Exercise guide
A deep vein thrombosis (DVT) is a blood clot in a vein, usually in the leg, and a pulmonary embolism (PE) is a clot that has reached the lungs. Once you've started blood thinners (anticoagulants), walking is part of getting better: in studies of more than 3,000 people, those who walked from the first days of treatment did no worse than those kept in bed, and their pain often eased sooner. Most people build back to their usual exercise over weeks to months.
This guide covers when to start and how to build up after a DVT or PE, breathlessness and rehabilitation after a PE, exercising on blood thinners, compression stockings, flying and post-thrombotic syndrome. It also lists the signs that mean calling 999 and when to get an urgent GP appointment. Your own team's advice about your blood thinners always comes first.
After a DVT, the NHS says stay active and walk regularly if you can, and keep your leg raised when you sit. Bed rest isn't needed: across 13 studies with 3,269 people, walking from early on didn't raise the chance of a clot reaching the lungs, and pain eased sooner in people who started with moderate or severe pain.
Blood thinners stop the clot growing and new clots forming while your body breaks the clot down over weeks to months. In the trials, walking began on the first day of treatment. A leg you think might have a clot that hasn't been checked needs a same-day check, not exercise.
Thrombosis UK's physiotherapists suggest short walks on 5 to 7 days a week, working until you're a little out of breath, then adding light strength work. The long-term aim is 150 minutes of moderate activity a week with strength work on 2 days, and getting there can take several months.
Breathlessness and tiredness can last weeks or months after a PE. European heart specialists advise going back to sport step by step, and waiting for strenuous exercise and flying until the right side of the heart has recovered: a few days after a small PE, several weeks after a bigger one. That's expert opinion, so ask your team which applies to you.
Exercise is encouraged on blood thinners, but you'll bleed and bruise more if you're injured. Your clinic may advise avoiding contact sports, and protective gear helps in others.
NICE (the National Institute for Health and Care Excellence) says not to offer stockings to prevent post-thrombotic syndrome or another clot, though they can be used for aching and swelling; in the largest trial, they didn't prevent it. If your team gave you stockings, wear them as advised.
A DVT is a blood clot in a vein, usually in the leg, though it can happen in an arm. The signs are throbbing pain and swelling in one leg (rarely both), usually in the calf or thigh, red, blue or darkened skin (harder to see on brown or black skin) and swollen veins. Some clots happen for no obvious reason.
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A PE is a blockage of a blood vessel in the lungs, usually by a clot that has travelled from a leg vein. It causes breathlessness that comes on suddenly, chest pain that's worse when you breathe in, and sometimes coughing up blood. PEs range from very mild to life-threatening, and the NHS says you should make a full recovery if it's spotted and treated early.
A first DVT affects 50 to 100 adults in every 100,000 each year, and the rate roughly doubles with each 10 years of age. At least 1 in 12 middle-aged adults will have a DVT or PE in the rest of their life, and 60% of clots happen in people over 65.
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The NHS lists:
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Anticoagulant tablets such as rivaroxaban or apixaban, or injections, usually for at least 3 months, after which your team reviews them; some people take them for longer. They're often called blood thinners, but they don't actually make the blood thinner: they slow down clotting. In pregnancy, injections usually continue until 6 weeks after the birth.
Damage to the valves in a leg vein can leave long-term aching, heaviness, swelling, darker or harder skin and, at worst, ulcers. Estimates of how often it follows a leg DVT vary: Thrombosis UK says up to 30% within 5 years, mostly between 6 months and 2 years; the European vascular surgeons give 20% to 50% at 1 to 2 years; and a Cochrane review says 1 in 3 within 5 years.
Breathlessness and tiredness are normal for weeks or months. European heart specialists say up to 40% to 60% of people report ongoing breathlessness, poorer fitness or low mood after 3 months of treatment, most often from losing fitness. A serious long-term problem with the lung's blood pressure (chronic thromboembolic pulmonary hypertension, CTEPH) affects 2% to 3%. The 2022 European pulmonary hypertension guideline recommends further tests for CTEPH if breathlessness or difficulty exercising continues, or starts, after a PE (class I, level C), and our pulmonary hypertension guide covers exercise with it.
