Supervised exercise training as an adjunct therapy for venous leg ulcers: a randomized controlled feasibility trial

Abstract

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.

A Lower Leg Physical Activity Intervention for Individuals With Chronic Venous Leg Ulcers: Randomized Controlled Trial

“…However, 100% of the participants were adherent to our 6-week exercise program more than 85% of the time in terms of duration, whereas 33% of the participants adhered more than 85% in terms of frequency of exercises. This finding is lower than findings of a 12-week home-based program in which 59% of individuals adhered to exercise more than 75% of the time [ 8 ]. Current evidence of mHealth interventions to promote physical activity demonstrate positive short-term effects (increased daily step counts and minutes spent on physical activity); however, evidence for long-term effects is lacking [ 28 ].…”

“…Exercise is recommended for patients with VLUs to enhance calf muscle pump function, which, in turn, improves lower extremity function and may aid in wound healing. Supervised and unsupervised programs that incorporate resistance, flexibility, and moderate-intensity aerobics can be safely performed by individuals with VLUs [ 8 ]. Other benefits of exercise include improved microvascular circulation of the lower limb [ 26 , 27 ] and improved wound healing [ 9 , 10 ]; however, a recent review of six randomized controlled trials to examine the effects of exercise on healing showed high-quality evidence is lacking to support healing [ 6 ].…”

“…Other problems with study methodology include patient and wound complexity, confounders such as comorbid conditions, the need for large samples sizes to show clinically relevant benefits, and the necessary long duration of the trials for wounds to heal, leading to high costs for high-quality trials [ 7 ]. However, data from studies of different types of physical activity such as supervised and self-management programs that include aerobic, resistance, and flexibility exercises specific for individuals with VLUs demonstrated high levels of feasibility, safety, and retention of participants [ 8 , 9 ]. Positive outcomes from these studies were noted in physical functions, including walking, sitting to standing, ankle range of movement, wound healing, pain, and lower ulcer recurrence rates.…”

Editorial: Exploration of the Physiological Effects of Exercise in Cardiovascular Diseases

“…These should be sufficiently effective to either reverse or slow-down the progression of these diseases and conditions, not only enhancing treatment, but also improving patients' quality of life. Exercise has been earmarked as one of the main lifestyle components that could be introduced in therapeutic interventions, as it is usually easy to implement by facilitators and be followed by clinical populations (i.e., Klonizakis et al, 2018 ; Mitropoulos et al, 2020 ), offering also societal and quality of life benefits (Kesterton et al, 2019 ).…”

Adjunctive therapy for healing venous leg ulcers

“…The current issue of the BJD contains an interesting article from Klonizakis et al ., which reports that the proportion of ulcers healed at 12 months was higher in patients receiving conventional compression therapy and adjunctive supervised exercise training than in those receiving compression alone (83% vs. 60%). This randomized controlled feasibility trial contradicts a Cochrane review from 2016, which found inadequate evidence to make a recommendation for exercise in nonulcerated chronic venous insufficiency, and a study of home exercise programmes that failed to find any significant association with VLU healing .…”