Raised Leg Exercises for Leg Edema in the Elderly

Abstract

Leg edema is a common problem in the elderly and requires further evaluation and management. Method: From October 1990 to July 1992, 245 patients presented to the Cleveland Clinic Florida with leg edema. All patients were counseled about the benefits of twenty-minute, three-times-a-day raised-leg exercises. Fifty seven (57) of the 245 patients were not compliant with this regimen (nonexercise group). Although not true controls, they formed a comparison group for those who performed the exercise regimen. The exercise group was composed of 188 patients with a mean age of 73 ±6.8 years, 25 (13%) men and 163 (87%) women; the nonexercise group was composed of 57 patients with a mean age of 71.9 ±4.3, 19 (33%) men and 38 (67%) women. Workup for leg edema included: comprehensive history, clinical examination including prostate or pelvic examination, complete blood count, chemistry profile, thyroid profile, electrocardiogram, chest radiograph, and, when indicated, pelvic or leg ultrasound and pelvic computed tomographic scan. The circumference of the leg with the maximum amount of edema was measured initially and on the fourth week. Results: In this study, the common causes of leg edema in the elderly population were venous stasis (63.2%), drug induced (13.8%), and heart failure (15.1%). Postphlebitic syndrome, cirrhosis, lymphedema, lipedema, prostate carcinoma (CA), and ovarian mass were the less frequent findings. Upon comparison of the circumference of leg edema on initial visit and four weeks after, both the exercise and nonexercise groups showed significant decreases in the measurement of the leg edema (P < .001) except those caused by lymphedema. The amount of change when compared between those who exercised and those who did not was significant only in venous stasis. Conclusion: Causes of leg edema in the elderly are multiple. Twenty-minute, three-times-a-day raised-leg exercises were significantly more effective in the management of leg edema due to venous stasis (P < 0.0001) but did not produce significant differences in other etiologies such as heart failure, drug induced, and other conditions, which include lymphedema, prostate and ovarian CA, and postphlebitic syndrome. Successful management of leg edema is based on adequate and thorough assessment to identify the cause.