Effects of physical activity as an adjunct treatment on healing outcomes and recurrence of venous leg ulcers: A scoping review

Abstract

Healing time is protracted and ulcer recurrence is common in patients with venous leg ulcers. Although compression is the mainstay treatment, many patients do not heal timely. Physical activity may be a clinically effective adjunct treatment to compression to improve healing outcomes. This scoping review provides a broad overview of the effect of physical activity as an adjunct treatment to compression on wound healing and recurrence. We followed the six‐step framework developed by Arksey and O'Malley. We searched electronic databases and trial registration websites for relevant studies and ongoing trials. Two authors independently screened and selected articles. Findings were presented in a descriptive statistical narrative summary. We consulted and presented our findings to the wound consumer group to ensure the relevance of our study. Physical activity interventions in 12 out of the 16 eligible studies consisted of only one component, eight studies were resistance exercises, three studies reported ankle and/or foot range of motion exercises, and one study reported aerobic/walking exercises. The remaining four studies involved multicomponent exercise interventions. Resistance exercise combined with ankle and/or foot range of motion exercise minimised ulcer size on day 12 (intervention group: 4.55 ± 1.14 cm2 vs. control group: 7.43 ± 0.56 cm2) and improved calf muscle pump performance on day 8 (ejection fraction: 40%–65%; residual volume fraction: 56%–40%). We identified one study that reported ulcer recurrence rate with no clinical difference in the intervention group versus the control group (i.e., 12% in intervention vs. 5% in control). Our review identified that resistance exercise was the most common type of physical activity intervention trialled in the published literature. Resistance exercise combined with ankle and/or foot range of motion exercise appears to be effective adjunct treatments; however, the overall evidence is still relatively weak as most programmes had a short intervention period which limited clinical outcomes.

Association between physical activity levels and healing in people with venous leg ulcers: secondary analysis of prospective cohort data

“…Our data suggested higher levels of PA were positively correlated with better QoL. This is consistent with prior research examining factors that influence PA levels in people with VLUs, where a strong positive correlation between PA levels and overall QoL in this patient population was also identified (10,21). Similarly, past clinical trials found that participants who undertook an exercise intervention had higher QoL scores than those who received standard compression treatment (22, 23).…”

“…Physical activity (PA) may be an effective adjunct treatment to compression to improve ulcer healing and recurrence (9). A recent scoping review has found that multicomponent exercises targeting the lower extremity as an adjunct for compression therapy may improve calf muscle pump function, thereby enhancing circulation in the lower extremities and ultimately improving ulcer healing and preventing recurrence (10). There are also multiple barriers to PA and exercising in people with VLUs, including pain, psychological distress, and a lack of clear exercise instructions (11).…”

Effect of Combined Electromagnetic Field and Plantar Flexion Resistance Exercise on Wound Healing in Patients with Venous Leg Ulcers: A Randomized Controlled Trial

“…Several types of physical activity, such as resistance exercise, walking, aerobic exercise, and ankle exercise, are suggested as adjunct therapies to compression therapy for managing VLU [ 5 , 51 , 52 ]. According to a recent analysis, resistance training is the physical activity/exercise intervention that has been studied the most and is clinically effective for reducing ulcer size and increasing calf muscle pump function in people with VLU [ 53 ]. The results of the study are supported by findings from earlier studies; indeed, a recent study demonstrated that the use of a supervised exercise program (a combination of resistance, aerobic, and flexibility training) in conjunction with compression therapy was feasible and acceptable in the treatment of venous ulcers [ 54 ].…”

No More Venous Ulcers—What More Can We Do?

“…Exercise programs focused on calf muscle activities and ankle rehabilitation are the most effective at increasing the VLU healing rate. Some reports demonstrated that patients adhering to exercise programs, specifically resistance exercise combined with ankle and/or foot range-of-motion exercises, as an adjunctive treatment to standard care, have a higher chance of healing and better functional outcomes than those who do not adhere to exercise programs [98][99][100][101]. In addition, they are also more likely to avoid an ulcer recurrence [95].…”