical review of research findings published in international databases, focusing on the role of MVP dysfunction in the pathogenesis of chronic venous insufficiency (CVI), as well as the effectiveness of various types of physical exercise.

MATERIAL AND METHODS. Fifty-one sources were identified from databases eLibrary.RU, Scopus, PubMed, Web of Science from 1998 to 2025, of which 19 were systematic reviews, including two Cochrane reviews, five practice guidelines, and 27 randomized controlled trials.

RESULTS. In patients with mild CVI, PE was found to improve venous reflux, muscle strength, ankle range of motion (AROM), and quality of life. In patients with severe CVI, PE increased ejection fraction, decreased residual volume, and improved muscle strength and AROM. Isotonic exercise was shown to improve muscle endurance, efficiency, and strength of the calf muscles, improving their contractility and overall hemodynamics in limbs with venous trophic ulcers (VTU). It was established that the effectiveness of MVP also depends on the mobility of the ankle joint and the calf muscles contractile strength.

DISCUSSION. Despite the compelling evidence base for prescribing progressive strength training and aerobic activity to patients with VTU, there are no studies examining the effectiveness of isokinetic training in the comprehensive rehabilitation of patients with post-thrombotic syndrome (PTS). This underscores the need to develop modern isokinetic training protocols for patients with PTS, as they achieve improved performance through maximal muscle loading, which enhances motor learning through real-time feedback.

CONCLUSION. Studying the effects of isokinetic exercise training on calf pump function, muscle strength, AROM, and quality of life in patients with PTS is a promising area of medical rehabilitation.

ВВЕДЕНИЕ. Дисфункция мышечно-венозной помпы (МВП) голени при венозной обструкции приводит к неэффективному опорожнению венозной крови из дистальных отделов нижних конечностей и может рассматриваться как терапевтическая мишень при лечении хронических заболеваний вен, а физические упражнения (ФУ) могут быть эффективным методом повышения гемодинамической эффективности МВП.

ЦЕЛЬ. Поиск и аналитический обзор опубликованных в международных базах данных результатов научных исследований, посвященных изучению роли дисфункции МВП в патогенезе хронической венозной недостаточности (ХВН), а также эффективности применения различных видов физических тренировок.

МАТЕРИАЛЫ И МЕТОДЫ. В базах данных eLIBRARY.RU, Scopus, PubMed, Web of Science с 1998 по 2025 г. был отобран 51 источник, из которых 19 составили систематические обзоры, включающие 2 Кокрановских обзора, 5 — практические руководства, а также 27 — рандомизированные контролируемые исследования (РКИ).

РЕЗУЛЬТАТЫ. Установлено, что у пациентов с легкой степенью ХВН применение ФУ приводит к улучшению показателей венозного рефлюкса, мышечной силы, диапазона движений в голеностопном суставе (AROM — Ankle Range of Motion) и качества жизни (КЖ). У пациентов с тяжелой ХВН ФУ увеличивали фракцию выброса, снижали фракцию остаточного объема и улучшали мышечную силу, AROM. Показано, что изотонические упражнения, повышая мышечную выносливость, эффективность и силу икроножных мышц, улучшают их сократительную способность и общую гемодинамику в конечностях с венозными трофическими язвами (ВТЯ). Установлено, что эффективность МВП также зависит от подвижности голеностопного сустава и силы сокращения икроножных мышц.

ОБСУЖДЕНИЕ. При наличии убедительной доказательной базы для назначения пациентам с ВТЯ прогрессивных силовых нагрузок и аэробной активности отсутствуют исследования, изучающие эффективность изокинетических тренировок в комплексной реабилитации пациентов с посттромботической болезнью (ПТБ). Это подчеркивает необходимость разработки современных протоколов изокинетических тренировок у пациентов с ПТБ, поскольку при этом достигается улучшенная производительность за счет максимальной нагрузки на мышцы, улучшающей двигательное обучение за счет обратной связи в режиме реального времени.