Across 13 studies (3,269 people), walking from early on with blood thinners didn't raise the chance of a new PE, the clot growing or dying, compared with bed rest, and pain eased sooner in people whose pain started moderate or severe. In a registry of 2,650 people, a new PE within 15 days happened in 0.5% after a DVT and 0.7% after a PE, whether people walked or rested. One trial that scanned everyone's lungs (129 people) found small new clots in 10.0% with 4 days of bed rest and 14.4% with walking, a difference that could be chance. The trials are small and older, but they agree.
In a trial of 72 people, described in a later paper, daily walking plus physiotherapy didn't change how much the vein had reopened at 6 months. Blood thinners stop the clot growing; your body clears it.
In a trial of 211 people still breathless 6 months to 6 years after a PE, 8 weeks of twice-weekly exercise classes added 53 metres to a walking test and improved quality of life, with no adverse events, and the walking gain lasted at least 6 months. In a trial of 140 people starting soon after a mostly mild PE, a home programme was safe but no better than advice and phone calls from a nurse.
Across 9 trials (583 people), exercise after a PE was safe, with gains in fitness and quality of life but not clearly in breathlessness, and the pooled results were inconsistent. In a US pilot of 23 people, most after a serious PE, supervised exercise started a median of 18 days after diagnosis with no exercise-related problems.
A treadmill session didn't make leg symptoms worse in 41 people with a past DVT, though the leg swelled a little more in those with post-thrombotic syndrome. In the only randomised trial (43 people with post-thrombotic syndrome), 6 months of strength, stretching and aerobic exercise improved leg-related quality of life, with a smaller change in severity that could be chance. A 2022 review found no other trials.
NICE says not to offer stockings to prevent post-thrombotic syndrome or another clot. In the SOX trial (806 people in Canada and the US), it affected 14.2% with real stockings and 12.7% with placebo stockings. A Cochrane review of 10 trials found a possible benefit with low-quality evidence, and the European vascular surgeons still suggest below-knee stockings. Either way, stockings can ease aching and swelling.
Blood thinners lower the risk of another clot and stop this one growing. Exercise works alongside them, never instead: keep taking them as prescribed until your team reviews them.
These are starting points for someone without warning signs. Your team's advice comes first.
Walk around the house and short distances outside several times a day from the day treatment starts, and sit with your leg raised (our editorial starting point, built on the NHS advice and the trials). If you've been given stockings, wear them as advised.
Walk on 5 to 7 days a week, on a flat route near home with places to rest. Warm up with 3 to 5 minutes of slow walking, then walk at a pace where you're a little out of breath: about 3 to 5 on a scale where 10 is the most out of breath you could be. Cool down by walking slowly. If you can only manage a few minutes at first, that's fine: you're building stamina with every walk. Exercise shouldn't be painful.
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Start with low weights or a light band and build up gradually, towards strength work on 2 days a week.
The NHS aims for 150 minutes of moderate activity a week, and European heart specialists suggest 150 to 300 minutes after a PE, with strength work on 2 days. Thrombosis UK says reaching your goal may take several months.
No trial or guideline sets a date. Our editorial suggestion: once brisk 30-minute walks feel easy without much leg pain or swelling, try run-walk intervals and lighter weights than before, building up over weeks. On blood thinners, think about falls (ice, trails, mountain biking) and dropped weights. After a PE, save hard or maximal efforts until your team says your heart has recovered.
NHS Lothian's leaflet, which is past its review date, says breathlessness and tiredness are normal and can last weeks or even months: don't push yourself too much in the first few weeks, and build up your exercise as you feel able. Thrombosis UK's effort target, a little out of breath (3 to 5 out of 10), works here too.
