Adjuvant exercise tied to increased healing of venous leg ulcers


By Marilynn Larkin

NEW YORK (Reuters Health) - Adding daily sets of heel raises and regular aerobic activity to compression is associated with increased healing rates of venous leg ulcers (VLUs), researchers say.

"The main treatment for VLUs is some form of compression worn on the lower leg, such as compression bandages or compression stockings," Dr. Andrew Jull of the University of Auckland in New Zealand, told Reuters Health. "But clinicians are always looking for treatments to add to compression to speed up ulcer healing."

Dr. Jull and colleagues searched the literature for randomized controlled trials (RCTs) of any exercise intervention compared to no exercise in people with VLUs, where compression was considered standard therapy and healing outcomes were included.

As reported online October 3 in JAMA Dermatology, after screening more than 500 studies, the team selected six overall, five of which (190 participants) met their inclusion criteria for meta-analysis. All included compression, with exercise as an adjuvant treatment.

Two RCTs with 53 participants used progressive resistance exercise (mainly heel raises) alone; two with 102 participants combined progressive resistance with prescribed physical activity (mainly walking); one with 35 participants used walking only; and one with 40 participants used ankle exercises in addition to resistance and aerobic exercise.

Overall, exercise was associated with increased VLU healing at 12 weeks (an additional 14 cases healed per 100 patients); however, the effect was "imprecise," according to the authors, with a wide confidence interval.

Progressive resistance exercise plus prescribed physical activity appeared to be most effective (additional 27 cases healed per 100 patients), but again with imprecision.

"The 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," the authors state.

Dr. Jull noted, "The evidence is quite preliminary (and) only applies to people with VLUs, as the biological mechanisms behind other types of leg ulcer are very different."

"Not everybody would be able to do this form of prescribed exercise," he acknowledged. "As well, some people may need to start slow and build up to the target levels."

"Regular contact with the research participants was important, not only to monitor progress, but to advance them to the next level of exercise," said Dr. Jull, who is hoping to obtain funding for a large clinical trial of the intervention.

Dr. Robert Kirsner of the University of Miami Miller School of Medicine, author of an accompanying editorial, told Reuters Health by email, "We now have evidence that exercise helps healing of VLUs when combined with standard care."

"Physicians caring for patients with leg ulcers and their patients should consider calf muscle strength training, including walking, as part of 'things to do' to improve outcomes," he said.

"Facilitating this with educational materials, referral to physical therapists and other facilitating technologies may help allow better implementation," Dr. Kirsner concluded.


JAMA Dermatol 2018.

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