Effects of exercise in treating patients with venous leg ulcers: A systematic review and meta‐analysis

Abstract

To determine the effects of exercise on VLU healing and exercise adherence, and to provide evidence for clinical practice and scientific investigation. PubMed, Embase and Scopus were searched from inception to 31st March, 2022. Pooled relative risks (RRs), standardised mean differences (SMDs), adherence rate with respective 95% confidence intervals (CIs) were calculated. Quality assessment of included studies were performed using the Cochrane Collaboration risk of bias evaluation. Heterogeneity between enrolled studies was evaluated. We identified eight randomised control studies (RCTs) that met the inclusion criteria. The pooled RR for healing rate was 1.38 (95% CI: 1.14 to 1.66; P = 0.0008) with no significant heterogeneity between component studies (I2 = 0%, P = 0.96). SMD for differences of total range of ankle joint motion (ROAM) at the end and at the initiation of follow‐up in the intervention and control groups was 0.87 (95% CI: 0.22, 1.52; P = 0.0091), no significant heterogeneity was detected (I2 = 59%, P = 0.0622). Pooled adherence rate was 64% (95% CI: 53%, 75%) with no significant heterogeneity. Exercise manifested positive effects on VLU healing, range of ankle mobility compared with the control group. Patients' adherence to the exercise regimens was favourable.

Effects of exercise in treating patients with venous leg ulcers: An umbrella review

“…The remaining articles underwent a meticulous full‐text review, resulting in the further exclusion of 124 studies. Ultimately, a mere 4 studies 24 , 25 , 26 , 27 satisfied our stringent inclusion criteria. The process of literature selection is delineated in a flow chart presented in Figure 1 .…”

“…A compilation of eight studies, including four systematic reviews/meta‐analyses, 24 , 25 , 26 , 27 has provided elucidation of the outcomes relevant to ulcer healing. Exercise has demonstrated efficacy in augmenting rates of ulcer healing, as evidenced by the pooled risk difference (RD) of 0.17 (95% CI: 0.06–0.28; p = 0.003) (refer to Figure 2 ).…”

Mobility range, level of pain and sleep quality of patients with venous leg ulcers

“…To counteract this, the increase in physical activity, which is an important adjunctive treatment for the management of VLUs, 5 was shown to provide better functional outcomes and make VLUs more likely to heal. 6,7 Calf-muscle pumping is considered the primary mechanism to promote blood return from the lower extremities back to the heart 8 and can be improved by physical exercise. [9][10][11] National guidelines recommend adequate and regular exercise.…”

“…In patients with VLUs, impaired range of ankle movement 2 is associated with decreased muscle contractility, low muscle oxygenation 3 and damaged skeletal muscles 4 that restrict mobility. To counteract this, the increase in physical activity, which is an important adjunctive treatment for the management of VLUs, 5 was shown to provide better functional outcomes and make VLUs more likely to heal 6,7 . Calf‐muscle pumping is considered the primary mechanism to promote blood return from the lower extremities back to the heart 8 and can be improved by physical exercise 9‐11 .…”

Chronic venous insufficiency and venous leg ulcers: Aetiology, on the pathophysiology‐based treatment

“…walking) may be the most effective form of exercise regimen 40 . Different forms of exercise and optimal exercise doses (including progressive resistance exercise, walking, and ankle exercises) are being compared 41 . Resistance exercise training, defined as an exercise strategy whereby muscles contract against an external resistance, revealed an approximately 70% reduction in ulcer area after exercise after 12 weeks of training, probably due to better skin oxygenation 42 …”