Prescribed Exercise With Compression vs Compression Alone in Treating Patients With Venous Leg Ulcers

Abstract

IMPORTANCEExercise is recommended as an adjuvant treatment for venous leg ulceration (VLU) to improve calf muscle pump function. However, the association of exercise with VLU healing has not been properly aggregated, and the effectiveness of different exercise interventions has not been characterized. OBJECTIVETo summarize the association of different exercise interventions with VLU healing when used as an adjuvant to any form of compression.DATA SOURCES The Cochrane Controlled Trials Register, MEDLINE, Embase, CINAHL, PsycInfo, and SCOPUS databases were searched through October 9, 2017.STUDY SELECTION Randomized clinical trials (RCTs) of any exercise compared with no exercise in participants with VLU were included, where compression was used as standard therapy and a healing outcome was reported. Independent title screening and full text review by 2 authors (A.J., J.S.) with appeal to a third author (J.P.) if disagreement was unresolved. Of the 519 articles screened, a total of 6 (1.2%) studies met the inclusion criteria for systematic review, including 5 for meta-analysis.DATA EXTRACTION AND SYNTHESIS Independent quality assessment for Cochrane risk of bias and data extraction by 2 authors with appeal to third author if disagreement unresolved (PRISMA). Data pooled using fixed effects model. MAIN OUTCOMES AND MEASURESThe a priori primary outcome was any healing outcome (proportion healed, time to healing, or change in ulcer area). Secondary outcomes (adverse events, costs, and health-related quality of life) were only collected if a primary outcome was reported.RESULTS Six RCTs were identified and 5 (190 participants) met inclusion criteria for meta-analysis. The exercise interventions were progressive resistance exercise alone (2 RCTs, 53 participants) or combined with prescribed physical activity (2 RCTs, 102 participants), walking only (1 RCT, 35 participants), or ankle exercises (1 RCT, 40 participants). Overall, exercise was associated with increased VLU healing at 12 weeks although the effect was imprecise (additional 14 cases healed per 100 patients; 95% CI, 1-27 cases per 100; P = .04). The combination of progressive resistance exercise plus prescribed physical activity appeared to be most effective, again with imprecision (additional 27 cases healed per 100 patients; 95% CI, 9-45 cases per 100; P = .004). CONCLUSIONS AND RELEVANCEThe evidence base may now be sufficiently suggestive for clinicians to consider recommending simple progressive resistance and aerobic activity to suitable patients with VLU while further research is produced.

Adjuvant therapies in venous leg ulcer management: A scoping review

“…Three SRs related to weight management were published, including one on nutritional status and supplements and two on exercising . The authors reported that increased body mass index was associated with delayed wound healing, but the evidence of effectiveness of weight management in improving VLU healing is lacking .…”

“…Earlier SR of the studies reporting the effect of exercise on VLU healing in patients indicates that the findings reporting positive effects were insignificant and further studies are necessary . Latest SR of studies on prescribed exercising indicates that there is low quality evidence of its effect on VLU healing, which is sufficient to recommend this adjuvant therapy for VLU patients…”

Neuromuscular stimulation of the common peroneal nerve increases arterial and venous velocity in patients with venous leg ulcers

“…Physical exercises aimed at activating the muscle pump 23 such as toe raises have been used with some success for healing venous leg ulcers, 24 and it has been shown that even minor movements of the foot are effective 25 . Furthermore, it has been found that poor muscle pump function can be improved by regular activation 26 .…”

Venöz Ayak Ülser Tedavisinde Güncel Yaklaşımlar

“…Progresif güçlendirme egzersizleri yapılması baldır kas pompası fonksiyonunu iyileştirmektedir. Alt ekstremite egzersizi aktif planter fleksiyona direnç (4 kg) en az 7 gün, her gün en az üç set şeklinde ve altı dakika süreyle 12 hafta boyu yapılması tavsiye edilmektedir (18). Beslenme ve Hidrasyon Protein ve aminoasitler, enerji, vitaminler (A, E) ve çinko yara iyileşmesi için gereklidir.…”