For some, a livelihood can be made from the strength of their bodies. Serena Williams. Michael Phelps. Usain Bolt. They worship their bodies with exercise, high-quality food, massages, and sleep. These athletes forge their bodies and skillsets into art; and we, the awe-inspired, wonder at them.

Yet for most of us, the body is not beauty, but utility.

We may pay homage to our bodies occasionally—a light jog, a weekend morning raking leaves, a walk along the beach—but these relished moments are pittances, when predominantly, we abuse our body to make ends meet.

Consider, it is Sunday night—10:30 p.m. You have indulged in apple pie à la mode, and are filing taxes. While your liver works industriously to convert excess sugar into long-term storage (fat and glycogen), the pineal gland in your brain begins to release melatonin (sleep-inducing hormone). Eyelids droop. You turn the intensity of lights up, thereby activating cells in the retina that inhibit melatonin secretion. Your body interprets that there is a reason to be awake, some danger to overcome. Cortisol (stress response hormone) is secreted, allowing you to nibble the crust of the apple pie and persevere.

Indeed, there is a certain beauty to the body’s industry, but also there are certain limits. Each day, we push these limits until the body pushes back. While prolonged standing can lead to venous dysfunctions as I’ve discussed previously, there is a danger at the other end of the spectrum: prolonged sitting.

“We have created for ourselves a modern way of living that clashes with the way we’re meant to be,” wrote Dr. James Levine,[i] the Director of the Mayo Clinic-Arizona State University Obesity Solutions Initiative, and author of “Get Up!”

The phrase has taken hold: “Sitting is the new smoking.” The National Institute of Health has launched an initiative aimed to address this problem, cities have increased the number of bike share options, and companies have even begun to install treadmill desks and promote active work environments. Why? Because even when defined by utility, the body is most productive when healthy, i.e. active.

Studies validate the need to be active, showing that sedentary lifestyle is a risk factor for obesity, diabetes, hypertension, cardiovascular disease, age-related frailty and cancer.[ii] Unfortunately, I also treat the effects of inactive lifestyle each day in my practice, since sedentary lifestyle puts people at risk for chronic venous insufficiency (CVI)[iii] [iv], peripheral vascular disease[v] [vi], vascular blot clots[vii] [viii], and other diseases. While inactivity puts individuals at risk, exercise can help in the treatment of these same venous disorders.[ix] [x]

Physical activity is crucial because the muscular and circulatory systems work cooperatively. Case in point: the calf-muscle pump. Did you know, that while arteries pump oxygenated blood away from the heart at relatively high pressures (120/80 mmHg), veins collect and transport de-oxygenated blood back to the heart at relatively low pressure (5-15 mmHg)—and as such, the calf muscle plays a crucial role in pumping the blood from our feet and legs at ground-level upwards to the heart some four feet above.

How? As the calf muscle flexes, it forces blood against gravity up along the course of the veins, which are lined with one-way valves that catch the blood as it travels, preventing it from flowing backwards. A normal, efficient calf muscle will force 70% of blood out of the calf as we walk.[xi]

The relationship is evident: the more efficient the muscles, the more efficient the blood flow, and vice versa. For people with venous insufficiency, healthy musculature is crucial, and physical activity can help without the need to start any onerous workout regime. As the ice and early dusk of winter settles into the Pioneer Valley, I encourage readers to incorporate simple movement into their daily habits.

The simple act of getting up to walk to the water cooler can engage your leg muscles, loosen back muscles, as well as promote blood flow that increases concentration and work productivity. In-chair exercises can also be helpful. One study investigated ten in-chair exercises most commonly recommended by airlines, and found that exercises requiring the heel to be raised caused the greatest calf-muscle pump activation (see below images).[xii] In the end, while scientific studies can validate, individuals must motivate themselves to be proactive, beginning with understanding the harm of inactivity, and the preventative and therapeutic benefits of physical activity.

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Figure (taken from O’Donovan, et al., 2006) showing that heel raising exercises 1, 4, 6, 7, and 8 significantly activated the calf-muscle pump.



[i] As quoted in Los Angeles Times:

[ii] Bouchard C, Blair SN, Katzmarzyk PT. Less Sitting, More Physical Activity, or Higher Fitness? Mayo Clin Proc. 2015 Nov;90(11):1533-40. doi: 10.1016/j.mayocp.2015.08.005. Epub 2015 Oct 5. Review. PubMed PMID: 26422244.

[iii] Medline Plus website:

[iv] New York Presbyterian website:

[v] MD Guidelines website:

[vi] Cleveland Clinic website:

[vii] Healy B, Levin E, Perrin K, Weatherall M, Beasley R. Prolonged work- and computer-related seated immobility and risk of venous thromboembolism. J R Soc Med. 2010 Nov;103(11):447-54. doi: 10.1258/jrsm.2010.100155. PubMed PMID: 21037335; PubMed Central PMCID: PMC2966881.

[viii] Suadicani P, Hannerz H, Bach E, Gyntelberg F. Jobs encompassing prolonged sitting in cramped positions and risk of venous thromboembolism: cohort study. JRSM Short Rep. 2012 Feb;3(2):8. doi: 10.1258/shorts.2011.011121. Epub 2012 Feb 14. PubMed PMID: 22393469; PubMed Central PMCID: PMC3291423.

[ix] Klyscz T, Jünger M, Jünger I, Hahn M, Steins A, Zuder D, Rassner G. [Vascular sports in ambulatory therapy of venous circulatory disorders of the legs. Diagnostic, therapeutic and prognostic aspects]. Hautarzt. 1997 Jun;48(6):384-90. German. PubMed PMID: 9333613.

[x] Partsch H, Blättler W. Compression and walking versus bed rest in the treatment of proximal deep venous thrombosis with low molecular weight heparin. J Vasc Surg. 2000 Nov;32(5):861-9. PubMed PMID: 11054217.

[xi] Chapter 11 of Physiology of Venous Insufficiency, by Kevin G. Burnand and Ashar Wadoodi, Abstracted by Teresa L. Carman

[xii] K.J. O’Donovan, T. Bajd, P.A. Grace, D.T. O’Keeffe, G.M. Lyons, Preliminary Evaluation of Recommended Airline Exercises for Optimal Calf Muscle Pump Activity, EJVES Extra, Volume 12, Issue 1, July 2006, Pages 1-5