An experimental study of prescribed walking in the management of venous leg ulcers

Meagher, Helen; Ryan, Damien; Clarke‐Moloney, Mary; ÓLaighin, Gearóid; Grace, Pierce A.

doi:10.12968/jowc.2012.21.9.421

Cited by 34 publications

(93 citation statements)

References 24 publications

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“…The only other studies to measure healing as an outcome in an exercise study have reported mixed outcomes with varying endpoints, making direct comparison difficult. Heinen et al reported that their intervention group had less wound days ( P < 0·01), and Meagher et al observed that participants who took more steps at both the baseline and 4‐week assessment healed more quickly than those who took fewer steps ( P = 0·052 and P = 0·008 for baseline and week 4, respectively). In contrast, Jull et al reported no significant differences in ulcer healing parameters (change in area, percentage change in area, number healed at 12 weeks, time to healing).…”

Section: Discussionmentioning

confidence: 99%

Evaluating the effectiveness of a self‐management exercise intervention on wound healing, functional ability and health‐related quality of life outcomes in adults with venous leg ulcers: a randomised controlled trial

O’Brien

Finlayson

Kerr

et al. 2016

International Wound Journal

182

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Exercise that targets ankle joint mobility may lead to improvement in calf muscle pump function and subsequent healing. The objectives of this research were to assess the impact of an exercise intervention in addition to routine evidence-based care on the healing rates, functional ability and health-related quality of life for adults with venous leg ulcers (VLUs). This study included 63 patients with VLUs. Patients were randomised to receive either a 12-week exercise intervention with a telephone coaching component or usual care plus telephone calls at the same timepoints. The primary outcome evaluated the effectiveness of the intervention in relation to wound healing. The secondary outcomes evaluated physical activity, functional ability and health-related quality of life measures between groups at the end of the 12 weeks. A per protocol analysis complemented the effectiveness (intention-to-treat) analysis to highlight the importance of adherence to an exercise intervention. Intention-to-treat analyses for the primary outcome showed 77% of those in the intervention group healed by 12 weeks compared to 53% of those in the usual care group. Although this difference was not statistically significant due to a smaller than expected sample size, a 24% difference in healing rates could be considered clinically significant. The per protocol analysis for wound healing, however, showed that those in the intervention group who adhered to the exercise protocol 75% or more of the time were significantly more likely to heal and showed higher rates for wound healing than the control group (P = 0·01), that is, 95% of those who adhered in the intervention group healed in 12 weeks. The secondary outcomes of physical activity, functional ability and health-related quality of life were not significantly altered by the intervention. Among the secondary outcomes (physical activity, functional ability and health-related quality of life), intention-to-treat analyses did not support the effectiveness of the intervention. However, per protocol analyses revealed encouraging results with those participants who adhered more than 75% of the time (n = 19) showing significantly improved Range of Ankle Motion from the self-management exercise programme (P = 0·045). This study has shown that those participants who adhere to the exercise programme as an adjunctive treatment to standard care are more likely to heal and have better functional outcomes than those who do not adhere to the exercises in conjunction with usual care.

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Section: Discussionmentioning

confidence: 99%

Evaluating the effectiveness of a self‐management exercise intervention on wound healing, functional ability and health‐related quality of life outcomes in adults with venous leg ulcers: a randomised controlled trial

O’Brien

Finlayson

Kerr

et al. 2016

International Wound Journal

182

View full text Add to dashboard Cite

show abstract

“…In recent years, there has been considerable attention to promotion of physical activity in Australia, including the development and implementation of the health promotion campaign to encourage adults to walk 10 000 steps per day. Meagher et al recommended adults with VLUs a walking regimen of 10 000 steps per day and indicated that 33% of their sample met this goal. In contrast, O'Brien et al found that only 9% of participants who received a 12‐week exercise intervention with a telephone coaching component and 6% in the usual care group reported an average of 10 000 steps per day.…”

Section: Discussionmentioning

confidence: 88%

“…People aged 65 years and older are recommended to complete 30 minutes of moderate intensity physical activity on most days . Recent research studies indicate that increased levels of physical activity in VLU patients as an adjunct to compression therapy may reverse venous hypertension, decrease wound‐healing time and prevent wound recurrence . However, despite motivation and interest in being physically active, people with VLU report health‐related obstacles, such as pain, increased wound discharge, and weakness related to comorbidities .…”

Section: Introductionmentioning

confidence: 99%

Factors associated with physical activity levels in people with venous leg ulcers: A multicentre, prospective, cohort study

Smith

Team

Barber

et al. 2017

International Wound Journal

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Increasing levels of physical activity among people with venous leg ulcers (VLUs) can potentially reduce the health cost burden, improve functional aspects of patients' lives and increase ulcer healing rates. The aim of this study was to investigate factors associated with physical activity levels in patients with VLUs. Data from 2016 to 2017 Aspirin for Venous Leg Ulcer cohort study were analysed for the present study. Ninety participants were recruited from 5 outpatient specialist wound clinics across Victoria, Australia between August 2016 and April 2017. There was a statistically significant association between diabetes and physical activity, with a higher proportion of people with type 2 diabetes in the sedentary category. Further, there was a statistically significant association between patient-reported VLU education and physical activity levels. An indirect advantage of relevant, easy-to-understand education about VLUs may increase physical activity levels, which may facilitate improved time to healing of VLUs.

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“…peripheral arterial disease and coronary artery disease) . In patients with VLUs, supervised calf muscle exercise has been shown to increase calf muscle pump function and improve lower‐limb haemodynamics, as well as mobility and QoL . A recent systematic review suggested further research to determine whether exercise training has an effect on ulcer healing and QoL …”

mentioning

confidence: 99%

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

et al. 2018

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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.

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An experimental study of prescribed walking in the management of venous leg ulcers

Abstract: There were no external sources of funding for this study. The authors have no conflict of interest to declare.

Cited by 34 publications

References 24 publications

Evaluating the effectiveness of a self‐management exercise intervention on wound healing, functional ability and health‐related quality of life outcomes in adults with venous leg ulcers: a randomised controlled trial

Evaluating the effectiveness of a self‐management exercise intervention on wound healing, functional ability and health‐related quality of life outcomes in adults with venous leg ulcers: a randomised controlled trial

Factors associated with physical activity levels in people with venous leg ulcers: A multicentre, prospective, cohort study

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

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