Jull A, Slark J, Parsons J, et al.
JAMA dermatology. Date of publication 2018 Oct 3;volume ():.
1. JAMA Dermatol. 2018 Oct 3. doi: 10.1001/jamadermatol.2018.3281. [Epub ahead of
print]
Prescribed Exercise With Compression vs Compression Alone in Treating Patients
With Venous Leg Ulcers: A Systematic Review and Meta-analysis.
Jull A(1)(2), Slark J(1), Parsons J(1).
Author information:
(1)School of Nursing, University of Auckland, New Zealand.
(2)National Institute for Health Innovation, University of Auckland, New Zealand.
Importance: Exercise is recommended as an adjuvant treatment for venous leg
ulceration (VLU) to improve calf muscle pump function. However, the association
of exercise with VLU healing has not been properly aggregated, and the
effectiveness of different exercise interventions has not been characterized.
Objective: To summarize the association of different exercise interventions with
VLU healing when used as an adjuvant to any form of compression.
Data Sources: The Cochrane Controlled Trials Register, MEDLINE, Embase, CINAHL,
PsycInfo, and SCOPUS databases were searched through October 9, 2017.
Study Selection: Randomized clinical trials (RCTs) of any exercise compared with
no exercise in participants with VLU were included, where compression was used as
standard therapy and a healing outcome was reported. Independent title screening
and full text review by 2 authors (A.J., J.S.) with appeal to a third author
(J.P.) if disagreement was unresolved. Of the 519 articles screened, a total of 6
(1.2%) studies met the inclusion criteria for systematic review, including 5 for
meta-analysis.
Data Extraction and Synthesis: Independent quality assessment for Cochrane risk
of bias and data extraction by 2 authors with appeal to third author if
disagreement unresolved (PRISMA). Data pooled using fixed effects model.
Main Outcomes and Measures: The a priori primary outcome was any healing outcome
(proportion healed, time to healing, or change in ulcer area). Secondary outcomes
(adverse events, costs, and health-related quality of life) were only collected
if a primary outcome was reported.
Results: Six RCTs were identified and 5 (190 participants) met inclusion criteria
for meta-analysis. The exercise interventions were 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). Overall, exercise was associated 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 = .04). The
combination of progressive resistance exercise plus prescribed physical activity
appeared to be most effective, again with imprecision (additional 27 cases healed
per 100 patients; 95% CI, 9-45 cases per 100; P = .004).
Conclusions and Relevance: The evidence base may now be sufficiently suggestive
for clinicians to consider recommending simple progressive resistance and aerobic
activity to suitable patients with VLU while further research is produced.
DOI: 10.1001/jamadermatol.2018.3281
PMID: 30285080
