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Klonizakis M, Gumber A, McIntosh E, Levesley M, Horspool M, Logan P. 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). Clin Exp Dermatol 2024; 49:135-142. [PMID: 37819015 DOI: 10.1093/ced/llad342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 09/08/2023] [Accepted: 10/01/2023] [Indexed: 10/13/2023]
Abstract
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.
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Affiliation(s)
- Markos Klonizakis
- Lifestyle, Exercise and Nutrition Improvement (LENI) Research Group, Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, UK
| | - Anil Gumber
- Lifestyle, Exercise and Nutrition Improvement (LENI) Research Group, Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, UK
| | - Emma McIntosh
- Lifestyle, Exercise and Nutrition Improvement (LENI) Research Group, Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, UK
- Research and Innovation, Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | - Maria Levesley
- Integrated Care Team, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Michelle Horspool
- Research and Innovation, Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | - Pip Logan
- Centre for Rehabilitation and Ageing Research, University of Nottingham, Nottingham, UK
- Nottingham CityCare Partnership, Nottingham, UK
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Yang H, Wei XS, Gong J, Du XM, Feng HB, Su C, Gilmore C, Yue C, Yu SB, Li C, Sui HJ. The relationship between myodural bridge, atrophy and hyperplasia of the suboccipital musculature, and cerebrospinal fluid dynamics. Sci Rep 2023; 13:18882. [PMID: 37919345 PMCID: PMC10622500 DOI: 10.1038/s41598-023-45820-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023] Open
Abstract
The Myodural Bridge (MDB) is a physiological structure that is highly conserved in mammals and many of other tetrapods. It connects the suboccipital muscles to the cervical spinal dura mater (SDM) and transmits the tensile forces generated by the suboccipital muscles to the SDM. Consequently, the MDB has broader physiological potentials than just fixing the SDM. It has been proposed that MDB significantly contributes to the dynamics of cerebrospinal fluid (CSF) movements. Animal models of suboccipital muscle atrophy and hyperplasia were established utilizing local injection of BTX-A and ACE-031. In contrast, animal models with surgical severance of suboccipital muscles, and without any surgical operation were set as two types of negative control groups. CSF secretion and reabsorption rates were then measured for subsequent analysis. Our findings demonstrated a significant increase in CSF secretion rate in rats with the hyperplasia model, while there was a significant decrease in rats with the atrophy and severance groups. We observed an increase in CSF reabsorption rate in both the atrophy and hyperplasia groups, but no significant change was observed in the severance group. Additionally, our immunohistochemistry results revealed no significant change in the protein level of six selected choroid plexus-CSF-related proteins among all these groups. Therefore, it was indicated that alteration of MDB-transmitted tensile force resulted in changes of CSF secretion and reabsorption rates, suggesting the potential role that MDB may play during CSF circulation. This provides a unique research insight into CSF dynamics.
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Affiliation(s)
- Heng Yang
- Department of Anatomy, Dalian Medical University, Dalian, Liaoning, China
| | - Xiao-Song Wei
- Department of Anatomy, Dalian Medical University, Dalian, Liaoning, China
| | - Jin Gong
- Department of Anatomy, Dalian Medical University, Dalian, Liaoning, China
| | - Xue-Mei Du
- Department of Nuclear Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Hong-Bo Feng
- Department of Nuclear Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Chang Su
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | | | - Chen Yue
- Department of Gynecology ands Obstetrics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Sheng-Bo Yu
- Department of Anatomy, Dalian Medical University, Dalian, Liaoning, China
| | - Chan Li
- Department of Anatomy, Dalian Medical University, Dalian, Liaoning, China.
| | - Hong-Jin Sui
- Department of Anatomy, Dalian Medical University, Dalian, Liaoning, China.
