Physical factors are known to influence hemodynamics in the veins of the lower extremities. In a controlled, randomized study the authors investigated the effects of combined physical therapy on varicose veins. Over a twenty-four-week period a treatment group consisting of 12 persons exercised under the supervision of a therapist twice a week for sixty minutes. This included muscle and joint activation by means of externally applied compression and cold-temperature stimuli (ie, thermosteresis). They also exercised once a day without supervision for fifteen minutes. During the same period a control group of 12 persons underwent the same measurements but no treatment. In the treatment group venous capacity decreased by an average of 16% from 4.9 +/- 0.3 (sd) mL/100 mL tissue to 4.1 +/- 0.4 (P < 0.005, U-test) while in the control group it remained practically unchanged at 4.8 +/- 0.4 vs 5.0 +/- 0.3. Venous refilling time in the lower extremities also increased in the treatment group, half refilling time rising from 7.8 +/- 1.0 to 11.3 +/- 0.9 seconds (P < 0.001) and total refilling time from 17.0 +/- 1.4 to 25.7 +/- 2.1 seconds (P < 0.001); these parameters remained virtually unchanged in the control group, with half refilling time dropping slightly from 7.7 +/- 1.1 to 7.1 +/- 1.3 seconds and total refilling time from 18.3 +/- 1.7 to 16.3 +/- 1.9 seconds. Patient self-rating scores obtained by use of a standardized questionnaire administered at baseline and at the end of week 24 improved in the treatment group only. The combined physical therapy was thus shown to be of long-term therapeutic value, improving venous function and reducing patients' symptoms. These findings indicate that for the further development of this combined treatment regimen it would be useful to identify the individual factors contributing to its efficacy and evaluate them separately.