Effects of supervised exercise training on lower-limb cutaneous microvascular reactivity in adults with venous ulcers

Benefit in physical function and quality of life to nonsurgical treatment of varicose veins: Pilot study

BACKGROUND

Studies on varicose veins have focused its effects on physical function; however, whether nonsurgical treatments alter muscle oxygenation or physical function remains unclear. Moreover, the differences in such functions between individuals with varicose veins and healthy individuals remain unclear.

AIM

To investigate changes in physical function and the quality of life (QOL) following nonsurgical treatment of patients with varicose veins and determine the changes in their muscle oxygenation during activity.

METHODS

We enrolled 37 participants (those with varicose veins, n = 17; healthy individuals, n = 20). We performed the following measurements pre- and post-nonsurgical treatment in the varicose vein patients and healthy individuals: Calf muscle oxygenation during the two-minute step test, open eyes one-leg stance, 30 s sit-to-stand test, visual analog scale (VAS) for pain, Pittsburgh sleep quality index, physical activity assessment, and QOL assessment.

RESULTS

Varicose veins patients and healthy individuals differ in most variables (physical function, sleep quality, and QOL). Varicose veins patients showed significant differences between pre- and post-nonsurgical treatment- results in the 30 sit-to-stand test [14.41 (2.45) to 16.35 (4.11), P = 0.018), two-minute step test [162.29 (25.98) to 170.65 (23.80), P = 0.037], VAS for pain [5.35 (1.90) to 3.88 (1.73), P = 0.004], and QOL [39.34 (19.98) to 26.69 (17.02), P = 0.005]; however, no significant difference was observed for muscle oxygenation.

CONCLUSION

Nonsurgical treatment improved lower extremity function and QOL in varicose veins patients, bringing their condition close to that of healthy individuals. Future studies should include patients with severe varicose veins requiring surgery to confirm our findings.

Testing the feasibility of a co-designed intervention, comprising self-managed, home-based, exercise training with embedded behavioural support and compression therapy for people with venous leg ulcers receiving treatment at home (FISCU-II)

BACKGROUND

Venous leg ulcers (VLUs) heal slowly, are painful for patients and are costly for healthcare systems; they also affect patients' quality of life. Previous work suggests that supervised exercise training used in combination with compression therapy may offer clinical benefits. However, a large population of people with VLUs are unable to access such an intervention due to frailty and age.

OBJECTIVES

To assess the feasibility of 'FISCU Home' (a co-designed, 12-week home-based self-managed lifestyle programme based on exercise and behaviour support) as an adjunct therapy to compression in people with VLUs.

METHODS

Forty people with VLUs, receiving treatment at home, were recruited from community nursing and tissue viability teams, and via a newspaper advertisement. Participants were randomized 1 : 1 either to exercise with behaviour support (three times per week) plus compression therapy or compression only. The feasibility of the programme was assessed using progression criteria that included exercise attendance rate, loss to follow-up, patient preference(s) and adverse events (AEs). Baseline assessments were repeated at 12 weeks and 6 months. Secondary outcomes (i.e. ulcer recurrence, healing rate and healing time) were also documented at these intervals. Intervention and healthcare utilization costs were calculated.

RESULTS

The study recruitment rate was 65%, while 75% of the exercise group participants attended all scheduled exercise sessions. All participants completed compression therapy. No serious AEs or exercise-related AEs were reported. Median (interquartile range) ulcer healing time was shorter in the exercise group [29 (7-108) vs. 42 (6-116) weeks].

CONCLUSIONS

The feasibility and acceptability of both a home- and exercise-based lifestyle intervention in conjunction with compression therapy and the study procedures are supported.

Chronic venous insufficiency and venous leg ulcers: Aetiology, on the pathophysiology-based treatment

The chronic venous disease covers a wide spectrum of venous disorders that are characterized by severely impaired blood return that primarily affects veins in the lower extremities. Morphological and functional abnormalities of the venous system led to chronic venous insufficiency (CVI), and present as leg heaviness/achiness, edema, telangiectasia, and varices. The term 'chronic venous insufficiency' (CVI) refers to a disease of greater severity. Venous dysfunction is associated with venous hypertension and is associated with venous reflux due to poorly functioning or incompetent venous valves, which ultimately reduces venous return, leading to a cascade of morphological, physiological, and histologic abnormalities such as blood pooling, hypoxia, inflammation, swelling, skin changes (lipodermatosclerosis), and in severe cases, venous leg ulcers (VLU). This review summarizes recent knowledge about the aetiology, risk factors, and pathophysiology of VLU and compared the possibilities of their treatment.