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Araujo DN, Ribeiro CT, Maciel AC, Bruno SS, Fregonezi GA, Dias FA. Physical exercise for the treatment of non-ulcerated chronic venous insufficiency. Cochrane Database Syst Rev 2023; 6:CD010637. [PMID: 37314059 PMCID: PMC10265938 DOI: 10.1002/14651858.cd010637.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Chronic venous insufficiency (CVI) is a condition related to chronic venous disease that may progress to venous leg ulceration and impair quality of life of those affected. Treatments such as physical exercise may be useful to reduce CVI symptoms. This is an update of an earlier Cochrane Review. OBJECTIVES To evaluate the benefits and harms of physical exercise programmes for the treatment of individuals with non-ulcerated CVI. SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 28 March 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing exercise programmes with no exercise in people with non-ulcerated CVI. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were intensity of disease signs and symptoms, ejection fraction, venous refilling time, and incidence of venous leg ulcer. Our secondary outcomes were quality of life, exercise capacity, muscle strength, incidence of surgical intervention, and ankle joint mobility. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS We included five RCTs involving 146 participants. The studies compared a physical exercise group with a control group that did not perform a structured exercise programme. The exercise protocols differed between studies. We assessed three studies to be at an overall unclear risk of bias, one study at overall high risk of bias, and one study at overall low risk of bias. We were not able to combine data in meta-analysis as studies did not report all outcomes, and different methods were used to measure and report outcomes. Two studies reported intensity of CVI disease signs and symptoms using a validated scale. There was no clear difference in signs and symptoms between groups in baseline to six months after treatment (Venous Clinical Severity Score mean difference (MD) -0.38, 95% confidence interval (CI) -3.02 to 2.26; 28 participants, 1 study; very low-certainty evidence), and we are uncertain if exercise alters the intensity of signs and symptoms eight weeks after treatment (MD -4.07, 95% CI -6.53 to -1.61; 21 participants, 1 study; very low-certainty evidence). There was no clear difference in ejection fraction between groups from baseline to six months follow-up (MD 4.88, 95% CI -1.82 to 11.58; 28 participants, 1 study; very low-certainty evidence). Three studies reported on venous refilling time. We are uncertain if there is an improvement in venous refilling time between groups for baseline to six-month changes (MD 10.70 seconds, 95% CI 8.86 to 12.54; 23 participants, 1 study; very low-certainty evidence) or baseline to eight-week change (MD 9.15 seconds, 95% CI 5.53 to 12.77 for right side; MD 7.25 seconds, 95% CI 5.23 to 9.27 for left side; 21 participants, 1 study; very low-certainty evidence). There was no clear difference in venous refilling index for baseline to six-month changes (MD 0.57 mL/min, 95% CI -0.96 to 2.10; 28 participants, 1 study; very low-certainty evidence). No included studies reported the incidence of venous leg ulcers. One study reported health-related quality of life using validated instruments (Venous Insufficiency Epidemiological and Economic Study (VEINES) and 36-item Short Form Health Survey (SF-36), physical component score (PCS) and mental component score (MCS)). We are uncertain if exercise alters baseline to six-month changes in health-related quality of life between groups (VEINES-QOL: MD 4.60, 95% CI 0.78 to 8.42; SF-36 PCS: MD 5.40, 95% CI 0.63 to 10.17; SF-36 MCS: MD 0.40, 95% CI -3.85 to 4.65; 40 participants, 1 study; all very low-certainty evidence). Another study used the Chronic Venous Disease Quality of Life Questionnaire (CIVIQ-20), and we are uncertain if exercise alters baseline to eight-week changes in health-related quality of life between groups (MD 39.36, 95% CI 30.18 to 48.54; 21 participants, 1 study; very low-certainty evidence). One study reported no differences between groups without presenting data. There was no clear difference between groups in exercise capacity measured as time on treadmill (baseline to six-month