Physical Activity, Sedentary Behaviors, and Venous Thromboembolism: A Narrative Review of the Current Evidence

Abstract

This narrative review aims to synthesize existing research on the impact of physical activity and sedentary behaviors on the risk of venous thromboembolism (VTE). It also delves into the biological mechanisms through which these lifestyle factors might influence VTE risk, assesses the clinical and public health implications of these findings, and highlights gaps in the current research landscape. Furthermore, it evaluates the causal relevance of physical activity and sedentary behaviors to VTE using Mendelian randomization studies. We conducted a literature search for interventional, observational cohort and genetic studies from MEDLINE and Embase up to April 2024. High physical activity levels are associated with a reduced risk of first-time VTE, independent of factors such as body mass index, age, sex, or geographical location. Nonetheless, the exact nature of the dose–response relationship between physical activity levels and VTE risk remains unclear, particularly regarding the optimal intensity, frequency, and duration needed for VTE prevention. Unlike its effects on initial VTE risk, physical activity does not appear to influence the risk of recurrent VTE. Conversely, sedentary behaviors such as prolonged television viewing and long-distance travel (e.g., long-haul flights) are linked to an increased risk of VTE, a risk that persists despite adherence to physical activity guidelines. The causality of these associations is supported by evidence suggesting biological pathways such as alterations in blood flow and coagulation, inflammation, endothelial and platelet function, and the modulation of cardiometabolic risk factors. Future research should aim to delineate the dose–response curves for the relationships, explore the use of objective measures to more accurately assess both physical activity and sedentary behaviors, and clarify their causal roles in VTE risk, potentially guiding targeted prevention strategies.