Heel compressions to stimulate circulation in the legs, along with regular walking or some other form of exercise, are helpful in healing venous leg ulcers (VLUs), a systemic review and meta-analysis found.
The findings were based on a comparison between exercise groups and control groups. Exercise was linked with increased healing rates of 14 additional cases per 100 patients, while progressive exercise in conjunction with prescribed physical activity was linked with increased healing of 27 additional cases per 100 patients, reported Andrew Jull, RN, PhD, of University of Auckland, and colleagues in JAMA Dermatology.
The evidence base is limited because of the number of randomized participants and the need for more conclusive trials. However, there is enough evidence for clinicians to recommend the appropriate patients implement progressive resistance exercises and 30 minutes of walking at least 3 days per week into their care, noted the study authors.
“Even if this evidence is found to be incorrect in the future, it is unlikely that such an approach will disadvantage patients, given the benefits of physical activity and the impact of prolonged inactivity on function,” the investigators continued.
Robert Kirsner, MD, PhD, of University of Miami Miller School of Medicine in Florida, noted in an accompanying editorial that venous leg ulcers are “among the most prevalent and costly skin diseases,” affecting some 2% of older individuals each year.
Even with quality care a substantial number “of leg ulcers do not fully heal after 6 months, leading to significant impact in quality of life from pain, mobility issues, and embarrassment from foul-smelling and draining wounds. Other targets for intervention, therefore, are critically needed,” Kirsner wrote.
He was generally supportive of the meta-analysis, while noting its inherent limitations. With the current findings, he wrote, “we are now empowered to recommend exercise for patients with VLUs, while we await further studies that better elucidate how to best target this intervention, informing us which patients with VLUs will benefit most and why.”
Weak Literature
But other dermatologists contacted by MedPage Today were more cautious.
“I don’t doubt that patients who did exercise healed better, but the data is not large enough to say how much effect the exercise does, and the exercise used in each study was not universal,” said Sahoko Little, MD, PhD, of University of Michigan in Ann Arbor.
“Many of the patients who have venous stasis ulcers are very sedentary, and/or have physical limitations. The patients who can do prescribed exercises are not [the] majority of the patients with venous stasis ulcers,” continued Little.
William Huang, MD, MPH, of Wake Forest School of Medicine in Winston-Salem, North Carolina, noted politely that Jull and colleagues “did their best to try and systematically review available literature.”
But that literature remains weak, he suggested. “Most of the studies are small, few in number, lack sufficient blinding, and outcomes vary, creating problems with coming up with definitive conclusions,” Huang told MedPage Today. “The evidence to support exercise as a component of venous leg ulceration treatment is still limited. Our ‘best evidence’ does suggest that this is a low-risk, low-cost, and simple intervention that may help some patients but we don’t have strong enough evidence to universally recommend [it] for all.”
Study Details
The researchers analyzed 190 participants using data from five randomized controlled trials (RCTs), in which exercise was compared with no exercise in venous leg ulcer patients, compression was a form of standard therapy, and healing outcomes were measured.
The investigators report using the following exercise interventions were included: exercise alone (two RCTs, 53 participants), progressive resistance exercise and prescribed physical activity (two RCTs, 102 participants), walking (one RCT, 35 participants), and ankle exercise (one RCT, 40 participants).
Two trials had participants with adverse events. In one of the trials, the researchers reported, if only the first event of a type was considered, 38 events were reported by intervention participants and 26 by usual care participants (OR 1.32; 95% CI 0.95-1.85), while the second trial reported two non-serious adverse events related to exercise and no adverse events among the group of patients receiving standard care.
One trial reported medical care costs. For exercise participants, the cost per patient to health services was €1,423 and €2,299 for the usual care group, translating to €875 in cost savings per patient each year. Moreover, the researchers also calculated the cost to the patient, which was €114 for the exercise group and €175 for the usual care group, resulting in a cost saving per patient of €61 each year. (Currently, €1 = $1.15.)
Jull, Kirsner, and Huang did not report any disclosures.
LAST UPDATED
Primary Source
JAMA Dermatology
Secondary Source
JAMA Dermatology
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