changes) (MD -0.53 minutes, 95% CI -5.25 to 4.19; 35 participants, 1 study; very low-certainty evidence). We are uncertain if exercise improves exercise capacity as assessed by the 6-minute walking test (MD 77.74 metres, 95% CI 58.93 to 96.55; 21 participants, 1 study; very low-certainty evidence). Muscle strength was measured using dynamometry or using heel lifts counts. We are uncertain if exercise increases peak torque/body weight (120 revolutions per minute) (changes from baseline to six months MD 3.10 ft-lb, 95% CI 0.98 to 5.22; 29 participants, 1 study; very low-certainty evidence). There was no clear difference between groups in baseline to eight-week change in strength measured by a hand dynamometer (MD 12.24 lb, 95% CI -7.61 to 32.09 for the right side; MD 11.25, 95% CI -14.10 to 36.60 for the left side; 21 participants, 1 study; very low-certainty evidence). We are uncertain if there is an increase in heel lifts (n) (baseline to six-month changes) between groups (MD 7.70, 95% CI 0.94 to 14.46; 39 participants, 1 study; very low-certainty evidence). There was no clear difference between groups in ankle mobility measured during dynamometry (baseline to six-month change MD -1.40 degrees, 95% CI -4.77 to 1.97; 29 participants, 1 study; very low-certainty evidence). We are uncertain if exercise increases plantar flexion measured by a goniometer (baseline to eight-week change MD 12.13 degrees, 95% CI 8.28 to 15.98 for right leg; MD 10.95 degrees, 95% CI 7.93 to 13.97 for left leg; 21 participants, 1 study; very low-certainty evidence). In all cases, we downgraded the certainty of evidence due to risk of bias and imprecision. AUTHORS' CONCLUSIONS There is currently insufficient evidence to assess the benefits and harms of physical exercise in people with chronic venous disease. Future research into the effect of physical exercise should consider types of exercise protocols (intensity, frequency, and time), sample size, blinding, and homogeneity according to the severity of disease.
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Affiliation(s)
- Diego N Araujo
- Department of Medicine, Federal University of Alagoas, Arapiraca, Brazil
| | - Cibele Td Ribeiro
- Department of Physiology, Federal University of Paraná, Curitiba, Brazil
| | - Alvaro Cc Maciel
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Selma S Bruno
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Guilherme Af Fregonezi
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
- PneumoCardioVascular Lab, Onofre Lopes University Hospital, Brazilian Company of Hospital Services (EBSERH), Natal, Brazil
| | - Fernando Al Dias
- Department of Physiology, Federal University of Paraná, Curitiba, Brazil
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Zhang Q, Lu L, Song JL, Wang L. Effects of exercise in treating patients with venous leg ulcers: A systematic review and meta-analysis. Int Wound J 2023; 20:1776-1783. [PMID: 36650634 PMCID: PMC10088832 DOI: 10.1111/iwj.14020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 11/07/2022] [Indexed: 01/19/2023] Open
Abstract
To determine the effects of exercise on VLU healing and exercise adherence, and to provide evidence for clinical practice and scientific investigation. PubMed, Embase and Scopus were searched from inception to 31st March, 2022. Pooled relative risks (RRs), standardised mean differences (SMDs), adherence rate with respective 95% confidence intervals (CIs) were calculated. Quality assessment of included studies were performed using the Cochrane Collaboration risk of bias evaluation. Heterogeneity between enrolled studies was evaluated. We identified eight randomised control studies (RCTs) that met the inclusion criteria. The pooled RR for healing rate was 1.38 (95% CI: 1.14 to 1.66; P = 0.0008) with no significant heterogeneity between component studies (I2 = 0%, P = 0.96). SMD for differences of total range of ankle joint motion (ROAM) at the end and at the initiation of follow-up in the intervention and control groups was 0.87 (95% CI: 0.22, 1.52; P = 0.0091), no significant heterogeneity was detected (I2 = 59%, P = 0.0622). Pooled adherence rate was 64% (95% CI: 53%, 75%) with no significant heterogeneity. Exercise manifested positive effects on VLU healing, range of ankle mobility compared with the control group. Patients' adherence to the exercise regimens was favourable.