Combined effect of yoga and naturopathy in uncomplicated varicose vein disease - a prospective randomized controlled trial

BACKGROUND

Though the treatment of uncomplicated varicose vein (UVV) might prevent late complications such as skin change or ulceration, but, there are limited studies available to justify this concept. Yoga and Naturopathy being a proficient tool in managing non communicable diseases including many cardiovascular diseases; no attempt was made to study its potential effect in Varicose Vein diseases.

OBJECTIVE

The present study aims to study the combination of Yoga and Naturopathy in uncomplicated varicose vein patients.

MATERIALS AND METHODS

50 UVV participants were prospectively recruited and randomly divided into two groups, Experimental and Active control groups. Both the groups practiced their respective interventions, and follow up was done after 1 and 3 months of active intervention. Finally study was completed with 46 participants (2 dropouts in each groups). The sample size was calculated based on the previous study, considering power as 0.8 and 'α' as 0.05, using 'G' power software. The variables such as Body weight, BMI, Systolic blood pressure (SBP), Diastolic blood pressure (DBP), Heart rate (HR), high-sensitivity C-reactive protein (hs-CRP), homocysteine (HCy) were recorded before and after the intervention, but Aberdeen Varicose Vein Questionnaire (AVVQ) and Visual analogue heaviness scale (VAHS) were recorded on 60 and 120 days of the follow up in addition to active intervention period.

RESULTS

There was a significant decrease in hs-CRP (p < 0.05) in the experimental group as compared to the control group. Body weight, BMI, SBP, HR, hs-CRP, HCy (p < 0.001) and DBP (p < 0.05) significantly decreases following the Combined Yoga and Naturopathy (CYN) intervention for a month in the experimental group. Also, the AVVQ (p < 0.01) and VAHS (p < 0.05) decreases following active intervention and two consecutive follow up. No adverse event was noted during or after the trial.

CONCLUSION

The combined effect of Yoga and Naturopathy reduced blood pressure and inflammatory markers suggestive of potential of recovery in inflammation in the endothelial tissue of the microvascular system in UVV patients.

TRIAL REGISTRY NUMBER

CTRI/2018/10/015895; Clinical Trials Registry- India; www.ctri.nic.in.

Active legs: Impact of physical activity as an adjuvant treatment in the healing of venous ulcers in primary care: a RCT protocol study

BACKGROUND

Venous ulcers usually present a torpid evolution with a negative impact on patients' quality of life. In primary care, they account for 2.5% of nursing consultations and their treatment represents high costs for national health systems. These patients usually have a low level of physical activity, with muscle pump dysfunction of the lower limbs, which may improve with increased physical activity. The purpose of this study is to analyse the effectiveness of a structured intervention involving physical activity and exercise (Active Legs) as an adjuvant treatment in improving healing of chronic venous ulcers at 3 months follow-up.

METHODS

A randomized, multicentre clinical trial. A total of 224 individuals receiving primary nursing care with a diagnosis of venous ulcer, with a diameter of 1 cm or greater and an ankle-brachial index between 0.8 and 1.3, able to comply with the study requirements and consenting to participate, will be sequentially included (112 per group). Both groups will receive the standard treatment in primary care, with cleansing, debridement and healing in a moist environment together with multilayer compression therapy. The intervention group will also receive a structured educational intervention involving lower limb physical exercise and daily ambulation guidelines. The primary response variables will be complete healing -understood as complete and sustained epithelialisation for at least 2 weeks- and time to healing. The secondary variables will be degree of healing, ulcer area, quality of life, pain and variables related to the healing process, prognosis, and recurrences. Sociodemographic variables, adherence to treatment and satisfaction variables will also be recorded. Data will be collected at baseline, at 3 months and at 6 months follow-up. Survival analysis (Kaplan-Meier and Cox) will be performed to measure primary effectiveness. Intention-to-treat analysis.