European heart specialists suggest waiting for strenuous exercise until the right side of the heart has recovered from the strain of the clot: in their words, this may take only a few days after a low-risk PE and several weeks after a bigger one, and some teams check with a heart scan. They advise going back to sport step by step. This is expert opinion, not trial evidence, so ask your team.
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In a US pilot of 23 people, most after a serious PE, a supervised programme started a median of 18 days after diagnosis: walking 3 times a week for 20 minutes, building over 3 weeks to 30 minutes at a harder effort, then 5 days a week. No one had an exercise-related problem. The authors concluded that exercise can start as early as 4 weeks after a PE, but 23 people is a small study.
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It's common, and usually comes from losing fitness, sometimes from anxiety, and rarely from a long-term problem with the lung's blood pressure. See your GP if it lasts more than 3 months or isn't improving. European specialists suggest an exercise test to find the cause, then rehabilitation if nothing else is found; in one trial, 8 weeks of classes improved walking distance. Rehabilitation after a PE isn't routine in the UK, so ask your team or GP.
Walking fast or climbing stairs can bring on breathlessness or a calf ache that feels like the first clot, and set off panic. Thrombosis UK's psychologists suggest slow breathing from your tummy and relaxing your muscles as soon as the fear starts, and getting checked if the symptoms continue once your breathing has settled. Their counting exercise includes breath holds; if holds feel uncomfortable, slow breathing without them works too. Breathlessness that comes on suddenly, or chest pain, always means 999.
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Short walks most days, at a pace where you're a little out of breath, with 3 to 5 minutes of slow walking or marching to warm up (Thrombosis UK). A recumbent bike suits days when your balance or leg feels unsure (our suggestion); its move page starts at 10 to 20 minutes, building towards 30.
Thrombosis UK suggests ankle pumps, knee straightening and seated marching every hour when you sit for long periods, and the NHS says bend and straighten your legs, feet and toes every 30 minutes on long journeys. Our suggestion: 10 ankle pumps, then 5 circles each way, and 10 knee straightens on each leg.
Start light, on 2 days a week, and build up: exercise shouldn't be painful (Thrombosis UK). Calf raises and calf stretches were part of the programme in the post-thrombotic syndrome trial. Slow breathing, without holds, helps if fear of another clot sets off panic.
3D demoSlow calf raiseBeginner · A wall
3D demoSit to stand from a chairBeginner · A bench or box
3D demoWall push-upBeginner · A wall
3D demoBand rowBeginner · A band + An anchor point
3D demoLow step-upBeginner · A step
3D demoWall calf stretch (gastrocnemius)Beginner · A wall
3D demoSoleus wall stretchBeginner · A wall
3D demoSlow breathing (6 breaths a minute)Beginner · No equipmentFrom the NHS DVT and pulmonary embolism pages and Thrombosis UK's leaflet; the counts are our suggestion.
See the movement on the 3D figure: Ankle circles
The risk on blood thinners is bleeding if you're hurt, not the exercise itself. The NHS asks you to try to avoid minor injuries and to use protection when playing sports, and says your GP or anticoagulant clinic may advise you to avoid contact sports. European specialists advise avoiding contact or injury-prone sport for as long as you take blood thinners.
Walking, swimming, cycling with a helmet, rowing machines, gym work and yoga suit most people (our suggestion, as in our atrial fibrillation guide). Leave out rugby, boxing, martial arts sparring and other contact sports unless your team says otherwise, and think about falls on ice, trails or a mountain bike.
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Know the signs of bleeding in the warning signs below. Get help straight away after a major accident, a significant blow to the head, or bleeding you can't stop; our atrial fibrillation guide lists the head injury signs that need 999.
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Don't take ibuprofen unless your doctor says you can, and ask a pharmacist before any other medicine or remedy. Ask before deep massage or foam rolling, and never roll or massage a leg that's still swollen from a clot.
NICE says not to offer stockings to prevent post-thrombotic syndrome or another clot after a DVT. Stockings for aching and swelling are a separate decision, and if you're given them, your team should explain how to wear and replace them.