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Affiliation(s)
- Qianting Zhang
- Department of Burn OrthopaedicsZhongda Hospital affiliated to Southeast UniversityNanjingChina
| | - Ling Lu
- Department of Burn OrthopaedicsZhongda Hospital affiliated to Southeast UniversityNanjingChina
| | - Jia lin Song
- Department of Burn OrthopaedicsZhongda Hospital affiliated to Southeast UniversityNanjingChina
| | - Lu Wang
- Department of Burn OrthopaedicsZhongda Hospital affiliated to Southeast UniversityNanjingChina
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Chauhan S, Patra S, Singh SP, Lakhani JD. Combined effect of yoga and naturopathy in uncomplicated varicose vein disease - a prospective randomized controlled trial. J Ayurveda Integr Med 2023; 14:100718. [PMID: 37356369 PMCID: PMC10320501 DOI: 10.1016/j.jaim.2023.100718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 11/01/2022] [Accepted: 04/24/2023] [Indexed: 06/27/2023] Open
Abstract
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.
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Affiliation(s)
- Shweta Chauhan
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, Swami Vivekananda Road, Kalluballu Post, Anekal, Jigani, Bangalore 560105, Karnataka, India
| | - Sanjib Patra
- Central University of Rajasthan, NH-8, Bandar Sindri, Dist, Ajmer 305817, Rajasthan, India.
| | | | - Jitendra D Lakhani
- Smt.B.K.Shah Medical Institute and Research Center and Dhiraj Hospital, Piparia, Dist., Vadodara, Gujarat, India
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6
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Erdal ES, Demirgüç A, Kabalcı M, Demirtaş H. Evaluation of physical activity level and exercise capacity in patients with varicose veins and chronic venous insufficiency. Phlebology 2021; 36:636-643. [PMID: 33745365 DOI: 10.1177/02683555211002339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The clinical indication of chronic venous insufficiency (CVI) is related to functional performance and the benefits of physical activity in patients with CVI are known. Despite its importance, the literature is limited in this regard. This study aimed to determine exercise capacity and physical activity level in patients with varicose veins and CVI. METHODS Volunteers who came to the polyclinic with leg pain complaints were enrolled in the study. Individual sociodemographic and clinical information was recorded. Individuals' pain severity was assessed by the visual analog scale (VAS) and exercise capacity was assessed by 6-minute walk test (6MWT). International Physical Activity Questionnaire (IPAQ) was used to assess the level of physical activity. RESULTS The study group consisted of 51 individuals who were diagnosed with varicose veins and CVI. The control group consisted of 51 individuals without varicose veins and CVI diagnosis. In the study group, the VAS during activity was significantly higher compared to the control group. The 6MWT distance, distance %, IPAQ total score and IPAQ walking score of the control group were significantly higher in comparison with the study group (p<0.05). CONCLUSIONS We believe that our findings will lead the planning of interventions to increase the level of physical activity in CVI patients.
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Affiliation(s)
- Elif Sakızlı Erdal
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Arzu Demirgüç
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Sanko University, Gaziantep, Turkey
| | - Mehmet Kabalcı
- Department of Cardiovascular Surgery, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Hüseyin Demirtaş
- Department of Cardiovascular Surgery, Dr. Nafiz Körez Sincan Public Hospital, Ankara, Turkey
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Volpe EFT, Resqueti VR, da Silva AAM, Gualdi LP, Fregonezi GAF. Supervised exercise protocol for lower limbs in subjects with chronic venous disease: an evaluator-blinded, randomized clinical trial. Trials 2020; 21:414. [PMID: 32430078 PMCID: PMC7238730 DOI: 10.1186/s13063-020-04314-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 04/10/2020] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
- Esther Fernandes Tinoco Volpe
- PneumoCardioVascular Lab/HUOL Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERRH) Departamento de Fisioterapia Universidade Federal do Rio Grande do Norte, Campus Universitário Central, Caixa Postal 1524/ Campus Universitário Lagoa Nova, Natal, Rio Grande do Norte, CEP: 59078-900, Brazil.,Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Vanessa R Resqueti
- PneumoCardioVascular Lab/HUOL Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERRH) Departamento de Fisioterapia Universidade Federal do Rio Grande do Norte, Campus Universitário Central, Caixa Postal 1524/ Campus Universitário Lagoa Nova, Natal, Rio Grande do Norte, CEP: 59078-900, Brazil.,Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Ana Aline Marcelino da Silva
- PneumoCardioVascular Lab/HUOL Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERRH) Departamento de Fisioterapia Universidade Federal do Rio Grande do Norte, Campus Universitário Central, Caixa Postal 1524/ Campus Universitário Lagoa Nova, Natal, Rio Grande do Norte, CEP: 59078-900, Brazil.,Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Lucien Peroni Gualdi