DISCUSSION

If the intervention is effective, a cost-effectiveness analysis could be conducted and implemented as an additional intervention in the usual venous ulcer treatment in primary care.

TRIAL REGISTRATION

NCT04039789. [ https://ClinicalTrials.gov ]. 07/11/2019.

Effects of Oral Nutritional Supplementation on Patients with Venous Ulcers: A Clinical Trial

Background: The dosage and safety of nutritional supplements for patients with venous ulcers are still not well established. Aim: To evaluate the effects of a high calorie, high protein, arginine-, zinc-, and vitamins A, C, and E-enriched nutritional supplement on the biochemical profile, dietary intake, anthropometry, muscle strength, and characteristics of lesions of patients with venous ulcers. Methods: A controlled before−after clinical trial with a four-week follow-up involved 27 patients with venous ulcers under outpatient treatment in Brazil. It was administered in two to three doses per day (200 mL each) of a high-calorie and high-protein supplement enriched with arginine, zinc, and vitamins A, C, and E. Patients were assessed for anthropometric parameters, dietary intake, biochemical tests, and healing conditions according to the Pressure Ulcer Scale for Healing (PUSH). Results: It was observed that an increase in energy and protein supply led to an adequate intake of immunonutrients (zinc and vitamins A, C, and E), increased body weight, increased body mass index, and stronger handgrip strength. The injury area and the score on the PUSH notably decreased after the intervention (p < 0.001). Conclusions: The administered supplement, at the tested dosage, improved the nutritional status and characteristics of lesions in patients with venous ulcers.

Medium- and longer-term cardiovascular effects of e-cigarettes in adults making a stop-smoking attempt: a randomized controlled trial

BACKGROUND

Smoking is a major risk factor for cardiovascular disease and smoking cessation reduces excess risk. E-cigarettes are popular for smoking cessation but there is little evidence on their cardiovascular health effect. Our objective was to compare the medium- and longer-term cardiovascular effects in smokers attempting to quit smoking using e-cigarettes with or without nicotine or prescription nicotine replacement therapy (NRT).

METHODS

This was a single-center, pragmatic three-arm randomized (1:1:1) controlled trial, which recruited adult smokers (≥ 10 cigarettes/day), who were willing to attempt to stop smoking with support (n = 248). Participants were randomized to receive behavioral support with either (a) e-cigarettes with 18 mg/ml nicotine, (b) e-cigarettes without nicotine, and (c) NRT. Flow-mediated dilation (%FMD) and peak cutaneous vascular conductance (CVCmax) responses to acetylcholine (ACh) and sodium nitroprusside (SNP), mean arterial pressure (MAP), and other outcomes were recorded at baseline, 3, and 6 months after stopping smoking. Data were analyzed using generalized estimating equations (GEE).

RESULTS

At 3- and 6-month follow-up, %FMD showed an improvement over baseline in all three groups (e.g., p < 0.0001 at 6 months). Similarly, ACh, SNP, and MAP improved significantly over baseline in all groups both at 3 and 6 months (e.g., ACh: p = 0.004, at 6 months).

CONCLUSIONS

Smokers attempting to quit experienced positive cardiovascular impact after both a 3- and 6-month period. None of the groups (i.e., nicotine-containing and nicotine-free e-cigarettes or NRT) offered superior cardiovascular benefits to the others.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03061253 . Registered on 17 February 2017.

THE EFFECTS OF INSPIRATORY MUSCLE TRAINING VERSUS CALF MUSCLE TRAINING ON QUALITY OF LIFE, PAIN, VENOUS FUNCTION AND ACTIVITY IN PATIENTS WITH CHRONIC VENOUS INSUFFICIENCY

OBJECTIVE

The aim of this study was to evaluate the effect of inspiratory muscle training(IMT) and calf muscle exercise training(ETC) in addition to compression therapy(CT) on quality of life, venous refilling time, disease severity, pain, edema, range of motion, muscle strength and functionality in patients with chronic venous insufficiency (CVI) compared to compression treatment alone.

METHODS

Thirty-two participants diagnosed with CVI were randomly divided into three groups. IMT in addition to compression therapy, Group 1, exercise training for the calf muscle in addition to compression therapy, Group 2, and compression therapy alone, Group 3. All the patients were assessed with the Chronic Venous Insufficiency Quality of Life Questionnaire-20, Nottingham Health Profile, photoplethysmography, venous clinical severity score, visual analog scale, intraoral pressure measurements, dynamometer, digital goniometer, 6-minute walk test and lower extremity functional scale.