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Wear them as advised: they can ease aching and swelling. The European vascular surgeons suggest starting compression early for pain and swelling, and stopping at 6 or 12 months if you have few symptoms. Wearing them while you exercise is fine if they help (our suggestion).
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Stockings aren't safe if the arteries in your legs are narrowed, or with severe heart failure. A GP may check the pulses in your feet and do an ankle pressure test first.
The calf pump exercises workout suits it: calf raises, ankle pumps, a brisk walk and calf stretches.
Damage to a vein's valves after a DVT raises the pressure in the leg veins, causing aching or cramping, heaviness, tingling, swelling, darker or harder skin, varicose veins and, at worst, ulcers. It's usually worse after standing or walking and better with your leg raised. Thrombosis UK says up to 30% of people develop it within 5 years, mostly between 6 months and 2 years after the clot; the European vascular surgeons give 20% to 50% at 1 to 2 years; a Cochrane review says 1 in 3 within 5 years. It's more likely after a second clot in the same leg.
Thrombosis UK lists sitting with your leg raised, grade 2 compression stockings, regular exercise, losing weight if you need to, painkillers and caring for any ulcers; no medicine has been shown to help much. In severe cases, a pump that squeezes the leg (intermittent pneumatic compression) is an option, with low-certainty evidence.
In the trial, people did strength exercises 3 to 4 times a week, stretches daily and 60 to 120 minutes of aerobic exercise a week, with a trainer, for 6 months. The leg may swell a little more after exercise, so raise it afterwards.
The NHS says delay flights or long journeys until at least 2 weeks after starting blood thinners for a DVT. NHS Lothian's PE leaflet, which is past its review date, says long-distance travel isn't recommended in the first 4 weeks after a PE. European heart specialists want the right side of the heart to have recovered before flying soon after a PE. These are expert advice rather than trial results, so ask your team.
On journeys of 4 hours or more, wear loose clothing, drink water, avoid much alcohol, walk about when you can, and bend and straighten your legs, feet and toes every 30 minutes. In 12 trials on flights of more than 5 hours, flight socks cut symptomless clots (3 against 47 in 2,637 people), with high-certainty evidence.
For people with a past PE planning flights of more than 4 hours after stopping blood thinners, European specialists propose either stockings or a preventive dose of blood thinner. Ask your team before booking.
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Arm DVTs are rare and often happen in younger, healthy people: from pressure where the vein leaves the chest (the thoracic outlet), or after vigorous upper-body activity, especially in swimmers and throwers. The same principles apply: start with treatment, build up gently, and ask your team before going back to the sport that triggered it (our suggestion). Our thoracic outlet syndrome guide covers the shoulder.
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Phlebitis (superficial thrombophlebitis) is inflammation of a vein near the skin, common with varicose veins: painful, warm, red, hard and tender. It often gets better on its own within 1 or 2 weeks. The NHS says keep using the leg or arm, raise it when resting and use a warm, moist flannel. Get an urgent GP appointment or call 111 for throbbing or cramping pain, sudden swelling, or veins that are hard or sore, in case it's a DVT.
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Clots are more likely after surgery, a hospital stay or 3 or more days in bed, and can happen weeks later. The NHS advises staying active and walking around if you can, and your team may give you stockings or medicine to prevent a clot, sometimes for weeks after you go home. Our knee and hip replacement guides, and our guides after a hysterectomy, a stoma operation and breast cancer surgery, have the exercises for those operations.
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Start with the easy cardio walk and the desk break. The calf pump routine suits leg aching after a DVT; the interval walks and run-walk sessions come later, once brisk walks feel easy. The breathing workout's box and 4-7-8 breathing use holds, which some people find uncomfortable.
A steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, A wallA 3-minute standing break to repeat every 30 to 60 minutes at your desk: sit-to-stands, calf raises, marching, an upper-back turn and chin tucks.
3 minBeginner5 movesA bench or box, A wallA 10-minute routine for straight after a meal: an easy walk, a few simple standing moves from blood sugar trials, then a short walk to finish.
