Jull A, et al. – Researchers conducted this systematic review and meta-analysis to analyze the association of different exercise interventions with venous leg ulceration (VLU) healing when used as an adjuvant to any form of compression. Findings revealed that daily sets of heel raises plus physical activity (eg, walking at least 3 times per week) might be an effective adjuvant to compression for the treatment of VLU. The authors also recommended practitioners to consider recommending simple progressive resistance and aerobic activity to suitable patients with VLU.

Methods

• Researchers searched The Cochrane Controlled Trials Register, MEDLINE, Embase, CINAHL, PsycInfo, and SCOPUS databases through October 9, 2017, for relevant reports.
• They included randomized clinical trials (RCTs) of any exercise vs no exercise in participants with VLU, where compression was used as standard therapy and a healing outcome was reported.
• Independent title screening and full text review was performed by two authors, with appeal to a third author if disagreement was unresolved.
• Of the 519 articles screened, 6 (1.2%) studies met the inclusion criteria for systematic review, including 5 for meta-analysis.
• Independent quality assessment for Cochrane risk of bias and data extraction was performed by two authors, with appeal to third author if disagreement unresolved (PRISMA).
• Using fixed effects model, data were pooled.
• Any healing outcome (proportion healed, time to healing, or change in ulcer area) was the a priori primary outcome.
• If a primary outcome was reported, secondary outcomes (adverse events, costs, and health-related quality of life) were only collected.

Results

• Of the 6 identified RCTs, 5 (190 participants) met inclusion criteria for meta-analysis.
• Progressive resistance exercise alone (2 RCTs, 53 participants) or combined with prescribed physical activity (2 RCTs, 102 participants), walking only (1 RCT, 35 participants), or ankle exercises (1 RCT, 40 participants) were the exercise interventions.
• Findings suggested an association of exercise with increased VLU healing at 12 weeks, although the effect was imprecise (additional 14 cases healed per 100 patients; 95% CI, 1-27 cases per 100; P=0.04).
• They found that the combination of progressive resistance exercise plus prescribed physical activity seemed to be most effective, again with imprecision (additional 27 cases healed per 100 patients; 95% CI, 9-45 cases per 100; P=0.004).