Skip to main navigation
Skip notifications
Access to POEMs and Essential Evidence Plus will no longer be included in CMA membership as of Dec. 1, 2023.
Search
Progressive resistance plus physical activity increases likelihood that venous leg ulcers will heal
Clinical Question
In patients being treated with compression therapy for a venous leg ulcer, does adding exercise improve outcomes?
Bottom line
The best evidence available suggests that adding progressive resistance exercise to compression and encouraging physical activity can increase the likelihood of venous leg ulcer healing more than compression alone. The studies were relatively few and small, so a large well-designed study could potentially change the direction of these conclusions. 1b-
Reference
Study design: Meta-analysis (randomized controlled trials)
Funding: Self-funded or unfunded
Setting: Outpatient (any)
Synopsis
This was a meta-analysis for the Cochrane Collaboration. The authors identified randomized trials that compared exercise with no intervention or sham therapy in patients with a venous leg ulcer, all of whom were also receiving compression therapy. The authors initially identified 519 studies, reviewed the full text of 33, and included 6 studies with 230 patients in their study. The primary threat to validity was a failure to mask outcome assessors in 4 of the 6 studies.The studies recommended one of the following: walking of 10,000 steps per day, resistance exercises, ankle exercises, or progressive resistance exercise plus prescribed physical activity. There was no benefit to progressive resistance exercise (2 studies) or walking 10,000 steps alone (1 study). However, the combination of progressive resistance exercise plus physical activity, reported in 2 studies with a total of 152 patients, led to a statistically and clinically significant improvement in ulcer healing of 27 percentage points (95% CI 9% - 45%). Adverse events were uncommon and not serious when reported.
Reviewer
Mark H. Ebell, MD, MS
Professor
University of Georgia
Athens, GA