RESULTS

After treatment, Group 2 improved more than groups 1 and 3 in terms of quality of life, venous refilling time, pain, edema, range of motion, muscle strength and functionality scores; Group 1 improved more than groups 2 and 3 in terms of disease severity, inspiratory and expiratory muscle strength values(p<0.05). Only physical mobility and right leg venous refilling time increased in group 3(p<0.05).

CONCLUSIONS

IMT and ETC improve venous function in both legs in patients with CVI while CT alone improves venous function only in the right leg of patients with CVI.

Short-Term Cardiovascular Effects of E-Cigarettes in Adults Making a Stop-Smoking Attempt: A Randomized Controlled Trial

Simple Summary

E-cigarettes are popular for smoking cessation but knowledge of their effect on cardiovascular health is limited. We compared the short-term cardiovascular effects in 248 smokers who quit smoking using e-cigarettes with or without nicotine or prescription nicotine replacement therapy (NRT). All participants received behavioural support. We assessed the cardiovascular effects of these stop smoking methods 3 days following quit date. Our work suggests that e-cigarettes offer similar vascular health benefits to that of NRT. This happens at a very early stage in the stop smoking process (3 days).

Abstract

Smoking increases cardiovascular disease (CVD) risk by leading to endothelial injury. E-cigarettes remain a popular way to stop smoking. Evidence on their effect on cardiovascular health is growing but remains limited, particularly in the short-term. The main objective of this study was to compare short-term cardiovascular effects in smokers who quit smoking using e-cigarettes with or without nicotine or prescription nicotine replacement therapy (NRT). This was a single-centre (Sheffield, UK) pragmatic three-arm randomised controlled trial which recruited adult smokers (≥10 cigarettes per day), who were willing to attempt to stop smoking with support (n = 248). Participants were randomised to receive either: (a) behavioral support and e-cigarettes with 18 mg/mL nicotine (n = 84); (b) behavioral support and e-cigarettes without nicotine (n = 82); (c) behavioral support and NRT (n = 82). Flow Mediated Dilation (%FMD), peak cutaneous vascular conductance responses to acetylcholine (ACh) and sodium nitroprusside (SNP) and mean arterial pressure (MAP) were recorded at baseline and three days after stopping smoking. General Linear Models were used to compare changes between groups and changes from follow-up. Adjusting for baseline, at follow-up, all outcomes (for the 208 participants that completed the 3-day assessments) with the exception of SNP had improved significantly over baseline and there were no differences between groups (%FMD F = 1.03, p = 0.360, df = 2,207; ACh F = 0.172, p = 0.84, df = 2,207; SNP F = 0.382, p = 0.68, df = 2,207; MAP F = 0.176, p = 0.84, df = 2,207). For smokers ≥20 cigarettes per day, benefits were also pronounced. Smoking cessation showed positive cardiovascular impact even after a 3-day period and the effects did not differ between nicotine-containing e-cigarettes, nicotine-free e-cigarettes and NRT.

Physical Activity as an Adjunct to Compression Therapy on Healing Outcomes and Recurrence in Patients With Venous Leg Ulcers: A Scoping Review Protocol

Background: Chronic venous leg ulceration is a common and costly clinical issue across the world, affecting up to 3 in 1,000 people. Compression therapy is recommended as the gold standard treatment in clinical practice, although a large number of venous leg ulcers remain unhealed after several years. Physical activity may improve healing although there is limited evidence on the effects of physical activity as an adjuvant treatment to compression to improve venous leg ulcers healing and prevent recurrence. Objectives: This scoping review protocol aims to systematically search, appraise, and synthesize quantitative research evidence to assess the effect of physical activity interventions applied in conjunction with compression therapy on venous leg ulcer healing and recurrence. Methods and Analysis: We will use the methodology framework suggested by Arksey and O'Malley, Levac et al., the JBI as a guide. We will also follow the three-step search strategy recommended by the JBI to systematic search for relevant published research, ongoing clinical trials, and grey literature. Two review authors will independently screen titles and abstracts followed by full-text review to determine final eligibility for inclusion. The search process will be reported using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart. Characteristics of physical activity interventions, primary outcomes related to ulcer healing and recurrence, and secondary outcomes of interest included quality of life, pain level, adverse effects, and economic costs will be extracted and summarized. The review will provide a descriptive account of the findings from included studies. Where appropriate, data will be pooled for a meta-analysis using a random effects model. Discussion: Physical activity interventions represent a low-cost, potentially useful adjuvant treatment to compression therapy for the management of venous leg ulcers. Several gaps in knowledge remain that are answerable via a targeted scoping review. This protocol outlines the rationale, objectives, and the planned methodology for conducting the study. Ethics and Dissemination: The scoping review will use data from publicly available sources and ethical approval is not required. Findings from this review will be submitted to a peer-reviewed journal, presented at relevant conferences and disseminated via social media.

