Summer travel: Nine ways to improve circulation

So, before embarking on summer travel (i.e. flights, trains, driving or cruises), consider these nine ways to improve circulation:

Parents have a limited window in the summer for family trips

The summer travel season is undoubtedly chaotic, crowded and unduly pricey, especially for families.

With strict regulations in place by the government who impose hefty fines for taking children on holiday outside school term time, this means the summer holidays are the only viable option for family trips. Otherwise, you need permission from a head teacher, either by an advance application or for exceptional circumstances. (UK Gov)

Parents are therefore under significant pressure to make the summer holidays memorable. As families seek to capitalise on school breaks to plan holidays, the limited window for travel outside the academic year has driven up demand and prices, making summer trips exorbitantly expensive.

Airport strikes

Summer travel in 2023 is proving to be as chaotic as summer 2022, which “saw a post-pandemic summer of travel chaos as airlines, airports and rail services across the country struggled to manage the demand for sunny escapes.” (CN Traveller)

Across Europe, thousands of flights have already been delayed and cancelled due to industrial action. So, here are the latest strikes taking place at European airports between July and August. Gatwick airport workers will be striking between Friday July 28 to Tuesday August 1, then from Friday August 4 to Tuesday August 8. (The Times) Therefore, there’s a good chance strikes will spread to other UK airports. Already, “long queues, strikes and bad weather” (Daily Express) have started to scupper the start of UK summer holidays.

Compounded by extreme weather conditions, the high demand for travel during the peak summer season alongside staff shortages, has made airport strikes and flight delays, disruptions and cancellations inevitable. It is expected that this will continue to overwhelm airports and border crossings throughout the summer.

Potential health risk

Long-haul travel is generally from 3 hours up, including long-distance driving, e.g, staycations and road trips across Europe.

Long waiting times and long-haul travel poses significant risk of blood clotting (deep vein thrombosis), especially for individuals aged over 40. Unfortunately, strikes, crowded airports, lengthy check-in, security lines and delays ahead of and during long-haul travel (e.g., flights, trains, driving and cruises) can result in travellers being sedentary or sitting in cramped conditions for long periods of time.Combined with added pressure from extreme heat and dehydration, the consequence is far from ideal for our health.

Over 300 million people travel on long-distance flights annually. “Anyone travelling more than four hours, whether by air, car, bus, or train, can be at risk for blood clots.” (Centers for Disease Control and Prevention) Less well known, is which preventative measures to consider and subsequently practise en route.

What does the research say?

Economy class syndrome, also known as travel-related thrombosis, is the increased risk of deep vein thrombosis (DVT) due to long-haul travel. The sitting posture, cramped seating arrangements in economy class seats and prolonged immobility can compress the blood vessels in the legs, hindering the smooth flow of blood and leads to blood pooling.

“Deep veins are large veins that are deep inside your body rather than close to the surface of your skin. You’re most likely to get DVT in one of your legs, but you can also get DVT in your pelvis, your arms or your abdomen (tummy).” (BUPA)

“You can get deep-vein clots at any age, but it usually affects people who are older than 40.” (Evan Starkman and Jennifer Robinson, MD)

If a blood clot breaks loose and travels to the lungs, it can cause a potentially life-threatening pulmonary embolism. “These clots often originate in the lower body as a result of deep vein thrombosis (DVT).” (Katey Davidson, MScFN, RD, CPT)

Notable research

1. Long-haul flights: “The incidence of deep vein thrombosis (DVT) was higher in passengers on long-haul flights than in the general population.” (Lapostolle, M.D., Surget, M.D.,Borron, M.D., Desmaizières, M.D., Sordelet, M.D., Lapandry, M.D., Cupa, M.D., and Adnet, M.D., Ph.D.)

2. Immobility: “Immobilisation associated with prolonged travel, by air or ground, increases the risk of DVTs by 2 to 4 folds.” (McLendon K, Goyal A, Attia M.)