- PneumoCardioVascular Lab/HUOL Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERRH) Departamento de Fisioterapia Universidade Federal do Rio Grande do Norte, Campus Universitário Central, Caixa Postal 1524/ Campus Universitário Lagoa Nova, Natal, Rio Grande do Norte, CEP: 59078-900, Brazil.,Faculdade de Ciências da Saúde do Trairi, Universidade Federal do Rio Grande do Norte (UFRN), Santa Cruz, Rio Grande do Norte, Brazil
| | - Guilherme A F Fregonezi
- PneumoCardioVascular Lab/HUOL Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERRH) Departamento de Fisioterapia Universidade Federal do Rio Grande do Norte, Campus Universitário Central, Caixa Postal 1524/ Campus Universitário Lagoa Nova, Natal, Rio Grande do Norte, CEP: 59078-900, Brazil. .,Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
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8
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Ribeiro-Samora GA, Carvalho MLV, de Moura RMF, Pereira DAG. Limitations of VEINES QOL/SYM for discriminating chronic venous insufficiency severity. J Vasc Bras 2019; 19:e20180096. [PMID: 31839797 PMCID: PMC6900879 DOI: 10.1590/1677-5449.180096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background The Venous Insufficiency Epidemiological and Economic Study - Quality of Life/Symptoms (VEINES-QOL / Sym) questionnaire was developed to evaluate the quality of life of individuals with chronic venous insufficiency (CVI), but it has shown limited sensitivity for discriminating between people with different of disease severity. Objectives a) to propose a new formula for calculating the VEINES-QOL/Sym score and to evaluate whether this new score is capable of discriminating disease severity; and b) to evaluate the association between VEINES-QOL/Sym scores and disease severity. Methods Ninety-eight participants with CVI of both sexes, aged 60.73 ± 14.11 years, answered the Portuguese Brazilian version of the VEINES-QOL/Sym questionnaire. The new score was calculated by transforming the original scores to a 0 to 100 scale. Discriminant analysis was used to test the capability of the original and modified VEINES-QOL/Sym scores to discriminate between and correctly classify groups characterized by the clinical, etiological, anatomical and pathophysiological classification (CEAP). Alpha of 5% was defined as the cutoff for significance. Results There were no significant differences between CEAP groups in terms of the original or modified VEINES-QOL/Sym scores. Discriminant analysis was also unable to correctly classify CEAP groups, using either original or modified scores. Furthermore, there were no associations between CEAP classifications and scores obtained using the questionnaire. Conclusions The VEINES-QOL/Sym proved to have limitations for assessment of the quality of life and symptomatology of people with CVI at different stages.
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Affiliation(s)
- Giane Amorim Ribeiro-Samora
- Universidade Federal de Minas Gerais - UFMG, Programa de Pós-graduação em Ciências da Reabilitação, Belo Horizonte, MG, Brasil
| | - Maria Luiza Vieira Carvalho
- Universidade Federal de Minas Gerais - UFMG, Programa de Pós-graduação em Ciências da Reabilitação, Belo Horizonte, MG, Brasil
| | | | - Danielle A Gomes Pereira
- Universidade Federal de Minas Gerais - UFMG, Programa de Pós-graduação em Ciências da Reabilitação, Belo Horizonte, MG, Brasil
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9
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Klonizakis M, Gumber A, McIntosh E, King B, Middleton G, Michaels JA, Tew GA. Exercise fidelity and progression in a supervised exercise programme for adults with venous leg ulcers. Int Wound J 2018; 15:822-828. [PMID: 29877047 DOI: 10.1111/iwj.12933] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/10/2018] [Indexed: 11/27/2022] Open
Abstract
Despite exercise being included in the recommended advice for patients with venous leg ulcers, there is a fear shared by clinicians and patients that exercise may be either inappropriate or harmful and actually delay rather than promote healing. Therefore, before implementing a larger-scale study exploring the effects of a supervised exercise programme in patients with venous ulcers being treated with compression therapy, it is important to assess exercise safety as well as fidelity and progression in a feasibility study. Eighteen participants randomised in the exercise group were asked to undertake 36 (3 times/week for 12 weeks) 60-min exercise sessions, each comprising moderate-intensity aerobic, resistance, and flexibility exercise components. For the purposes of this paper, we analysed the data collected during the exercise sessions. The overall session attendance rate was 79%, with 13 of 18 participants completing all sessions. No in-session adverse events were reported; 100% aerobic components and 91% of resistance components were completed within the desired moderate-intensity target. Similarly, 81% of aerobic components and 93% of flexibility components were completed within the prescribed duration targets. Our data showed that patients with venous ulcers could safely follow a supervised exercise programme incorporating moderate-intensity aerobic, resistance, and flexibility components.
