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“Economy Class Syndrome” Is Real—and It’s About to Get Worse

With a recent American Airlines announcement revealing that the airline is reducing the legroom in their new aircrafts, passengers are at increased risk of deep vein thrombosis (DVT). But is it just those long red-eye plane rides that we should be worried about? Our experts walk you through what you should know.

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Sitting still for a long time poses problems

Most recently experts have pinpointed travel of any sort as being potentially problematic when it comes to blood clots in the legs or deep vein thrombosis (DVT). "We're now expanding the concern from 'economy class syndrome' to traveler's thrombosis, which reflects the idea that people who travel for long periods, whether by air, car, bus or train are all at increased risk for blood clots," says David Fox, MD, a New York City-based vascular surgeon. "It comes down to prolonged periods of immobility that worry us most." Tip: There's even a new term called E-thrombosis, which means that people who sit at computers for long stretches are also at risk for developing DVT.

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The window seat is the worst

While window seats are great if you're into watching takeoffs and landings or taking a snooze, it's the worst spot to snag from a DVT perspective. In fact, according to a Dutch study conducted in 2009 that looked at flights and blood clots, the risk of blood clots for those sitting in a window seat was more than twice that of an aisle seat. "That goes to immobility and the fact that it's not as easy to get up and walk around when you're three seats in," Dr. Fox says.

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Who's (most) at risk

While most of us are at low risk of developing DVT, some individuals are at higher risk and they're not always the ones you would expect, says Mounir Haurani, MD, a vascular surgeon at The Ohio State University Wexner Medical Center and an expert in treating DVT. Those risk factors that place you already at higher risk for DVT include pregnancy, cancer, recent surgery, estrogen replacement and smoking. "If this is your situation, then you need to be aware that your risk is higher on long flights," he says.

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Height matters

It might be easy to assume that only tall people are at increased risk while sitting in exceedingly cramped seats. Not the case—as those on either extremes of height have increased risk. "If you're very tall—over 6'3"—you have less leg room, but if you're under 5'3" your feet don't reach the floor," Dr. Fox says. "This means that the edge of the seat cuts into the region behind the knee and that can block blood flow in your veins."

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Get up and move

The longer the flight (or road trip of any sort), the higher the risk. Your best bet: When it's safe, get up and walk. Your goal: To get up and walk the aisles or power walk around a rest stop every hour for two to five minutes if possible, Dr. Fox says.

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Help yourself while you're seated

If you're unable to get up and walk, stretch and squeeze your calf muscles by raising and lowering your heels, Dr. Haurani says. Or try these stress relief stretches. Compression socks can also help to gently squeeze the blood back up through your veins and you should avoid crossing your legs since that can slow down blood flow. "Try to avoid wearing tight clothing since that might further constrict blood flow," Dr. Fox says.

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Do what you can to maximize legroom

With space at a premium, be a smart traveler and keep the foot space you do have clear of any items. "If you're on a long flight, plan to store all of your carry-on items in the overhead bin to make sure your legs have more room," says Danielle Bajakian, MD, a vascular surgeon at New York Presbyterian/Columbia University Hospital in New York City. "Don't fill up your foot space with non-essential items."

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Stay hydrated

When we travel we frequently reach for beverages laden with alcohol and/or caffeine. "These can lead to moderate to severe dehydration which has also been associated with DVT," Dr. Bajakian says. "When these risks factors are combined, physicians view this as a 'perfect storm' of risk factors and we take them very seriously." Tip: Drink lots of water throughout the trip. This will also make you more likely to walk up (or down) the aisle to the restroom.

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You may need an Rx

If you're pregnant, a cancer patient, or are obese you might want to consult with a doctor before your trip about using medications to decrease your risk of blood clots. "A low-dose blood thinner may be of benefit," Dr. Fox says.

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Stay vigilant after your trip

Once you're at your destination, keep walking. "Sometimes the best way to sight see is on foot," Dr. Haurani says. Staying active is not only healthy but important in the days (and weeks) after a long trip. "The blood clot risk lasts for weeks after your travels," Fox says and, keep in mind, there are several silent signs of DVT. "If you develop leg swelling, shortness of breath or chest pain after a flight, you may have developed a blood clot and should see a doctor immediately."