ЗАКЛЮЧЕНИЕ. Изучение влияния изокинетических физических тренировок на функцию икроножной помпы, мышечную силу, AROM и качество жизни пациентов с ПТБ является перспективным направлением медицинской реабилитации.

muscle-venous pumpankle jointpost-thrombotic syndromephysical exerciseisokinetic trainingмышечно-венозная помпаголеностопный суставпосттромботическая болезньфизические упражненияизокинетические тренировкиChaitidis N., Kokkinidis D.G., Papadopoulou Z., et al. Management of Post-thrombotic Syndrome: A Comprehensive Review. Curr Pharm Des. 2022; 28(7): 550–559. https://doi.org/10.2174/1381612828666220131094655Kahn S.R., Galanaud J.P., Vedantham S., Ginsberg J.S. Guidance for the prevention and treatment of the post-thrombotic syndrome. J Thromb Thrombolysis. 2016; 41(1): 144–153. https://doi.org/10.1007/s11239-015-1312-5Wendelboe A.M., Raskob G.E. Global Burden of Thrombosis: Epidemiologic Aspects. Circ Res. 2016; 118(9): 1340–1347. https://doi.org/10.1161/circresaha.115.306841Bergan J.J, Schmid-Schönbein G.W., Smith P.D., et al. Chronic venous disease. N Engl J Med. 2006; 355(5): 488–498. https://doi.org/10.1056/NEJMra055289Eberhardt R.T., Raffetto J.D. Chronic venous insufficiency. Circulation. 2014; 130(4): 333–346. https://doi.org/10.1161/circulationaha.113.006898Williams K.J., Ayekoloye O., Moore H.M., Davies A.H. The calf muscle pump revisited. J Vasc Surg Venous Lymphat Disord. 2014; 2(3): 329–334. https://doi.org/10.1016/j.jvsv.2013.10.053Tauraginskii R.A., Lurie F., Simakov, S., et al. The human lower leg muscle pump functions as a flow diverter pump, maintaining low ambulatory venous pressures during locomotion. J Vasc Surg Venous Lymphat Disord. 2025; 13(1): 101996. https://doi.org/10.1016/j.jvsv.2024.101996Raju S., Neglen P.N., Carr-White P.A., et al. Ambulatory venous hypertension: component analysis in 373 limbs. J Vasc Endovasc Surg 1999; 33: 257–266.Uhl J.F., Chahim M., Allaert F.A. Static foot disorders: a major risk factor for chronic venous disease? Phlebology. 2012; 27(1): 13–18. https://doi.org/10.1258/phleb.2011.010060Meissner M.H. Lower extremity venous anatomy. Semin Intervent Radiol. 2005; 22(3): 147–156. https://doi.org/10.1055/s-2005-921948Lattimer C.R., Franceschi C., Kalodiki E. Optimizing calf muscle pump function. Phlebology. 2018; 33(5): 353–360. https://doi.org/10.1177/0268355517709410Qiao T., Liu C., Ran F. The impact of gastrocnemius muscle cell changes in chronic venous insufficiency. Eur J Vasc Endovasc Surg. 2005; 30(4): 430–436. https://doi.org/10.1016/j.ejvs.2005.05.017Azirar S., Appelen D., Prins M.H., et al. Compression therapy for treating post-thrombotic syndrome. Cochrane Database Syst Rev. 2019 Sep 18; 9(9): CD004177. https://doi.org/10.1002/14651858.CD004177.pub2Orsted H.L., Radke L., Gorst R. The impact of musculoskeletal changes on the dynamics of the calf muscle pump. Ostomy Wound Manage. 2001; 47(10): 18–24.Orr L., Klement K.A., McCrossin L., et al. A Systematic Review and Meta-analysis of Exercise Intervention for the Treatment of Calf Muscle Pump Impairment in Individuals with Chronic Venous Insufficiency. Ostomy Wound Manage. 2017; 63(8): 30–43. https://doi.org/10.25270/owm.2017.08.3043Araujo D.N., Ribeiro C.T., Maciel A.C., et al. Physical exercise for the treatment of non-ulcerated chronic venous insufficiency. Cochrane Database Syst Rev. 20163; 12(12): CD010637. https://doi.org/10.1002/14651858.CD010637.pub2. Update in: Cochrane Database Syst Rev. 2023; 6: CD010637. https://doi.org/10.1002/14651858.CD010637.pub3Silva K.L.S., Figueiredo E.A.B., Lopes C.P., et al. The impact of exercise training on calf pump function, muscle strength, ankle range of motion, and health-related quality of life in patients with chronic venous insufficiency at different stages of severity: a systematic review. J Vasc Bras. 2021; 20: e20200125. https://doi.org/10.1590/1677-5449.200125Jull A., Parag V., Walker N., et al. The prepare pilot RCT of home-based progressive resistance exercises for venous leg ulcers. J Wound Care. 2009; 18(12): 497–503. https://doi.org/10.12968/jowc.2009.18.12.45606Ercan S., Çetin C., Yavuz T., et al. Effects of isokinetic calf muscle exercise program on muscle strength and venous function in patients with chronic venous insufficiency. Phlebology. 