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Abstract

ng, heaviness, or pain and any skin changes.The methodology this study employed to standardize these outcomes.The evaluation utilized the Clinical, Etiological, Anatomical, and Pathophysiological (CEAP) classification, which is widely adopted by vascular specialists. This system standardizes the classification from the presence of reticular veins and telangiectasias (CEAP 1) to more severe cases of chronic venous insufficiency, including the presence of ulcers (CEAP 6).The study also employed the Carpentier score to assess symptoms, assigning scores based on the presence of heaviness, swelling, exacerbation by heat, and alleviation with walking. Doppler ultrasounds were performed to evaluate the diameter and reflux.The results were intriguing. In the HPAV group (high-intensity physical activity), we observed more dilated deep and superficial veins, as well as a higher prevalence of reflux. Intense volumes of physical activity were associated with a higher frequency of visible varicose veins (CEAP classification 2); however, interestingly, this did not influence discomfort.The authors arrived at the following conclusion:“The VARISPORT study reported an increase in the caliber of the lower limb veins without impact on functional discomfort. Further studies are needed to determine whether these athletic veins are truly pathological varicose veins or simply an adaptation to high physical activity volumes.”<h2 id="9d64">Let’s delve further into the study’s design.</h2>This is a cross-sectional study, which is observational in nature. It evaluates the prevalence of a disease at a specific moment in time across two groups and makes comparisons between them.Through this comparison, it is possible to calculate the odds ratio, absolute risk, and relative risk based on prevalence. The advantage of this study model is its cost-effectiveness. However, a disadvantage is the inability to establish a causal relationship. For the question we are addressing, this study is quite suitable and boasts a good number of participants, with 119 in each group.Insights into the quality of the study.This study adhered to two standards of scientific rigor. Firstly, it followed the guidelines of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). STROBE is a set of recommendations guiding researchers on

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how to report observational studies clearly and comprehensively.Additionally, it was registered in the Clinical Trials database (NCT02846051), a globally recognized platform for the registration of clinical studies. These two factors enhance the credibility and transparency of the research.Analyzing the study’s findings.The frequency of reflux in the great saphenous veins was higher in the HPAV group compared to the control group: 20/218 vs. 5/233 (p=.030). Likewise, the incidence of reflux in superficial veins, excluding the saphenous vein, was 41/197 vs. 13/225 (p<.001).These athletes also presented more visible varicose veins classified as CEAP 2 compared to the control group.No reflux was found in the deep veins of either group. In other words, there is a statistically significant difference, with an increase in varicose veins in patients engaging in high-intensity physical activity.Assessing potential limitations.Despite conducting a clinical evaluation, the study does not address secondary distal venous hypertension resulting from these refluxes, nor does it explore histopathological characteristics and inflammation. Varicose veins feature a hypertrophied wall with increased collagen and decreased elastin.However, a critical finding is that these athletes did not exhibit more symptoms than the control group. Another consideration is the selection and representation of the control group, balanced for age, gender, and BMI — do they accurately represent the population?Additionally, the study was unmasked, meaning the investigators were aware of the participants’ group assignments.<h2 id="d8bf">Conclusions</h2>Indeed, engaging in physical activity is beneficial for the health of your veins and legs. Increasing intensity can lead to arterial and venous adaptations, making your veins more visible.However, this study does not conclude that such visibility represents a pathological alteration. As a vascular surgeon, I adopt a more tolerant approach towards varicose veins in high-performance athletes, focusing primarily on conservative measures for treatment.Returning to my marathon runner patient, I will first focus on elastic compression management; if that proves insufficient, I will consider a better physiological assessment.</article></body>

Does Physical Activity Lead to Varicose Veins?

Exploring the link between physical activity and varicose veins.

There is a common perception that increasing physical activity makes the veins in our limbs more noticeable. In some extreme cases, individuals have even reported reducing or completely stopping their physical activities due to the fear of developing varicose veins. Conversely, it is widely recognized that a sedentary lifestyle is a risk factor for venous disease.

Recently, an ultra-marathon runner shared his ultrasound Doppler results with me, revealing minor alterations such as a segment of reflux in the great saphenous vein in the thigh, but without a significant increase in caliber. He reported only a sensation of heaviness after long runs.

He questioned whether this could worsen his performance and if surgery was the best approach. This raises the question: what exactly is the relationship between physical activity and the development of varicose veins in the limbs?

Let’s examine the science behind this!

