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Airline Chair-Rest Deconditioning

Induction of Immobilisation Thromboemboli?

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Abstract

Air passenger miles will likely double by year 2020. The altered and restrictive environment in an airliner cabin can influence haematological homeostasis in passengers and crew. Flight-related deep venous thromboemboli (DVT) have been associated with at least 577 deaths on 42 of 120 airlines from 1977 to 1984 (25 deaths/million departures), whereas many such cases go unreported. However, there are four major factors that could influence formation of possible flight-induced DVT: sleeping accommodations (via sitting immobilisation); travellers’ medical history (via tissue injury); cabin environmental factors (via lower partial pressure of oxygen and lower relative humidity); and the more encompassing chair-rest deconditioning (C-RD) syndrome. There is ample evidence that recent injury and surgery (especially in deconditioned hospitalised patients) facilitate thrombophlebitis and formation of DVT that may be exacerbated by the immobilisation of prolonged air travel.

In the healthy flying population, immobilisation factors associated with prolonged (>5 hours) C-RD such as total body dehydration, hypovolaemia and increased blood viscosity, and reduced venous blood flow (pooling) in the legs may facilitate formation of DVT. However, data from at least four case-controlled epidemiological studies did not confirm a direct causative relationship between air travel and DVT, but factors such as a history of vascular thromboemboli, venous insufficiency, chronic heart failure, obesity, immobile standing position, more than three pregnancies, infectious disease, long-distance travel, muscular trauma and violent physical effort were significantly more frequent in DVT patients than in controls. Thus, there is no clear, direct evidence yet that prolonged sitting in airliner seats, or prolonged experimental chair-rest or bed-rest deconditioning treatments cause DVT in healthy people.

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Acknowledgements

The authors thank Ester Johnson and Beth Little for reprint acquisition. Supported by NASA Task UPN 11-10-20 and The Ames Associate Fellow Fund for 2000. The authors have no conflicts of interest directly relevant to the content of this review.

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Authors and Affiliations

  1. Laboratory for Human Environmental Physiology, NASA Ames Research Center, Moffett Field, California, USA

    John E. Greenleaf, David T. Quach & David G. Evans

  2. School of Physical Education, Otago University, Dunedin, New Zealand

    Nancy J. Rehrer

  3. Department of Community Health, Wright State University, Dayton, Ohio, USA

    Stanley R. Mohler

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  1. John E. Greenleaf
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  2. Nancy J. Rehrer
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  3. Stanley R. Mohler
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  4. David T. Quach
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  5. David G. Evans
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Greenleaf, J.E., Rehrer, N.J., Mohler, S.R. et al. Airline Chair-Rest Deconditioning. Sports Med 34, 705–725 (2004). https://doi.org/10.2165/00007256-200434110-00002

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