Venous Leg Ulcers and Exercise (VaLUE): Theory and Intervention Strategies

Introduction:The objective of this paper is to describe an exercise intervention for treating chronic venous leg ulcer patients using Social Cognitive Theory (SCT) [1]. This study will assess the benefits of an intervention promoting exercise for adults with venous leg ulcers. Physical activity interventions based on SCT are reported to be more successful than those without. Social Cognitive Theory is widely used and accepted within the physical activity domain. The primary intervention strategy for this study is to enhance self-efficacy which is the main construct of SCT and is known to be an important predictor of exercise and a critical concept in chronic disease management.This is Phase Two of a larger project and follows on from previous pilot work by the authors [2]. Phase One of the study involves focus group sessions which will be conducted to understand the meaning of exercise to adults with venous leg ulcers thereby helping to inform the intervention. The presence of venous insufficiency and subsequent venous hypertension may lead to calf muscle changes such as muscle fibre atrophy, abnormal gait and reduced strength and functioning of the calf muscle. Despite evidence to suggest that exercise improves calf muscle function in this patient population [3-5] to date only one study [3] and the author?s pilot work [2] has investigated the effect of improving the calf muscle pump function on healing rates. Methods:An extensive literature review on the theoretical underpinnings of SCT interventions in combination with clinical experience and the results from phase one will inform the intervention. A RCT will be conducted over two clinical sites in South East Queensland. The primary outcomes will be the incidence of complete wound closure at the completion of the study, time to healing and ulcer area percentage reduction. Secondary outcomes will include physical activity levels, functional ability, psychosocial factors and quality of life. Ethical Approval will be obtained prior to commencement of each study and written informed consent will be obtained from the participants prior to commencement of the studies.Results:A review of the effectiveness of interventions in older adults with chronic disease has found evidence to support the use of SCT. Facets of SCT will be integrated into this intervention such as goal setting and self-monitoring and will be described in this paper. Conclusions/Discussion: There is a paucity of research in this area; and a need for clinical guidelines based on evidence to assist health professionals and patients in using exercise as an adjunct therapy in the management of chronic venous leg ulcers. It is proposed that a physical activity intervention based on SCT will enable participants to be able to self-regulate and adhere to their exercise program in order to be able to improve the calf muscle pump thereby improving the healing rates of their venous leg ulcers.