3. Intercontinental travel: “Intercontinental air travel is associated with a high incidence of DVT and PTE during or within 48 hours of long-distance flights. This situation is known as the economy class syndrome and can affect both the cabin crew and passengers.” (Şabanoğlu C.)

Nine ways to improve circulation for travel

So, before embarking on long-haul travel (e.g., flights, trains, driving and cruises), consider these nine preventative measures to improve circulation and maximise comfort, as recommended by the experts in elderly mobility, The Mobility Furniture Company:

When travelling

1. Hydration: Extreme heat leads to dehydration, thickening the blood and making it more prone to clotting. During long flights, passengers may not drink enough fluids due to the inconvenience of accessing beverages or the desire to avoid frequent bathroom visits. Staying hydrated throughout the journey can help maintain proper blood viscosity and circulation, and reduce the risk of swelling and discomfort. Avoid excessive caffeine or alcohol consumption, as they can contribute to dehydration.

2. Compression garments: Compression garments help reduce swelling and improve blood circulation in your legs during long-haul travel. “Studies examining the effectiveness of compression stockings have found a link between compression stockings and DVT prevention in hospitalised patients.” (Elaine K. Luo, M.D. and Valencia Higuera)

3. Stay active: Avoid long periods of sitting, get up and walk around the cabin to stretch your legs and improve blood flow. Simple exercises like ankle circles, leg lifts and walking down the aisle can stimulate blood flow in your legs and prevent blood from pooling, in turn reducing the risk of deep vein thrombosis (DVT).

4. In-seat exercises: Long-haul travel can cause musculoskeletal discomfort, particularly in the back, neck, and legs. Perform gentle stretches and exercises while seated, such as shoulder rolls, neck stretches and wrist movements to reduce muscle tension and improve circulation. Airlines tend to give guidance about in-seat exercises in their in-flight entertainment systems.

5. Avoid crossing legs: Try to keep your feet flat, as crossing legs can temporarily “increase your blood pressure and lead to poor posture. For optimum health, try to avoid sitting in any one position, whether you cross your legs or not, for long periods of time.” (William Morrison, M.D. and Corinne O'Keefe Osborn) If possible, elevate your legs slightly using a footrest or other means, as this can help reduce swelling and encourage blood flow back to the heart.

6. Seating upgrades: Whenever possible, opting for seats with more legroom can help alleviate circulation issues. If possible, select an aisle seat so that you have more freedom to get up and move around without disturbing other passengers.

When home

7. Regular intervals of standing and walking: If you sit for long periods, set a timer to remind you to get up out of your chair at regular intervals. Mobility furniture can help lead to better circulation. “If you have difficulty in standing up from your chair, consider a rise and recline chair or adjustable bed that helps you to a standing position.” (Dr. Rob Hicks)

8. Cut down ultra-processed foods: “Eating a healthy diet low in ultra-processed foods is linked with lower body weight, which may help reduce the risk of blood clots and DVT.” (Katey Davidson, MScFN, RD, CPT)

9. Avoid smoking: “Smoking causes blood vessels to narrow and become blocked.” (NHS) Avoid smoking before the flight, and of course ideally you won’t smoke at all. As “smoking hinders your blood from circulating as it should by damaging and narrowing your arteries. After just 20 minutes without smoking your pulse rate is beginning to return to normal. And blood circulation improves after two to 12 weeks without a cigarette.” (Dr. Rob Hicks)

Overall, strategies such as moving around, performing in-seat exercises, wearing compression socks, and staying hydrated, help promote blood flow and reduce the risk of DVT. Economy class syndrome is not limited to air travel; similar risks can apply to long periods of immobility within cars, trains, cruises and waiting at border crossings.

Please consult your GP before embarking on long-haul travel, especially if you have specific risk factors, such as a personal or family history of blood clotting disorders. And if you experience any severe discomfort or symptoms en route, inform the crew immediately.

Looking after your health beforehand and on the journey can help get your holiday off to the best start possible; after all, rest, recuperation and a change of scenery are good for us all.

Disclaimer: This story is not intended to be official medical advice. For any concerns about your health, please contact your GP or the NHS 111 line prior to travelling.