Impaired dermal microvascular reactivity and implications for diabetic wound formation and healing: an evidence review

Diabetic foot ulcers (DFUs) are among the most consequential and costly complications faced by patients with diabetes and the global healthcare system. Acknowledged risk factors for DFUs include diabetic peripheral neuropathy (DPN), peripheral arterial disease (PAD), microtrauma and foot deformities. Research on additional risk factors for DFUs has recently focused on dysregulated, autonomic vasomotor control in the skin of patients with DPN. In particular, impaired dermal microvascular reactivity (IDMR) with its attendant reduction in nutritive capillary blood flow has been identified as an emerging risk factor. This especially relates to refractory wounds noted in patients without overt PAD signs. In this paper, evidence will be reviewed supporting the evolving understanding of IDMR and its impact on DFU formation and healing. Advances in diagnostic instrumentation driving this research along with the most promising potential therapies aimed at improving microvascular function in the diabetic foot will be discussed in brief.

Effectiveness of combined conventional treatment with a tailored exercise training program on wound healing in patients with venous leg ulcer: A randomized controlled trial

INTRODUCTION

Venous leg ulcer (VLU) is a therapeutic challenge. The mainstay of care is compression therapy and wound care. Exercise is also recommended for facilitating wound healing. This study aimed to determine whether adding tailored exercise training to conventional treatment would be superior on wound healing, ankle mobility, calf muscle function, and functional ability compared to those with the conventional treatment alone.

METHODS

A randomized controlled trial, single-blinded was conducted. VLU patients were randomized to the conventional treatment plus tailored exercise training (intervention group) and the conventional treatment alone (control group) (12/group). The conventional treatment contained foam dressing and short-stretch bandage, while the tailored exercise training consisted of stretching, resistive, and aerobic exercise sessions (3-day/week, for 12-week). Primary outcomes included healing rate and wound size parameters. Secondary outcomes were ankle range of motion (ROM), calf circumference, calf muscle endurance and strength, and functional ability. All outcomes were assessed at baseline, 6-, and 12-week intervention.

RESULTS

The intervention group had a higher trend of healing rate after 12-week training than those in the control group, but this trend was not significantly different (92% versus 58%, p = 0.06). After training, the intervention group had significantly decreased wound size. The intervention group had significantly higher ankle ROM and dorsiflexor muscle strength after 6- and 12-week training than those in the control group.

CONCLUSION

Adding the tailored exercise training incorporated with the conventional treatment may provide a greater tendency on wound healing and have the potential to improve ankle mobility than the conventional treatment alone.

TRIAL REGISTRATION NUMBER

TCTR20170405002.

The Physics of Fluid Dynamics Applied to Vascular Ulcers and Its Impact on Nursing Care

The high incidence of vascular ulcers and the difficulties encountered in their healing process require the understanding of their multiple etiologies to develop effective strategies focused on providing different treatment options. This work provides a description of the principles of the physics of fluid dynamics related to vascular ulcers. The morphological characteristics of the cardiovascular system promote blood flow. The contraction force of the left ventricle is enhanced by its ability to reduce its radius of curvature and by increasing the thickness of the ventricular wall (Laplace’s Law). Arterial flow must overcome vascular resistance (Ohm’s equation). The elastic nature of the artery and the ability to reduce its diameter as flow rate progresses facilitate blood conduction at high speed up to arteriolar level, and this can be determined by the second equation of continuity. As it is a viscous fluid, we must discuss laminar flow, calculated by the Reynolds number, which favors proper conduction while aiming at the correct net filtration pressure. Any endothelial harmful process that affects the muscle wall of the vessel increases the flow speed, causing a decrease in capillary hydrostatic pressure, thus reducing the exchange of nutrients at the interstitial level. With regard to the return system, the flow direction is anti-gravity and requires endogenous aid to establish the Starling’s equilibrium. Knowledge on the physics of vascular fluid dynamics makes it easier to understand the processes of formation of these ulcers so as to choosing the optimal healing and prevention techniques for these chronic wounds.