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Affiliation(s)
- Markos Klonizakis
- Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, UK
| | - Anil Gumber
- Department of Allied Health Professions, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Emma McIntosh
- Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, UK
| | - Brenda King
- Manor Clinic, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Geoff Middleton
- School of Sport and Exercise Science, University of Lincoln, Lincoln, UK
| | - Jonathan A Michaels
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Garry A Tew
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK
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Klonizakis M, Tew GA, Gumber A, Crank H, King B, Middleton G, Michaels JA. Supervised exercise training as an adjunct therapy for venous leg ulcers: a randomized controlled feasibility trial. Br J Dermatol 2018; 178:1072-1082. [PMID: 29077990 PMCID: PMC6001633 DOI: 10.1111/bjd.16089] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 01/22/2023]
Abstract
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
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Affiliation(s)
| | - G A Tew
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, NE1 8ST, U.K
| | - A Gumber
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, S10 2BP, U.K
| | - H Crank
- Centre for Sport and Exercise Science
| | - B King
- Manor Clinic, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S12 2ST, U.K
| | - G Middleton
- School of Sport and Exercise Science, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS, U.K
| | - J A Michaels
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, U.K
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Smith D, Lane R, McGinnes R, O'Brien J, Johnston R, Bugeja L, Team V, Weller C. What is the effect of exercise on wound healing in patients with venous leg ulcers? A systematic review. Int Wound J 2018; 15:441-453. [PMID: 29446252 DOI: 10.1111/iwj.12885] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/29/2017] [Accepted: 12/04/2017] [Indexed: 11/30/2022] Open
Abstract
Standard best practice for the treatment of venous leg ulcers (VLUs) is compression bandaging of the lower leg to reduce hydrostatic pressure. There is considerable variation in reported healing rates when using this gold-standard approach; therefore, a systematic and robust evaluation of other interventions is required. Exercise interventions, in addition to standard compression therapy, could improve wound-healing time and prevent their recurrence. We have conducted a systematic review to examine the effects of exercise on wound characteristics, including time to heal, size and recurrence, pain, quality of life, adverse events, and economic outcomes. This review was registered with PROSPERO 2016:CRD42016046407. A systematic search of Ovid Medline, Ovid EMBASE, Ovid CINAHL, The Cochrane Library, PsycINFO, Web of Science, and PEDro was conducted on January 30, 2017, for randomised control trials to examine the effects of exercise on time to heal, size and recurrence, pain, quality of life, adverse events, and economic outcomes. Six studies met the inclusion criteria, but all had design flaws leading to biases, most commonly performance and selective reporting bias. Three studies compared a progressive resistance exercise programme (PREG) plus compression with compression alone for a period of 12 weeks. Low-quality evidence indicates the following: possibly no difference in the proportion of ulcers healed (risk ratio [RR] 1.14, 95% CI 0.71 to 1.84, I2 36%; 3 trials, 116 participants); probably no difference in quality of life (mean difference [MD] 3 points better on 100 point scale with exercise, 95% CI -1.89 to 7.89, 1 trial, 59 participants); possible increase in the risk of adverse events with exercise (OR 1.32, 95% CI 0.95 to 1.85, 1 RCT, 40 participants); and no difference in ankle range of motion and calf muscle pump. Evidence was downgraded due to susceptibility to bias and imprecision. Recurrence, pain, and economic outcomes were not measured in these trials, and time to healing was measured but not fully reported in 1 trial. We are uncertain of the effects of other interventions (community-based exercise and behaviour modification, ten thousand steps, supervised vs unsupervised exercise) due to the availability of low- or very low-quality evidence only from single trials. The review highlights the need for further research, with larger sample sizes, to properly address the significance of the effect of exercise on VLU wound characteristics.
