RAISED LEG EXERCISES FOR LEG EDEMA IN THE ELDERLY

Leg edema is a common problem in the elderly and requires further eval uation and management. Method: From October 1990 to July 1992, 245 pat ients presented to the Cleveland Clinic Florida with leg edema. All pa tients 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 tru e controls, they formed a comparison group for those who performed the exercise regimen. The exercise group was composed of 188 patients wit h a mean age of 73 +/- 6.8 years, 25 (13%) men and 163 (87%) women; th e 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 inclu ded: comprehensive history, clinical examination including prostate or pelvic examination, complete blood count, chemistry profile, thyroid profile, electrocardiogram, chest radiograph, and, when indicated, pel vic or leg ultrasound and pelvic computed tomographic scan. The circum ference of the leg with the maximum amount of edema was measured initi ally and on the fourth week. Results: In this study, the common causes of leg edema in the elderly population were venous stasis (63.2%), dr ug 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 circumfe rence of leg edema on initial visit and four weeks after, both the exe rcise and nonexercise groups showed significant decreases in the measu rement of the leg edema (P < .001) except those caused by lymphedema. The amount of change when compared between those who exercised and tho se who did not was significant only in venous stasis. Conclusion: Caus es of leg edema in the elderly are multiple. Twenty-minute, three-time s-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 fail ure, drug induced, and other conditions, which include lymphedema, pro state and ovarian CA, and postphlebitic syndrome. Successful managemen t of leg edema is based on adequate and thorough assessment to identif y the cause.