The 2023 VARISPORT study published in European Journal of Vascular & Endovascular Surgery explored the correlation between physical activity and an increase in the caliber of the deep and superficial lower limb veins. Its main objective was to evaluate the lower limb veins — clinically, morphologically, and hemodynamically — and the symptoms of chronic venous disease in 238 participants.

This cross-sectional study compared a group of volunteers with a high volume of exercise training (more than eight hours of uninterrupted vigorous intensity physical activity per week for more than six months, referred to as the high physical activity volume group, HPAV) with a control group matched for age, sex, and body mass index.

Vein physiology in the limbs is characterized by a unidirectional flow facilitated by a valvular system. Dysfunction in this mechanism can result in dilatation and the development of varicose veins. Doppler ultrasound is employed to detect such alterations. Additionally, venous diseases of the limbs should be evaluated clinically, with particular attention to symptoms such as swelling, heaviness, or pain and any skin changes.

The methodology this study employed to standardize these outcomes.

The evaluation utilized the Clinical, Etiological, Anatomical, and Pathophysiological (CEAP) classification, which is widely adopted by vascular specialists. This system standardizes the classification from the presence of reticular veins and telangiectasias (CEAP 1) to more severe cases of chronic venous insufficiency, including the presence of ulcers (CEAP 6).

The study also employed the Carpentier score to assess symptoms, assigning scores based on the presence of heaviness, swelling, exacerbation by heat, and alleviation with walking. Doppler ultrasounds were performed to evaluate the diameter and reflux.

The results were intriguing. In the HPAV group (high-intensity physical activity), we observed more dilated deep and superficial veins, as well as a higher prevalence of reflux. Intense volumes of physical activity were associated with a higher frequency of visible varicose veins (CEAP classification 2); however, interestingly, this did not influence discomfort.

The authors arrived at the following conclusion:

“The VARISPORT study reported an increase in the caliber of the lower limb veins without impact on functional discomfort. Further studies are needed to determine whether these athletic veins are truly pathological varicose veins or simply an adaptation to high physical activity volumes.”

Let’s delve further into the study’s design.

This is a cross-sectional study, which is observational in nature. It evaluates the prevalence of a disease at a specific moment in time across two groups and makes comparisons between them.

Through this comparison, it is possible to calculate the odds ratio, absolute risk, and relative risk based on prevalence. The advantage of this study model is its cost-effectiveness. However, a disadvantage is the inability to establish a causal relationship. For the question we are addressing, this study is quite suitable and boasts a good number of participants, with 119 in each group.

Insights into the quality of the study.

This study adhered to two standards of scientific rigor. Firstly, it followed the guidelines of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). STROBE is a set of recommendations guiding researchers on how to report observational studies clearly and comprehensively.

Additionally, it was registered in the Clinical Trials database (NCT02846051), a globally recognized platform for the registration of clinical studies. These two factors enhance the credibility and transparency of the research.

Analyzing the study’s findings.

The frequency of reflux in the great saphenous veins was higher in the HPAV group compared to the control group: 20/218 vs. 5/233 (p=.030). Likewise, the incidence of reflux in superficial veins, excluding the saphenous vein, was 41/197 vs. 13/225 (p<.001).

These athletes also presented more visible varicose veins classified as CEAP 2 compared to the control group.

No reflux was found in the deep veins of either group. In other words, there is a statistically significant difference, with an increase in varicose veins in patients engaging in high-intensity physical activity.

Assessing potential limitations.

Despite conducting a clinical evaluation, the study does not address secondary distal venous hypertension resulting from these refluxes, nor does it explore histopathological characteristics and inflammation. Varicose veins feature a hypertrophied wall with increased collagen and decreased elastin.

However, a critical finding is that these athletes did not exhibit more symptoms than the control group. Another consideration is the selection and representation of the control group, balanced for age, gender, and BMI — do they accurately represent the population?

Additionally, the study was unmasked, meaning the investigators were aware of the participants’ group assignments.

Conclusions

Indeed, engaging in physical activity is beneficial for the health of your veins and legs. Increasing intensity can lead to arterial and venous adaptations, making your veins more visible.

However, this study does not conclude that such visibility represents a pathological alteration. As a vascular surgeon, I adopt a more tolerant approach towards varicose veins in high-performance athletes, focusing primarily on conservative measures for treatment.

Returning to my marathon runner patient, I will first focus on elastic compression management; if that proves insufficient, I will consider a better physiological assessment.