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What is circulation?

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Professor Mark Whiteley, Vascular Surgeon, explains how circulation works

The average adult has about 8 to 10 pints of blood in their body. Blood is very important because it carries and delivers many things that the body needs to stay well. For example, blood enables oxygen from the air that we breathe to be carried from our lungs to all other parts of our body. Blood also carries waste that the body wants to get rid of. This is taken to areas of the body where it can be broken down and removed.

‘Circulation’ is the word used to describe the constant movement of blood around the body, made possible by the pumping action of the heart. This movement or ‘flow’ of blood takes place in a network of tubes known as ‘blood vessels’
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Heart Diagram

Arteries carry blood away from the heart

Veins carry blood back to the heart

Blood Vessels

In order to understand how circulation works, let’s first look at the two types of blood vessels:

Blood in the arteries is under high pressure, like water in a hose pipe, due to the powerful pumping action of the heart. Because of this, blood can only travel in one direction through the arteries. However, blood in the veins is under far lower pressure, because it is much further away from the pumping action of the heart, compared to the blood in arteries. Veins therefore have little one-way ‘doors’ inside them, to help make sure that the blood can only flow in one direction, that is, towards the heart - these one-way doors are called 'valves'.

How the valves inside veins work

When working normally, the valves within veins can only open one way, so blood can only pass through them in one direction (i.e. towards the heart).

Arteries are connected to veins by very tiny blood vessels called ‘capillaries’, which branch out in many directions like the roots of a tree. Because they are so small, capillaries can reach into every single part of the body, delivering the blood that carries the oxygen needed for life. Blood in the capillaries then drains into the veins and is taken back to the heart.

Open Valve Diagram

Open Valve

Closed Valve Diagram

Closed Valve

Circulation in the legs - an uphill task

An uphill task

Returning blood to the heart from lower parts of the body, such as the feet and legs, is hard work for the circulation. That’s because the blood has to be pushed ‘uphill’. To do this, the circulation needs help from muscles that surround the veins. When we walk, for example, muscles in the feet and legs help to pump blood upwards, in the same way as you would squeeze liquid along a tube.

The more the muscles work – that is, the more we move – the greater the squeezing action and the easier it is to push blood back to the heart. This pumping action by muscles is vital for helping to maintain good circulation. In effect, muscles in areas such as the feet and legs work as your ‘second heart’.

Circulation Problems

As we grow older, we are often less active than we used to be. This, combined with the general ‘wear and tear’ of aging, can cause the circulation to work less effectively than it once did. However, it is not only advancing age that can lead to poorer circulation and the problems this can cause. Circulation problems can affect anyone who isn’t as active as they might be, whatever their age. What’s more, certain medical conditions can cause or play a part in circulation problems too.

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How to spot poorer circulation

Poorer circulation means that oxygen carried in the blood may not be transported to all parts of the body as well as it normally would be.

Getting oxygen to the far-reaches of the body, such as the fingers and toes, is particularly difficult if the circulation is not working well. Symptoms such as cold hands and feet, caused by poor blood flow to these areas, are therefore common in people with poorer circulation. There may also be feelings of tiredness or having less energy than usual, which again can be a result of too little oxygen getting to the parts of the body where it’s needed. Similarly, cuts, scratches and sores may take longer to heal than usual.

Returning blood to the heart from lower parts of the body, such as the feet and legs, is very difficult if the circulation system isn’t working as well as it should. That’s because this blood has to be pushed ‘uphill’ back to the heart. This can result in pooling of blood lower down the body, causing pain and swelling in the feet, ankles and legs. People with poorer circulation may also have muscle cramps or ‘heavy’, aching legs.

  • Feeling tired/having less energy than usual
  • Cuts, scratches and sores take longer to heal than usual
  • Cold, numb or tingling hands
  • Cramps, achy or ‘heavy’ legs
  • Swollen ankles
  • Cold, numb or tingling feet
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What can affect our circulation?