2018; 33(4): 261–266. https://doi.org/10.1177/0268355517695401Leal F.J., Couto R.C., Silva T.P., Tenório V.O. Fisioterapia vascular no tratamento da doença venosa crônica. J Vasc Bras. 2015; 14(3): 224–230. https://doi.org/10.1590/1677-5449.0029Szewczyk M.T., Jawień A., Cwajda-Białasik J., et al. Randomized study assessing the influence of supervised exercises on ankle joint mobility in patients with venous leg ulcerations. Arch Med Sci. 2010; 6(6): 956–963. https://doi.org/10.5114/aoms.2010.19308O’Brien J., Edwards H., Stewart I., Gibbs H. A home-based progressive resistance exercise programme for patients with venous leg ulcers: a feasibility study. Int Wound J. 2013; 10(4): 389–396. https://doi.org/10.1111/j.1742-481X.2012.00995.xPadberg F.T.Jr., Johnston M.V., Sisto S.A. Structured exercise improves calf muscle pump function in chronic venous insufficiency: a randomized trial. J Vasc Surg. 2004; 39(1): 79–87. https://doi.org/10.1016/j.jvs.2003.09.036Yang D., Vandongen Y.K., Stacey M.C. Effect of exercise on calf muscle pump function in patients with chronic venous disease. Br J Surg. 1999; 86(3): 338–341. https://doi.org/10.1046/j.1365-2168.1999.00993.xHartmann B.R., Drews B., Kayser T. Physical therapy improves venous hemodynamics in cases of primary varicosity: results of a controlled study. Angiology. 1997; 48(2): 157–162. https://doi.org/10.1177/000331979704800209Elsisi H.F.E.M., Mahmoud T.H., Serry Z.M.H., et al. Effect of strengthening exercise versus intermittent pneumatic compression device to calf muscle on blood flow in patients with varicose veins. Biosci Res. 2019; 16(2): 2360–2368.Caggiati A., De Maeseneer M., Cavezzi A., et al. Rehabilitation of patients with venous diseases of the lower limbs: State of the art. Phlebology. 2018; 33(10): 663–671. https://doi.org/10.1177/0268355518754463O’Brien J.A., Edwards H.E., Finlayson K.J., Kerr G. Understanding the relationships between the calf muscle pump, ankle range of motion and healing for adults with venous leg ulcers: a review of the literature. Wound Pract Res. 2012; 20(2): 80–85.Kan Y.M., Delis K.T. Hemodynamic effects of supervised calf muscle exercise in patients with venous leg ulceration: a prospective controlled study. Arch Surg. 2001; 136(12): 1364–1369. https://doi.org/10.1001/archsurg.136.12.1364Tew G.A., Gumber A., McIntosh E., et al. Effects of supervised exercise training on lower-limb cutaneous microvascular reactivity in adults with venous ulcers. Eur J Appl Physiol. 2018; 118(2): 321–329. https://doi.org/10.1007/s00421-017-3772-0de Souza N.I, de Oliveira F.LF, de Almeida G.I.I.L., et al. Impairments in ankle range of motion, dorsi and plantar flexors muscle strength and gait speed in patients with chronic venous disorders: A systematic review and meta-analysis. Phlebology. 2022; 37(7): 496–506. https://doi.org/10.1177/02683555221094642Davies J.A., Bull R.H., Farrelly I.J., Wakelin M.J. A home-based exercise programme improves ankle range of motion in long-term venous ulcer patients. Phlebology. 2007; 22(2): 86–89. https://doi.org/10.1258/026835507780346178Houghton D.E., Ashrani A., Liedl D., et al. Reduced calf muscle pump function is a risk factor for venous thromboembolism: a population-based cohort study. Blood. 2021; 137(23): 3284–3290. https://doi.org/10.1182/blood.2020010231Halkar M., Inojosa M.J., Liedl D., et al. Calf muscle pump function as a predictor of all-cause mortality. Vasc Med. 2020; 25(6): 519–526. https://doi.org/10.1177/1358863X20953212Кравцов П.Ф., Каторкин С.Е., Волковой В.В., Сизоненко Я.В. Влияние тренировки мышечного компонента мышечно-венозной помпы нижних конечностей на течение варикозной болезни. Вопросы курортологии, физиотерапии и лечебной физической культуры. 