Handgrip Exercises for Blood Clots

Enrolling by invitation at 1 trial location

Overseen By Rachel Baker, PhD, RN

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: TriHealth Inc.

Disqualifiers: Under 18, Bleeding disorder, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: up to 4 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if handgrip exercises can reduce the risk of developing deep vein thrombosis (DVT), a type of blood clot, in patients with a PICC line. Participants will either receive standard hospital care or perform handgrip exercises three times a day. The trial is ideal for those who have had a PICC line placed in the past 24 hours at Bethesda North Hospital or Good Samaritan Hospital. As an unphased trial, this study provides a unique opportunity to contribute to innovative research that could enhance patient care.

Do I have to stop taking my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications.

Do I need to stop my current medications for the trial?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that handgrip exercises are safe for preventing DVTs?

Research shows that handgrip exercises are generally safe for most people. One study found these exercises safe for patients with deep vein thrombosis (DVT), as they did not increase side effects when combined with regular treatments.

Another study found that handgrip exercises can reduce the risk of blood clots and improve blood flow. Stronger handgrip strength is also linked to a lower risk of DVT. Thus, these exercises not only appear safe but may also help with blood clot issues. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about handgrip exercises for blood clots because they offer a simple, non-pharmaceutical method to potentially improve circulation and reduce clot formation. Unlike standard treatments that often rely on blood thinners or anticoagulants, this approach uses a physical activity to stimulate blood flow. This makes it an attractive option for individuals who may not tolerate medication well or are looking for a more natural way to manage their condition. Additionally, handgrip exercises can be easily incorporated into daily routines, providing a convenient and accessible alternative to traditional treatments.

What evidence suggests that handgrip exercises might be an effective treatment for DVT?

Research has shown that handgrip exercises might help lower the risk of developing deep vein thrombosis (DVT), a type of blood clot. People with stronger hand grip strength have nearly a 30% lower risk of DVT. Physical activities like handgrip exercises can improve blood flow, which helps prevent blood clots. Studies also indicate that these exercises can reduce the chance of blood clots related to PICC lines by enhancing blood flow in the veins. In this trial, participants in the Handgrip Exercise Group will perform these exercises, while those in the Standard Care Group will not receive instruction on handgrip exercises. Although this study is the first of its kind in the U.S. for hospitalized adults, early results suggest it could be promising in managing blood clot risks. ^{1 2 3 4 6}

Who Is on the Research Team?

Rachel Baker, PhD, RN

Principal Investigator

TriHealth Nurse Researcher

Are You a Good Fit for This Trial?

This trial is for adult patients who have a PICC line in place and are currently hospitalized. The goal is to see if handgrip exercises can prevent deep vein thrombosis (DVT), which is a type of blood clot that can occur with PICC lines.

Inclusion Criteria

Patient is admitted to either Bethesda North Hospital or Good Samarian Hospital

I had a PICC line inserted by a specialist team within the last day.

Exclusion Criteria

I am unable to give consent for research participation.

I have a bleeding disorder.

I am under 18 years old.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants perform hand grip exercises or receive standard care from PICC placement to removal

up to 4 weeks

Daily exercises, no additional visits specified

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Handgrip Exercises

Trial Overview The study tests whether doing handgrip exercises can reduce the risk of developing DVT in patients with peripherally-inserted central catheters. It's the first study of its kind in the U.S., aiming to find an innovative prevention method.

How Is the Trial Designed?

Group I: Handgrip Exercise Group Experimental Treatment 1 Intervention

Participants will be instructed to firmly grip and squeeze the ball for 10 seconds, relax for 10 seconds and repeat for 10 minutes. They will be instructed to do this 3 times per day.

Group II: Standard Care Group Active Control 1 Intervention

Participants will receive standard care that includes no instruction about conducting hand grip exercises.

Who Is Running the Clinical Trial?

TriHealth Inc.

Lead Sponsor

Trials

103

Recruited

54,100+

Published Research Related to This Trial

In a study involving 48 rabbits with induced deep vein thrombosis, early ambulation did not significantly increase the incidence of pulmonary embolism compared to immobilization, suggesting that movement may be safe post-thrombosis when anticoagulation is administered.

The research showed that regardless of the stage of thrombus organization (early, medium, or later), there were no statistically significant differences in pulmonary embolism incidence between immobilized and mobile groups, indicating that early exercise may not pose additional risks.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Exercise versus immobilization in the treatment of acute deep vein thrombosis during different clot-organized stage: an animal experiment]. Qi, H., Zhang, F., Liu, Y., et al.[2014]

Early exercise, such as walking, is safe for patients with acute DVT and can help reduce limb pain without increasing the risk of pulmonary embolism, based on a review of 9 studies.

For patients with previous DVT, structured exercise programs improve calf muscle strength and flexibility, and high levels of physical activity may reduce postthrombotic symptoms, indicating that exercise is beneficial for recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Physical activity in patients with deep venous thrombosis: a systematic review. Kahn, SR., Shrier, I., Kearon, C.[2022]

A novel leg exercise apparatus (LEX) was tested on 20 patients after total joint arthroplasty, showing that 80% completed the 7-day exercise regimen without severe adverse events.

The use of LEX did not result in any cases of deep vein thrombosis or significant changes in vital signs, indicating it is a safe and feasible method for preventing venous thromboembolism (VTE) in postoperative patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility and Safety of a Novel Leg Exercise Apparatus for Venous Thromboembolism Prophylaxis after Total Joint Arthroplasty of the Lower Extremities-A Pilot Study. Tanaka, K., Shimizu, Y., Kamada, H., et al.[2022]

In a study of 72 patients with deep vein thrombosis (DVT), early supervised exercise combined with standard treatment was found to be safe, showing no increase in complications such as recurrent DVT or pulmonary embolism over a six-month follow-up period.

