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Venous surgeon Professor Mark Whiteley explains all you need to know about varicose veins and how they’re affected by exercise

What are varicose veins?

What are varicose veins?

Varicose veins are swollen bulging veins that usually occur on the legs and around the ankles, though they can be found on the thighs, calves and sometimes in intimate areas around the genitalia and buttocks. They’re a relatively common condition that can affect up to 30% of us in our lifetime. They appear as enlarged lumps on standing that reduce on lying down. If deep, they’re colourless but if near the surface can appear green, purple, blue or red. The bulging appearance can leave many feeling self-conscious.

What causes varicose veins?

Varicose veins occur when valves in our leg veins fail, letting venous blood fall back down the veins when standing up, rather than flowing upwards towards the heart as it should.

Can exercise cause varicose veins?

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No – in fact, it’s almost the opposite. The more you exercise, the bigger your veins get because they must return blood back to heart. However, these are normal veins with working valves. They tend to get smaller in the cool weather and only bulge in warm weather or when you exercise. However, there’s good evidence that the more you exercise the healthier the veins are. Without getting too scientific, the faster the blood flows up a vein, the more “shear stress” there is on the wall and the more the cells in the vein wall secrete a substance called nitric oxide. This chemical keeps the vein wall very healthy. So, exercise doesn’t cause varicose veins and indeed is highly recommended in patients with or without venous problems.

Does exercise prevent varicose veins, improve them or conversely, make them worse?

Whether you get varicose veins or not depends upon your genetic makeup. However, the speed at which your veins deteriorate depends very much upon exercise. People who exercise regularly tend to get fewer complications from varicose veins. Those that exercise infrequently are more likely to deteriorate to swollen ankles, skin damage, clots in the veins, venous eczema, and leg ulcers. Therefore, anyone with varicose veins should keep exercising to reduce the risk of deterioration, although they’ll not get a permanent cure until they have proper endovenous treatment.

Do varicose veins affect you when you swim, bike, and run and your athletic performance? 

Until recently the answer to this would be “no”. However, I’ve recently seen some unpublished research where a new research stocking has been shown to improve blood supply to the legs by helping venous blood out of the varicose veins. The research study looked at some of the available “sport stockings” and didn’t find any improvement. However, using a new stocking that has been designed specifically for sports, an improvement in blood supply to the muscles during exercise was found. Therefore, although this isn’t available at the moment, I think there are exciting developments coming in this area.

Probably the biggest tip for athletes at the moment is that, if you have got varicose veins, you do need to get them treated if they cause any aching, tired legs, discomfort at all or if you get any swollen ankles, red or brown patches around ankles, eczema over the ankles or veins themselves, or if you have ever had phlebitis in the varicose veins (hard red lumps that get painful) or a bleed from the veins. All of these are medical indications outlined in NICE Clinical Guidelines 168 that have been shown by research to require veins to be treated. Nowadays, it’s been shown that no one should have the vein stripped and all the new effective techniques are done under local anaesthetic as walk-in walkout endovenous procedures.

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