The Effects of Exercise Interventions for Patients with Venous Lower Limb Ulcers: A Systematic Review

The Effects of Exercise Interventions for Patients with Venous Lower Limb Ulcers: A Systematic Review Student Researchers: Christian San Pedro, SPT Jordan Hoffman, SPT Sabrina Mendez, SPT Mentored by: Kristen Karnish, PT, MPH, DEd, GCS, CEEAA Background: Approximately 30 million Americans are affected by vascular disease with greater numbers world wide. Chronic wound care is costly, as seen by the 1.5 billion dollars Medicare spent treating wounds in 2014. Vascular disease can predispose individuals to lower limb ulcers, chronic wounds, necrosis, and amputation. In patients with chronic wounds, exercise has been hypothesized to decrease healing times by triggering cortisol release and increasing blood flow to the tissue. The purpose of this study was to evaluate the effects of exercise on wound healing, functional status and quality of life for patients with lower limb venous wounds. Methods: An article search was conducted between August 2020 and September 2020 and again in February 2021. Databases, PEDRO, Medline, and PubMed, were searched using the terms “Venous Ulcer” or “Venous Leg Ulcer” and “physical therapy” or “physiotherapy” or “rehabilitation” or “exercise” and “lower leg”. Articles were also obtained from forward search of included articles. Inclusion criteria included: peer reviewed articles, publication between 2015-2020, randomized controlled trials, and PEDro score ≥ 4/10. Nine articles were included based on the inclusion criteria. Articles addressed the effects of exercise on wound healing, functional outcomes, and quality of life. Results: Wound healing measures included healing rates, wound size, and PUSH scores. Wound healing rates and PUSH scores of the exercise groups showed significant improvement when compared to control groups, however ulcer size measurements between exercise and control groups were not significantly different. Functional outcome measures included: ankle ROM, strength, and gait outcome measures. Ankle ROM measurements between control and exercise groups were not significantly different overall with some outliers, while strength measurements between control and exercise groups were not significantly different. Gait measures between control and exercise groups were not significantly different at final assessment. Quality of life measures included pain scales and quality of life questionnaires. Quality of life questionnaires showed no significant differences and no trends between exercise and control groups, however pain scores showed significant improvement within intervention groups and significant difference when comparing exercise and control groups. Conclusions: Exercise is an effective adjunct intervention when treating patients with venous leg ulcers. Physical activity can aid in speeding up the healing process and can lead to better functional and quality of life outcomes. Even modest movement and activity was beneficial to aid in the rehabilitation and healing of those with venous leg ulcers, however further research is required to determine the most effective interventions to be provided by physical therapists.https://digitalcommons.misericordia.edu/research_posters2021/1009/thumbnail.jp