However, early exercise did not significantly improve the recanalization of thrombi or reduce symptoms like pain and swelling compared to the control group, indicating that while safe, it may not provide additional therapeutic benefits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Does supervised exercise after deep venous thrombosis improve recanalization of occluded vein segments? A randomized study. Isma, N., Johanssson, E., Björk, A., et al.[2018]

Upper body exercise, specifically three intermittent 30-second bouts of low-intensity cycling, significantly increased venous blood flow in the lower extremities by up to 57% in healthy individuals, suggesting a potential method to prevent DVT when lower body movement is restricted.

In patients with acute DVT, the same upper body exercise protocol resulted in an even greater increase in venous blood flow by 45% to 83%, lasting over 13 minutes, indicating its efficacy as a prophylactic measure for DVT.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Upper body exercise increases lower extremity venous blood flow in deep venous thrombosis. Caldwell, K., Prior, SJ., Kampmann, M., et al.[2017]

Exercise-based rehabilitation is safe for patients with venous thromboembolism (VTE), including those with deep vein thrombosis (DVT), pulmonary embolism (PE), and postthrombotic syndrome (PTS), based on a review of nine studies.

However, there is limited evidence to suggest that regular exercise significantly improves exercise capacity in VTE patients, indicating a need for more robust studies in this emerging field.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effectiveness of exercise training in treating venous thromboembolism: a systematic review. Xu, L., Fu, C., Zhang, Q., et al.[2021]

A six-month supervised exercise training program showed significant improvement in quality of life for patients with post-thrombotic syndrome, as measured by the VEINES-QOL questionnaire, compared to a control group.

The exercise training also led to a reduction in the severity of post-thrombotic syndrome symptoms, although this result was not statistically significant, indicating potential benefits that warrant further investigation in larger trials.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Six-month exercise training program to treat post-thrombotic syndrome: a randomized controlled two-centre trial. Kahn, SR., Shrier, I., Shapiro, S., et al.[2021]

Preventing blood clots, such as deep vein thrombosis (DVT) and pulmonary embolism, is more cost-effective than treating them, yet compliance with prevention guidelines is often poor, highlighting the need for better adherence to clinical practices.

Both pharmacological (like heparin and factor Xa inhibitors) and nonpharmacological (like compression stockings and pneumatic devices) interventions are effective in preventing and treating DVT, but they must be properly implemented to reduce the risk of complications like excessive bleeding.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Venous thromboembolism: pharmacological and nonpharmacological interventions. Long, JB.[2014]

In a study of 1289 patients with acute deep vein thrombosis (DVT), early ambulation combined with compression therapy resulted in a low incidence of recurrent and fatal pulmonary emboli, supporting this approach over traditional bed rest.

The study found that 35.1% of patients with lower leg vein thrombosis had pulmonary emboli, highlighting the need for thorough diagnosis and treatment of calf clots, as many were asymptomatic.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Therapy of deep vein thrombosis with low molecular weight heparin, leg compression and immediate ambulation. Partsch, H.[2012]

Preventing deep vein thrombosis (DVT) is crucial to avoid post-thrombotic syndrome (PTS), which can severely impact quality of life; pharmacologic or mechanical thromboprophylaxis is recommended for high-risk patients.

For patients already experiencing PTS, daily use of 20-30 mm Hg knee-length elastic compression stockings is suggested, and if symptoms persist, stronger stockings or intermittent compression devices may be beneficial.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Guidance for the prevention and treatment of the post-thrombotic syndrome. Kahn, SR., Galanaud, JP., Vedantham, S., et al.[2022]

The Leg Exercise Apparatus (LEX) significantly increased blood flow in the lower leg compared to conventional ankle exercises, with a 1.76-fold increase in blood flow after using the LEX versus a 1.44-fold increase with traditional exercises.

The LEX also enhanced blood vessel diameter more effectively, suggesting it could be a promising new tool for preventing deep vein thrombosis (DVT) in bedridden individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The use of a novel in-bed active Leg Exercise Apparatus (LEX) for increasing venous blood flow. Tanaka, K., Kamada, H., Shimizu, Y., et al.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11557092/

Effect of muscle strength on deep vein thrombosis For low hand grip strength (EWGSOP), the OR was 0.702, indicating a 29.8% lower risk of DVT in individuals with stronger hand grip strength.

2. withpower.com withpower.com/trial/phase-deep-vein-thrombosis-9-2023-71735

Handgrip Exercises for Blood Clots · Info for Participants Studies suggest that physical activities, like handgrip exercises, can increase blood flow and may help in preventing or managing blood clots.

3. clinicaltrials.gov clinicaltrials.gov/ct2/show/NCT06370702?draw=2&rank=1

Evaluating the Use of Grip Exercises to Decrease Deep ... The current study will be the first study to evaluate hand grip exercises for the prevention of DVTs in adult patients hospitalized in the United States.

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9997825/

Quantified versus willful handgrip exercises for the prevention ... Quantified grip exercises can effectively reduce the occurrence of PICC-related thrombosis and infection, improve the venous hemodynamics.

5. researchgate.net researchgate.net/publication/372017626_Hand_grip_strength_in_venous_thromboembolism_risk_of_recurrence_and_mortality

Hand grip strength in venous thromboembolism: risk of ... Objectives: To investigate whether weak hand grip strength (HGS) was associated with risk of recurrence and mortality in patients with VTE ...

6. journals.lww.com journals.lww.com/md-journal/fulltext/2023/03100/quantified_versus_willful_handgrip_exercises_for.12.aspx

Quantified versus willful handgrip exercises for the... Quantified grip exercises can effectively reduce the occurrence of PICC-related thrombosis and infection, improve the venous hemodynamics.