How to Reduce Your Risk of Economy Class Syndrome

By: Michael Lam, MD, MPH

People who might be experiencing Economy Class SyndromeIt’s wonderful to travel the world and explore exotic locations, but often times that includes long, bothersome airline flights. Unless you’ve been blessed with flying first class, chances are your leg space is limited in economy. For most, this won’t cause any complications other than discomfort or minor cramping, but for others, it could be a life-threatening condition known as economy class syndrome, or ECS. There are certain people who are at a higher risk of contracting this disorder. However, there are also ways to prevent this mile-high ailment.

What is Economy Class Syndrome?

DVT or deep vein thrombosis is a condition where blood clots form in the deep veins of the body, specifically those found in the legs. Deep vein thrombosis is usually caused when a lack of proper circulation occurs in the leg, leading to a stagnation of blood in the deep veins. It has been seen to occur most frequently in patients who have long stays in hospitals or nursing homes, and in long-distance air passengers. More so, those traveling in crammed quarters with limited space such as economy class, thus given the name “economy class syndrome.”

Researchers have also found that passengers aboard a plane often become dehydrated due to the dryness of the air in the plane cabin. This often causes the blood to thicken, which combined with the immobility and low cabin pressure could be an equation for the rise in DVT among flight passengers.

Economy class syndrome can lead to a very serious and fatal condition called pulmonary embolism. If a blood clot breaks off from the leg and lodges into a lung, this could be a sudden death situation for a passenger. Pulmonary embolism is a fatal occurrence that sadly claims the lives of over 200,000 American citizens a year. It is important before traveling to be preventative. Know your body, and know what measures to take to avoid economy class syndrome.

Signs and Symptoms of Economy Class Syndrome

The onset of economy class syndrome can be very sudden. The most common presenting symptom is shortness of breath but there are other signs to look for in the calf area such as

  • Muscle pain
  • Tenderness
  • Swelling
  • Redness

In a severe case, the swelling and redness can even extend from the leg to the thigh and even hip areas. It can even take up to two weeks for symptoms to develop.

The Science behind Economy Class Syndrome

Studies have shown that economy class syndrome, or DVT, has been linked to a high blood level of homocysteine, a very sulfuric amino acid. High homocysteine levels have also been linked to cardiovascular diseases and the development of atherosclerosis, a narrowing of the arteries due to plaque building up on the artery walls. Making sure your homocysteine levels are in normal ranges could be very beneficial to your health, especially prior to traveling.

A University of Milano study found the following results pertaining to homocysteine levels:

  • The probability of developing economy class syndrome/DVT doubles among people who have higher homocysteine levels.
  • People with low levels of vitamin B6 are twice as likely to develop economy DVT over people who have levels above 46.5 nmol/L.
  • Supplementing with vitamin B6 inhibits the accumulation of platelets and prolongs bleeding time, causing the blood to thin. Vitamin E, ginkgo, and fish oil have the same effect.

The B vitamins play a huge role in preventative wellness especially when it comes to metabolic pathways. They are extremely helpful in boosting energy levels and fighting fatigue.

Exercises To Do On A Plane To Reduce Economy Class Syndrome

Yes, to avoid all this, you could sit in first class for more leg room, but if you follow the exercises below, and know your body’s chemistry before you depart on your travels, you could greatly reduce your chances of having economy class syndrome. Regardless of where you sit on a long flight, it is important that you get up and walk around every 15 to 30 minutes.

While you are seated, the following exercises will help with circulation:

  • Ankle Circles. One at a time, raise your feet off the floor pointing your toes. Move them around in circles, first clockwise, then counterclockwise. Repeat several times.
  • Foot Lifts. Place both feet flat on the floor. Keeping the toes on the floor, lift the heels as high as they will go. Return back to neutral. Next, keeping the heels on the floor, raise the toes as high as they can go. Continue alternating this exercise back and forth for a few minutes
  • Knee Lifts. With knees bent, contract the thigh muscle to lift one leg up at a time. Hold and lower, alternating back and forth for 20 to 30 repetitions.
  • Knee to Chest. Bend forward and place your hands on the top of your shin. Pull the knee into the chest and hold this position for 15 seconds. Lower the leg down and repeat several times switching sides.

There are also a set of exercises to promote circulation that can be completed while standing in the aisle by your seat, or near the restrooms:

  • Calf Raises. While holding onto a seat back or airplane wall, slowly rise up onto the balls of your feet and hold for a couple of seconds. Make sure your feet are hip-distance apart and repeat 10 to 20 times.
  • March in Place. Bring a knee up as high as you can, return to standing, then switch legs. Repeat this exercise 10 to 20 times.
  • Stretch the Quads. Bend the knee bringing the leg behind you and grab the foot or ankle with your same-sided hand. Pull the foot into the body and hold for 15 seconds. Release and switch sides.
  • Forward Fold. Separate the feet hip-distance apart and fold forward at the hips. Keep your knees slightly bent and reach the fingers towards the shins or the floor. Hold for approximately 15 seconds and then slowly roll up one vertebra at a time.

Practicing these stretches and exercises when you are confined to a seat for more than 3 hours at a time is very important for circulation and overall health, especially for anyone who is more prone to economy class syndrome.

Who’s at Risk for Economy Class Syndrome?

Not everyone is at risk for ECS. Those predisposed to clotting include the following people:

  • Individuals with cancer
  • Those who have cardiovascular issues such as chronic heart or respiratory failure
  • People with a predisposition to obesity
  • People with a predisposition to varicose veins
  • People who have just had surgery or who have been bedridden
  • Individuals who have endured a leg injury
  • Women who are pregnant or postpartum
  • Women who are taking birth control pills or who are undergoing hormone replacement therapy
  • People who are older than 40
  • Sufferers of Adrenal Fatigue Syndrome (AFS)

Vitamin B Pill helping with economy class syndromeAdrenal fatigue is the body’s response from an overexposure to stress. With the adrenal glands playing such an important part in health, when they are injured, the entire body suffers tremendously. People who suffer from AFS may be more prone to economy class syndrome for many reasons, one being that they may be compromised in fluid balance. Many with AFS tend to be prone to dehydration and fluid imbalances. There is a frequent need for sufferers to be well-hydrated. The air being dry in airplanes can contribute to more fluid needs.

If you suffer from adrenal fatigue or any other chronic illness, it is important to discuss your travel arrangements with your healthcare practitioner and to make sure your fluid status is taken care of to support healthy cardiovascular flow. They can help you prepare for long flights by sharing on-board exercise plans, introducing diets rich in the B6 vitamin, and offering advice on ways to lower the risk of economy class syndrome.

© Copyright 2012 Michael Lam, M.D. All Rights Reserved.

Dr. Lam’s Key Question

Yes, people who suffer from chronic illnesses such as Adrenal Fatigue are at a greater risk of developing Economy Class Syndrome due to many factors. Recent studies have pointed to low vitamin B6 levels. Prior to flying, AFS sufferers should be sure to take supplements.

Economy class syndrome
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Dr. Lam
Beautiful – Thank you once again. You are a truly AMAZING coach of health and life. I wish every doctor in the health field was even half as committed as yourself. It is extremely hard these days to find even a good doctor…but if a person finds a great one – they need to cherish them.