SummaryBackgroundVenous leg ulcers (VLUs) are typically painful and heal slowly. Compression therapy offers high healing rates; however, improvements are not usually sustained. Exercise is a low‐cost, low‐risk and effective strategy for improving physical and mental health. Little is known about the feasibility and efficacy of supervised exercise training used in combination with compression therapy patients with VLUs.ObjectivesTo assess the feasibility of a 12‐week supervised exercise programme as an adjunct therapy to compression in patients with VLUs.MethodsThis was a two‐centre, two‐arm, parallel‐group, randomized feasibility trial. Thirty‐nine patients with venous ulcers were recruited and randomized 1 : 1 either to exercise (three sessions weekly) plus compression therapy or compression only. Progress/success criteria included exercise attendance rate, loss to follow‐up and patient preference. Baseline assessments were repeated at 12 weeks, 6 months and 1 year, with healing rate and time, ulcer recurrence and infection incidents documented. Intervention and healthcare utilization costs were calculated. Qualitative data were collected to assess participants’ experiences.ResultsSeventy‐two per cent of the exercise group participants attended all scheduled exercise sessions. No serious adverse events and only two exercise‐related adverse events (both increased ulcer discharge) were reported. Loss to follow‐up was 5%. At 12 months, median ulcer healing time was lower in the exercise group (13 vs. 34·7 weeks). Mean National Health Service costs were £813·27 for the exercise and £2298·57 for the control group.ConclusionsThe feasibility and acceptability of both the supervised exercise programme in conjunction with compression therapy and the study procedures is supported.

Objectives To investigate the effectiveness of non-benzodiazepine hypnotics (Z drugs) and associated placebo responses in adults and to evaluate potential moderators of effectiveness in a dataset used to approve these drugs.Design Systematic review and meta-analysis. Data source US Food and Drug Administration (FDA).Study selection Randomised double blind parallel placebo controlled trials of currently approved Z drugs (eszopiclone, zaleplon, and zolpidem). Data extractionChange score from baseline to post-test for drug and placebo groups; drug efficacy analysed as the difference of both change scores. Weighted raw and standardised mean differences with their confidence intervals under random effects assumptions for polysomnographic and subjective sleep latency, as primary outcomes. Secondary outcomes included waking after sleep onset, number of awakenings, total sleep time, sleep efficiency, and subjective sleep quality. Weighted least square regression analysis was used to explain heterogeneity of drug effects.Data synthesis 13 studies containing 65 separate drug-placebo comparisons by type of outcome, type of drug, and dose were included. Studies included 4378 participants from different countries and varying drug doses, lengths of treatment, and study years. Z drugs showed significant, albeit small, improvements (reductions) in our primary outcomes: polysomnographic sleep latency (weighted standardised mean difference, 95% confidence interval −0.57 to −0.16) and subjective sleep latency (−0.33, −0.62 to −0.04) compared with placebo. Analyses of weighted mean raw differences showed that Z drugs decreased polysomnographic sleep latency by 22 minutes (−33 to −11 minutes) compared with placebo. Although no significant effects were found in secondary outcomes, there were insufficient studies reporting these outcomes to allow firm conclusions. Moderator analyses indicated that sleep latency was more likely to be reduced in studies published earlier, with larger drug doses, with longer duration of treatment, with a greater proportion of younger and/or female patients, and with zolpidem. ConclusionCompared with placebo, Z drugs produce slight improvements in subjective and polysomnographic sleep latency, especially with larger doses and regardless of type of drug. Although the drug effect and the placebo response were rather small and of questionable clinical importance, the two together produced to a reasonably large clinical response. IntroductionHypnotic drugs are often prescribed in primary care for insomnia.1 Despite a reduction in prescribing of benzodiazepine hypnotics in the past decade, hypnotic use and costs remain high because of the introduction and increase in use of Z drugs, 2 a group of non-benzodiazepine hypnotic drugs (including eszopiclone, zaleplon, and zolpidem), which act on the GABA (γ aminobutyric acid) receptor and are used in the treatment of insomnia. These are now the most commonly prescribed hypnotic agents worldwide. Prescriptions exceed costs of $285m (£178m, €221m) in the Unite...

Summary Venous leg ulcers (open sores) can be caused by a blockage or breakdown in the veins of the leg. Compression, using bandages or hosiery (stockings), can help heal ulcers, however, they do not always work. Venous ulcer patients are often encouraged to exercise, but little is known about the effects and safety of exercise training in this population. This study therefore tried out supervised exercise training in people in the U.K. who are being treated with compression for a venous leg ulcer. Participants were randomly allocated to receive usual care, or usual care plus a 12‐week supervised exercise programme. The exercise programme involved three sessions per week, with each session involving a combination of walking, cycling and strength and flexibility exercises for the leg muscles. Participants were followed for up to 1 year, with data collected on ulcer healing, quality of life and healthcare use (e.g. visits to GP). Thirty‐nine people were recruited, with 18 being allocated to the exercise group. All but two participants completed the study. The overall exercise session attendance rate was 79%, with 13 participants (72%) completing all sessions. There were no serious adverse events (unwanted side effects). The average ulcer healing time was shorter for the exercise group: 13 versus 35 weeks. These findings support the feasibility of supervised exercise training in people being treated with compression for a venous leg ulcer. A larger study is needed to confirm the effects on ulcer healing and if exercise is cost‐effective.

The reproducibility of cutaneous PORH was better when assessed with LSCI compared to SP-LDF and IP-LDF; probably due to measuring larger skin areas (lower inter-site variability). However, when measuring sympathetic vasomotor reflexes on the finger pad, reproducibility was better with SP-LDF and IP-LDF, perhaps due to the high sensitivity of LSCI to changes in skin blood flow at low levels.

The impact of cardiopulmonary fitness (VO(2max)) on the age-related decline in skin-microvessel vasodilator function has not been fully established and the inter-relationships among different measures of microvascular vasodilator function are unknown. We used laser Doppler flowmetry to assess relative changes in forearm skin blood flow to various stimuli in three groups of adults: young (n = 15; 27 +/- 2 years), older sedentary (n = 14; 65 +/- 6 years) and older fit (n = 15; 61 +/- 5 years). Local-heating induced and post-occlusive hyperaemia responses were higher in the young and older fit groups compared to the older sedentary group (P < 0.05) and were moderately correlated with VO(2max) in the pooled cohort of older adults (r = 0.49-0.58; P < 0.05). Peak hyperaemia responses to acetylcholine and sodium nitroprusside were higher in young compared to older sedentary adults (P < 0.05) and were not associated with VO(2max) in older adults (P > 0.05). Associations among different measures of microvascular vasodilator function were generally moderate at best. In summary, the local heating and reactive hyperaemia data indicate that the age-related decline in skin-microvessel vasodilator function can be ameliorated through regular aerobic exercise training. As this is not supported by the iontophoresis data, we recommend that, when assessing microvascular function, the use of a single physiological or pharmacological stimulation coupled to laser Doppler flowmetry should be avoided. Finally, the moderate correlations between outcomes probably reflect the distinct mediators that are responsible for the vasodilator response to each test.