10 minBeginner6 movesCardio machine, A bench or boxA 15-minute calf pump routine for varicose veins and heavy, swollen legs: ankle pumps, calf raises, a brisk walk, calf stretches and legs up to finish.
15 minBeginner10 movesA bench or box, A wallA gentle 20-minute beginner home workout with a chair, a wall and a band: sit-to-stands, wall push-ups, band rows, step-ups and dead bugs.
20 minBeginner11 movesA bench or box, A wallA 25-minute walk with short faster bouts: notice your heart and breathing speed up, then settle. A gentle way to get used to the feelings of effort.
25 minBeginner5 movesCardio machine, A wallA 30-minute beginner run-walk session: a brisk walk, then 1-minute jogs with 1-minute walks, building to 3-minute runs over your first three weeks.
30 minBeginner5 movesCardio machine, A wallA 6-minute breathing routine: slow breathing, crocodile breathing, alternate nostril breathing, box breathing and 4-7-8 breathing.
6 minBeginner5 movesNo equipmentThe walking plan builds towards 150 minutes a week. The couch to 5K plan is a run-walk return once your team agrees.
A free 8-week walking plan for beginners: build to 150 minutes of brisk walking a week, with intervals, hills and two short strength sessions.
6 training days40 minBeginner2 days a weekYour first four weeks: two, then three short strength sessions a week at home plus walks, building gently to a full routine.
2 training days20 minBeginner3 days a weekA 9-week beginner plan with the same walk-to-run shape as Couch to 5K: three run-walk sessions a week, from 1-minute jogs to 30 minutes of running.
3 training days35 minBeginnerThis is general information, not a diagnosis: your own team knows your clot and your treatment. A&E means accident and emergency, and GP means general practitioner. In the US, call 911 where this page says 999.
Call 999, or have someone drive you to A&E (don't drive yourself), if:
Ask for an urgent GP appointment or get help from NHS 111 if:
Call 111 or go to A&E for severe or repeated bleeding, such as:
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A burst Baker's cyst, a calf strain and cramp can feel similar. If you think it could be a DVT, get an urgent GP appointment or call 111 the same day; our calf pain guide explains the differences.
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Once treatment has started, walking doesn't make the clot more likely to travel. In studies of more than 3,000 people, those who walked from the first days did no worse than those kept in bed, and their pain often eased sooner. A suspected clot that hasn't been checked still needs a same-day check first.
Bed rest isn't needed and doesn't make you safer: the NHS says stay active and walk regularly if you can. Being in bed for 3 days or more makes a clot more likely, not less.
Your body breaks the clot down over weeks to months, and in one trial daily walking didn't change how much the vein reopened. Exercise works alongside your blood thinners, not instead of them: keep taking them exactly as prescribed until your team reviews them.
NICE doesn't recommend stockings to prevent it, and in the largest trial they didn't, though a Cochrane review and the European vascular surgeons see a possible benefit. Stockings are for aching and swelling: if your team gave you some, wear them as advised.
Exercise is encouraged. The risk is bleeding if you're hurt, so choose activities where a fall or a blow is unlikely, and ask your clinic about contact sports.
Clots take weeks to months to break down, but walking began on the first day of treatment in the trials, and the NHS advises walking. What waits is strenuous exercise after a bigger PE, until your team says your heart has recovered.
No trial has shown this. The only trial of exercise for post-thrombotic syndrome was in people who already had it, and it improved quality of life. In one small trial, walking with compression from the start was followed by less post-thrombotic syndrome, but the two can't be separated. Exercise is good for you after a clot; your blood thinners are what prevent another one.
Feeling breathless for weeks or months is common and usually comes from losing fitness. If it lasts more than 3 months or isn't improving, see your GP. If breathlessness comes on suddenly, call 999.