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It probably comes as no surprise that smoking is bad for the circulation, given its harmful effects on other parts of the body. Tobacco harms the circulation in many ways, including:

  • Increasing the pressure that blood puts on the walls of arteries when it is pumped through the body (i.e. raising blood pressure)
  • Making the heart beat faster, which increases the strain on it
  • Narrowing blood vessels in the skin, so blood can’t flow as easily
  • Causing less oxygen to be carried in the blood than normal
  • Making blood ‘stickier’ and this makes it unable to flow as well
  • Damaging the lining of arteries, making them more likely to clog up with fatty substances (atherosclerosis)
  • Reducing blood flow to the fingers and toes (i.e. the parts of the body furthest away from the heart)

The effects of alcohol on the circulation are less clear than for smoking:

  • In moderate amounts, alcohol can cause blood vessels to become wider, which improves the circulation by enabling the blood to flow more easily
  • The findings of one scientific study pointed to a slight benefit after one alcoholic drink, whereas two or more caused unwanted effects on circulation
  • The effects of alcohol vary widely though, according to a person’s gender, general health and size


It’s important to keep the arteries clear, as these are the tubes that carry oxygen-rich blood away from the heart and to the rest of the body. An unhealthy diet can lead to the arteries becoming clogged up with fatty substances – a condition called ‘atherosclerosis’. Affected arteries narrow and harden, which stops blood from flowing through them as well as it normally would. As a result, some parts of the body may not be able to get the blood flow needed to work properly, which can cause serious health problems, such as a heart attack.

Circulation friendly diet


As explained in ‘What is circulation’, physical movement of the body is very important for helping to keep blood flowing through the veins, particularly in the legs. As we walk for example, muscles in the lower legs and feet operate like a pump, pushing blood back up to the heart, like squeezing liquid through a tube. This action of the muscles helps to maintain good circulation.

If we don’t move for a prolonged period of time (especially if we are sitting down), this can lead to pooling of blood in the legs, which in turn can cause swelling, stiffness and discomfort. Lack of movement is also one of the things that can cause blood to form sticky little lumps, called ‘blood clots’. If a blood clot forms in a vein located deep within the body, it is called a ‘deep vein thrombosis’ – ‘DVT’ for short.

Veins within leg muscles are the most common place for a DVT to form. You may well have heard about people developing a DVT in their leg as a result of being seated for a long time, on an airline flight for example. As DVTs are a direct result of poor circulation and can be very dangerous, regular movement to keep leg muscles working and thus blood flowing is a key part of DVT prevention.

Medical Conditions

A wide range of medical conditions can affect circulation. These include:


Diabetes is a complex condition that can affect many parts of the body. This can include poor circulation and reduced feeling in the feet, which can lead to foot sores called ‘ulcers’. People with diabetes are more likely to be admitted to hospital with a foot ulcer than with any other complication of diabetes. Diabetes may also harm the circulation by contributing to the development of blocked arteries (‘atherosclerosis’).

High blood pressure

High blood pressure – also called ‘hypertension’ – is a condition in which blood being pumped through the body places too much pressure on the walls of arteries. The condition is often linked with blocked arteries (atherosclerosis), and with a higher than normal level of a fatty substance called ‘cholesterol’ in the blood. Cholesterol is mainly made by the body, but it is also found in some foods.

High blood pressure is a problem because it can damage arteries, tearing their walls and providing a ‘roughed up’ area that provides a perfect base for cholesterol to be laid down and a blockage to develop. Also, damaged arteries may not be able to deliver enough blood to the organs (e.g. kidneys). Over time, this lack of blood flow can cause affected organs to be severely damaged.