2016; 93(6): 33–36. https://doi.org/10.17116/kurort2016633-36 [Kravtsov P.F., Katorkin S.E., Volkovoy V.V., Sizonenko Ia.V. The influence of the training of the muscular component of the musculo-venous pump in the lower extremities on the clinical course of varicose vein disease. Problems of Balneology, Physiotherapy and Exercise Therapy. 2016; 93(6): 33–36 (In Russ.).]Volpe E.F.T., Resqueti V.R., da Silva A.A.M., et al. Supervised exercise protocol for lower limbs in subjects with chronic venous disease: an evaluator-blinded, randomized clinical trial. Trials. 2020; 21(1): 414. https://doi.org/10.1186/s13063-020-04314-1Menegatti E., Mandini S., Pagani A., et al. The Effect of Active Stretching Training in Patients with Chronic Venous Insufficiency Monitored by Raster-Stereography. Sensors (Basel). 2022; 22(21): 8509. https://doi.org/10.3390/s22218509Jull A., Slark J., Parsons J. Prescribed Exercise With Compression vs Compression Alone in Treating Patients With Venous Leg Ulcers: A Systematic Review and Meta-analysis. JAMA Dermatol. 2018; 154(11): 1304–1311. https://doi.org/10.1001/jamadermatol.2018.3281Ercan S., Çetin C., Yavuz T., et al. Evaluation of the Isokinetic Calf Muscle Strength and the Range of Motion of Joint in C3 Chronic Venous Insufficiency. Vasc Specialist Int. 2019; 35(2): 95–100. https://doi.org/10.5758/vsi.2019.35.2.95van Uden C.J., van der Vleuten C.J., Kooloos J.G., et al. Gait and calf muscle endurance in patients with chronic venous insufficiency. Clin Rehabil. 2005; 19(3): 339–344. https://doi.org/10.1191/0269215505cr809oaZajkowski P.J., Draper T., Bloom J., et al. Exercise with compression stockings improves reflux in patients with mild chronic venous insufficiency. Phlebology. 2006; 21(2): 100–104. https://doi.org/10.1258/026835506777304764Back T.L., Padberg F.T.Jr., Araki C.T., et al. Limited range of motion is a significant factor in venous ulceration. J Vasc Surg. 1995; 22(5): 519–523.E Santos L.V.S, Maia J.N., de Vasconcelos C.R., et al. The relationship between the clinical severity of chronic venous insufficiency and the calf muscle pump: A cross-sectional study. J Bodyw Mov Ther. 2023; 36: 153–157. https://doi.org/10.1016/j.jbmt.2023.04.068Lalchhuanawma A., Sanghi D. The effect of strength training of the calf muscle pump on cardiovascular parameters. Arch Med Health Sci. 2020; 8: 26–30.Obara K., Silva P., Silva M., et al. Isokinetic Training Program to Improve the Physical Function and Muscular Performance of an Individual with Partial Injury of the Medial Meniscus: A Case Report. IJSPT. 2023; 18(3): 758–768. https://doi.org/10.26603/001c.74945Kahn S.R., Shrier I., Shapiro S., et al. Six-month exercise training program to treat post-thrombotic syndrome: a randomized controlled two-centre trial. CMAJ. 2011; 183(1): 37–44. https://doi.org/10.1503/cmaj.100248Jasionowska S., Turner B.R.H., Machin M., et al. Systematic review of exercise therapy in the management of post-thrombotic syndrome. Phlebology. 2022; 37(10): 695–700. https://doi.org/10.1177/02683555221129738Shiman M.I., Pieper B., Templin T.N et al. Venous ulcers: A reappraisal analyzing the effects of neuropathy, muscle involvement, and range of motion upon gait and calf muscle function. Wound Repair Regen. 2009; 17(2): 147–152. https://doi.org/10.1111/j.1524-475X.2009.00468.xForelli F., Moiroux-Sahraoui A., Mazeas J., et al. Gastrocnemius activation deficits and running biomechanics after anterior cruciate ligament reconstruction: the missing link? Front Sports Act Living. 2025; 7: 1594247. https://doi.org/10.3389/fspor.2025.1594247Lepley A.S., Lepley L.K. Mechanisms of Arthrogenic Muscle Inhibition. J Sport Rehabil. 2021; 31(6): 707–716. https://doi.org/10.1123/jsr.2020-0479Makedonov I., Kahn S.R., Galanaud J.P. Prevention and Management of the Post-Thrombotic Syndrome. J Clin Med. 2020; 9(4): 923. https://doi.org/10.3390/jcm9040923