Yes, once it's been diagnosed and you've started blood thinners: the NHS advises walking regularly and keeping the leg raised when you sit. In trials, walking from the first day of treatment was as safe as bed rest and eased pain sooner. If you think you have a clot that hasn't been checked, get an urgent GP appointment or call NHS 111 the same day instead of exercising.
Not once treatment has started, as far as the studies show. Across 13 studies with 3,269 people, walking early didn't raise the chance of a clot reaching the lungs, and in a registry of 2,650 people a new pulmonary embolism within 15 days happened in fewer than 1 in 100, whether people walked or rested. Blood thinners stop the clot growing while your body breaks it down.
You can walk from the day treatment starts. Thrombosis UK's physiotherapists suggest short walks on 5 to 7 days a week, warming up for 3 to 5 minutes and working until you're a little out of breath, then adding light strength work. Build towards 150 minutes a week; getting back to where you were can take several months.
Gentle walking can start straight away, building up as you feel able, but don't push hard in the first few weeks. European heart specialists advise waiting for strenuous exercise until the right side of your heart has recovered: a few days after a small PE, several weeks after a bigger one. That's expert opinion; in a small US study of 23 people, supervised exercise started a median of 18 days after a PE without problems. Ask your team which applies to you.
Breathlessness and tiredness can last weeks or months, and up to 4 to 6 in 10 people report some ongoing limits after 3 months, most often from losing fitness. See your GP if it lasts more than 3 months or isn't improving, so other causes, including a less common long-term lung pressure problem, can be checked. In a trial of 211 people still breathless after a PE, 8 weeks of exercise classes improved how far they could walk.
Some aching is common at first, and in the trials pain eased sooner in people who walked than in those who rested. Exercise shouldn't be painful, so slow down if it hurts and rest with your leg raised afterwards. Pain and swelling that suddenly get worse need an urgent GP appointment or NHS 111, and 999 if you're also breathless or have chest pain.
Yes, exercise is encouraged. The risk is bleeding if you're hurt, so your GP or anticoagulant clinic may advise avoiding contact sports such as rugby, boxing or martial arts, and protective gear helps in other sports. Get help straight away after a major accident, a significant blow to the head or bleeding you can't stop.
Yes, but build up to it: no trial or guideline sets a date. Thrombosis UK advises starting with low weights and increasing gradually, and once brisk 30-minute walks feel easy, run-walk intervals are a sensible next step (our suggestion). After a PE, save hard or maximal efforts until your team says your heart has recovered.
If your team gave you stockings, wear them as advised: they can ease aching and swelling. The NHS doesn't use them to prevent post-thrombotic syndrome, because in the largest trial (806 people) they didn't, though European vascular surgeons still suggest them. They aren't safe if the arteries in your legs are narrowed, so get advice before buying strong ones.
The NHS says wait at least 2 weeks after starting blood thinners for a DVT. For a PE, NHS Lothian's leaflet (past its review date) says 4 weeks, and European specialists want your heart to have recovered first; these are expert advice, so ask your team. On journeys of 4 hours or more, walk about, bend and straighten your legs, feet and toes every 30 minutes, drink water and consider flight socks.
It's long-term aching, heaviness, swelling and skin changes in the leg after a DVT. Estimates vary: Thrombosis UK says up to 30% of people within 5 years, and the European vascular surgeons 20% to 50% at 1 to 2 years. Exercise didn't make symptoms worse in a treadmill study, and a 6-month programme improved leg-related quality of life in a small trial of 43 people.
That's common: walking fast or climbing stairs can bring on breathlessness or a calf ache that feels like the first clot. Thrombosis UK's psychologists suggest slow breathing from your tummy and relaxing your muscles as soon as the fear starts, and getting checked if the symptoms continue once your breathing has settled. Start with short, easy walks, and remember that sudden breathlessness or chest pain always means 999.
Exercise education, not a diagnosis or treatment plan, and clinical review of these guides is pending. Stop and get advice for chest pain, unusual breathlessness, dizziness or fainting, or new pain, and check with your doctor or midwife first if they have told you to limit activity. Health disclaimer.