Supervised exercise protocol for lower limbs in subjects with chronic venous disease: an evaluator-blinded, randomized clinical trial

Background

Chronic venous insufficiency (CVI) causes pathophysiological changes in the lower-limb muscles, particularly the calf muscles, and limits ankle range of motion (ROM). These changes reduce functional activities and decrease quality of life (QOL). Although several studies have shown the benefits of exercise (strengthening the calf muscles to improve calf-muscle pumping and QOL) in patients with CVI, few studies are randomized controlled trials. This has led to a weak indication of exercise for the treatment of patients with CVI. The aim of this study is to analyze the effects of a supervised exercise program to improve calf-muscle endurance as well as QOL in patients with CVI.

Methods/design

This is an evaluator-blind, randomized clinical trial with an 8-week duration and a follow-up evaluation at week 16. A pilot study with subjects with a CVI diagnosis will be performed to calculate sample size. The participants will be randomly allocated (1:1) into a treatment or a control group (usual care/no intervention). The treatment intervention consists of a bi-weekly supervised exercise program of the lower limbs that will include aerobic training, strengthening and cardiovascular exercises. The participants from both groups will participate in a health education lecture. Primary outcomes are changes in calf-muscle endurance and QOL score. Secondary outcomes are changes in exercise capacity, ankle ROM, electrical muscle activity and cardiac output. The first statistical comparison will be performed after 8 weeks’ intervention.

Discussion

Patients with CVI may have an impaired calf-muscle pump and decreased exercise capacity. A randomized controlled trial evaluating a supervised exercise program should provide much needed information on the management of CVI to promote health and independence.

Trial registration

This study was registered on the Brazilian Clinical Trials Database (REBEC) (RBR-57xtk7). The results will be disseminated at scientific events, presentations, and publications in peer-reviewed journals.

A Lower Leg Physical Activity Intervention for Individuals With Chronic Venous Leg Ulcers: Randomized Controlled Trial

BACKGROUND

Individuals with venous leg ulcers (VLUs) suffer disproportionately with multiple chronic conditions, are often physically deconditioned, and demonstrate high levels of physical inactivity.

OBJECTIVE

The primary objective of this randomized controlled trial was to establish the feasibility of a mobile health (mHealth) physical activity exercise app for individuals with VLUs to improve lower leg function.

METHODS

In a 6-week study, adults with VLUs were recruited from 2 wound centers in South Carolina, United States, and enrolled if they were aged 18 years or older with impaired functional mobility and an ankle-brachial index between 0.8 and 1.3. Participants were randomized 1:1 to receive evidence-based, phased, nonexertive physical conditioning activities for lower leg function (FOOTFIT) or FOOTFIT+ with an added patient-provider communication feature. The mHealth Conditioning Activities for Lower Leg Function app also provided automated educational and motivational messages and user reports. Foot movement on the VLU-affected leg was tracked by a Bluetooth-enabled triaxial accelerometer. The study was guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to assess the feasibility of reach, adherence, acceptability, implementation, and maintenance.

RESULTS

A total of 24 patients were recruited, enrolled, and randomized in the study. Most patients reported difficulty following the protocol for exercising and using the accelerometer and mobile phone and did not use the provider contact feature. However, all patients were adherent to the 6-week exercise program more than 85% of the time for duration, whereas 33% (8/24) of patients adhered more than 85% for the frequency of performing the exercises. Across the three exercise levels, adherence did not differ between the two groups. Confidence limits around the difference in proportions ranged from -0.4 to 0.7. Providers in FOOTFIT+ were inconsistent in checking participant progress reports because of lack of time from competing work commitments. The technology became outdated quickly, making maintenance problematic. Participants said they would continue to exercise their foot and legs and liked being able to follow along with the demonstrations of each level of exercise provided through the app.