This is a condition in which fatty substances (often from an unhealthy diet) are laid down in the arteries. These cause affected arteries to become narrower and harden, thus stopping blood from flowing through them as freely as it otherwise would. Atherosclerosis is a serious concern, because it increases the likelihood of developing a range of conditions involving reduced blood flow, including:

  • Heart attack (sudden damage to the heart due to lack of blood)
  • Stroke (sudden damage to the brain due to lack of blood)
Heart disease

This is a general term used to describe a range of disorders affecting the heart and blood vessels. As you might imagine, if the heart and/or blood vessels aren’t working as well as they should, it follows that the circulation will be affected too.

Various forms of heart disease can lead to circulation problems, which often affect the hands and feet in particular.

Raynaud’s phenomenon

You may also see this called ‘Raynaud’s disease’. It is a condition that causes blood vessels to narrow, thus preventing normal blood flow. An ‘attack’ can last from several minutes to several hours, with the fingers and toes being the most commonly affected areas. Other parts of the body can be affected too though, such as the ears and nose.

The main symptoms are changes to skin colour in the affected area, which usually occur in three stages:

  • Stage one - The affected area turns white because blood supply is restricted.
  • Stage two - The affected area turns blue due to lack of oxygen (the body part can feel cold and numb).
  • Stage three - The affected area turns red as blood returns at a higher rate than normal (there may be a tingling or throbbing sensation, together with some swelling).

These symptoms gradually disappear as the flow of blood returns to normal.

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How Can We Improve Our Circulation?

If you have symptoms of poorer circulation for the first time, such as pain in your legs or cold hands and feet, the first thing to do is visit you doctor for a check up.

If no medical problems are found, that would prevent you from exercising and changing your diet, there are some simple steps you can take to help improve your circulation:



Exercising is important to help maintain healthy circulation. Here we look at some easy ways to help improve circulation


  • One of the simplest and best exercises for all ages
  • Perfect for getting the leg muscles working, helping to pump blood through the veins and back to the heart
  • Can be as simple as:
    • Getting off the bus one stop earlier and walking the rest of the way
    • Walking to the shops rather than taking the car
    • Taking stairs rather than the lift or escalator
  • Start with short walks 2 to 3 times per week, then build up as you get fitter, ideally doing some walking each day


  • The ideal exercise in many ways – swimming gets your heart, lungs and muscles working, yet puts no load on your joints
  • Can be as gentle or energetic as you want
  • Again, start by swimming perhaps once a week, then build up as you get fitter.

Combining swimming with other exercise, such as walking, helps to exercise different muscle groups, especially the leg muscles, which act as that "second heart", pumping blood back up to the (first!) heart.

Heel-toe raises

  • Great for getting blood pumping again when you feel numbness, tingling or pain in your feet or legs
  • When you are sitting at home such as when you are watching the television
  • When you are out and about, on the bus or while you are waiting for an appointment
  • A perfect way to ease yourself back into being more active and improving your circulation

It can be a struggle to incorporate exercise in your daily routine, especially when the weather is bad. The Revitive Circulation Booster has been developed to improve circulation, helping to activate the muscles in your feet and lower legs, to increase blood circulation. Revitive can be used from the comfort of your home, while you are sitting reading, working on the computer or watching TV.


Add foods that improve circulation into your diet

Maintaining a healthy, balanced diet is one of the most important things that we can do to help our circulation. This includes drinking plenty of water and eating recommended amounts of fruit, vegetables and wholegrain foods. The following foods in particular are said to have ‘circulation-boosting’ properties:

  • OrangesOranges and other citrus fruits high in vitamin C
  • Dark ChocolateDark Chocolate
  • TomatoesTomatoes
  • SalmonSalmon
  • AvocadoesAvacados
  • Cayenne PepperCayenne Pepper
  • Sunflower SeedsSunflower Seeds
  • GingerGinger
  • GarlicGarlic
  • Ginkgo BilobaGinkgo Biloba
  • Goji BerriesGoji Berries
  • WatermelonWatermelon
  • Pink GrapefruitPink Grapefruit
  • ApricotsApricots
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