Physical exercises as a method for correcting dysfunction of the calf muscle-venous pump in patients with post-thrombotic disease: a review

INTRODUCTION. Dysfunction of the calf muscle-venous pump (MVP) associated with venous obstruction contributes to ineffective venous blood emptying from the distal lower extremities and can be considered a therapeutic target in the treatment of chronic venous diseases. Physical exercise (PE) can be an effective method for increasing the hemodynamic efficiency of the MVP. AIM. A search and analytical review of research findings published in international databases, focusing on the role of MVP dysfunction in the pathogenesis of chronic venous insufficiency (CVI), as well as the effectiveness of various types of physical exercise. MATERIAL AND METHODS. Fifty-one sources were identified from databases eLibrary.RU, Scopus, PubMed, Web of Science from 1998 to 2025, of which 19 were systematic reviews, including two Cochrane reviews, five practice guidelines, and 27 randomized controlled trials. RESULTS. In patients with mild CVI, PE was found to improve venous reflux, muscle strength, ankle range of motion (AROM), and quality of life. In patients with severe CVI, PE increased ejection fraction, decreased residual volume, and improved muscle strength and AROM. Isotonic exercise was shown to improve muscle endurance, efficiency, and strength of the calf muscles, improving their contractility and overall hemodynamics in limbs with venous trophic ulcers (VTU). It was established that the effectiveness of MVP also depends on the mobility of the ankle joint and the calf muscles contractile strength. DISCUSSION. Despite the compelling evidence base for prescribing progressive strength training and aerobic activity to patients with VTU, there are no studies examining the effectiveness of isokinetic training in the comprehensive rehabilitation of patients with post-thrombotic syndrome (PTS). This underscores the need to develop modern isokinetic training protocols for patients with PTS, as they achieve improved performance through maximal muscle loading, which enhances motor learning through real-time feedback. CONCLUSION. Studying the effects of isokinetic exercise training on calf pump function, muscle strength, AROM, and quality of life in patients with PTS is a promising area of medical rehabilitation.