CONCLUSIONS

The findings of this study suggest that despite initial interest in using the app, several components of the program as originally designed had limited acceptability and feasibility. Future refinements should include the use of more modern technology including smaller wearable accelerometers, mobile phones or tablets with larger screens, an app designed with larger graphics, automated reporting for providers, and more engaging user features.

TRIAL REGISTRATION

ClinicalTrials.gov NTC02632695; https://clinicaltrials.gov/ct2/show/NCT02632695.

Participant experiences in a feasibility trial of supervised exercise training in adults with venous leg ulcers: A qualitative study

Exercise training can improve lower-limb cutaneous microvascular reactivity in adults with venous leg ulceration; however, there is a lack of research on patients' views about the acceptability and feasibility of exercise interventions. The aim of this study was to explore participants' experiences of the trial "Exploring the Feasibility of Implementing a Supervised Exercise Training and Compression Hosiery Intervention in Patients with Venous Ulceration" (FISCU). Semi-structured face-to-face and telephone interviews were used to investigate participants' experiences (n = 16) of taking part in the FISCU trial. Data were analysed using thematic analysis. Three overarching themes were identified, along with 11 sub-themes: (a) sedentary cautious living (because of pain and reduced mobility, treatment and perceived control, and advice to rest and be careful), (b) key components of the exercise trial (including motivation, an individualised intervention supervised by a specialist exercise professional, and satisfaction with the intervention), and (c) benefits of exercise (physical benefits and healing, psychological well-being, positive impact on comorbidities, and an improved self-management strategy). This study found that an exercise intervention was viewed by participants as positive, acceptable, and feasible while living with a venous leg ulcer. An individualised and supervised exercise programme was key to build confidence to exercise.

Supervised exercise training as an adjunct therapy for venous leg ulcers: a randomized controlled feasibility trial

Background

Venous leg ulcers (VLUs) are typically painful and heal slowly. Compression therapy offers high healing rates; however, improvements are not usually sustained. Exercise is a low‐cost, low‐risk and effective strategy for improving physical and mental health. Little is known about the feasibility and efficacy of supervised exercise training used in combination with compression therapy patients with VLUs.

Objectives

To assess the feasibility of a 12‐week supervised exercise programme as an adjunct therapy to compression in patients with VLUs.

Methods

This was a two‐centre, two‐arm, parallel‐group, randomized feasibility trial. Thirty‐nine patients with venous ulcers were recruited and randomized 1 : 1 either to exercise (three sessions weekly) plus compression therapy or compression only. Progress/success criteria included exercise attendance rate, loss to follow‐up and patient preference. Baseline assessments were repeated at 12 weeks, 6 months and 1 year, with healing rate and time, ulcer recurrence and infection incidents documented. Intervention and healthcare utilization costs were calculated. Qualitative data were collected to assess participants’ experiences.

Results

Seventy‐two per cent of the exercise group participants attended all scheduled exercise sessions. No serious adverse events and only two exercise‐related adverse events (both increased ulcer discharge) were reported. Loss to follow‐up was 5%. At 12 months, median ulcer healing time was lower in the exercise group (13 vs. 34·7 weeks). Mean National Health Service costs were £813·27 for the exercise and £2298·57 for the control group.

Conclusions

The feasibility and acceptability of both the supervised exercise programme in conjunction with compression therapy and the study procedures is supported.

What's already known about this topic?

Almost 70% of all leg ulcers have a venous component.

Up to 30% of venous leg ulcers (VLUs) do not respond to compression alone, remain open after 1 year of treatment and need an average of 51 treatment visits to heal.

Adjunct therapies to compression are needed.

Exercise can form part of the therapeutic pathway, but evidence to determine whether exercise training has an effect on ulcer healing and quality of life is limited.

What does this study add?

The findings support the feasibility and acceptability of supervised exercise training as an adjunct therapy for adults with VLUs.

The preliminary data also support the potential effectiveness of exercise training in improving ulcer healing.

An appropriately powered, multicentre trial is required to confirm the clinical and cost‐effectiveness of the intervention.

Linked Comment: https://doi.org/10.1111/bjd.16523.

https://doi.org/10.1111/bjd.16618 available online

https://goo.gl/Uqv3dl