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Affiliation(s)
- Daisy Smith
- Monash Nursing and Midwifery, Monash University, Clayton, Victoria
| | - Rebecca Lane
- Department of Physiotherapy, Monash University, Frankston, Victoria
| | | | - Jane O'Brien
- School of Health Sciences, University of Tasmania, Tasmania, Australia
| | - Renea Johnston
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria
| | - Lyndal Bugeja
- Monash Nursing and Midwifery, Monash University, Clayton, Victoria
| | - Victoria Team
- Monash Nursing and Midwifery, Monash University, Clayton, Victoria
| | - Carolina Weller
- Monash Nursing and Midwifery, Monash University, Clayton, Victoria
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Tew GA, Gumber A, McIntosh E, Kesterton S, King B, Michaels JA, Klonizakis M. Effects of supervised exercise training on lower-limb cutaneous microvascular reactivity in adults with venous ulcers. Eur J Appl Physiol 2017; 118:321-329. [PMID: 29197931 PMCID: PMC5767192 DOI: 10.1007/s00421-017-3772-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/25/2017] [Indexed: 11/29/2022]
Abstract
Purpose To investigate the effects of a 12-week supervised exercise programme on lower-limb cutaneous microvascular reactivity in adults with venous leg ulceration. Methods Thirty-eight adults with unilateral venous ulceration who were being treated with lower-limb compression therapy (58% male; mean age 65 years; median ulcer size 5 cm2) were randomly allocated to exercise or control groups. Exercise participants (n = 18) were invited to attend thrice weekly sessions of lower-limb aerobic and resistance exercise for 12 weeks. Cutaneous microvascular reactivity was assessed in the gaiter region of ulcerated and non-ulcerated legs at baseline and 3 months using laser Doppler fluxmetry coupled with iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP). Cutaneous vascular conductance (CVC) was calculated as laser Doppler flux (AU)/mean arterial pressure (mmHg). Results Thirty-seven participants completed follow-up assessments. Median session attendance was 36 (range 2–36). Analyses of covariance revealed greater peak CVC responses to ACh in the exercise group at 3 months in both the ulcerated (adjusted difference = 0.944 AU/mmHg; 95% CI 0.504–1.384) and non-ulcerated (adjusted difference = 0.596 AU/mmHg; 95% CI 0.028–1.164) legs. Peak CVC responses to SNP were also greater in the exercise group at 3 months in the ulcerated leg (adjusted difference = 0.882 AU/mmHg; 95% CI 0.274–1.491), but not the non-ulcerated leg (adjusted difference = 0.392 AU/mmHg; 95% CI − 0.377 to 1.161). Conclusion Supervised exercise training improves lower-limb cutaneous microvascular reactivity in adults with venous leg ulceration.
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Affiliation(s)
- Garry A Tew
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, NE1 8ST, UK
| | - Anil Gumber
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Emma McIntosh
- Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Sue Kesterton
- Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Brenda King
- Manor Clinic, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S12 2ST, UK
| | - Jonathan A Michaels
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Markos Klonizakis
- Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, S10 2BP, UK.
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Sallam RAE, El Ghaweet AI, Regal SAH. Value of combined exercise and ultrasound as an adjunct to compression therapy in chronic venous leg ulcers. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2017. [DOI: 10.4103/1110-161x.205660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Klonizakis M, Crank H, Gumber A, Brose LS. Smokers making a quit attempt using e-cigarettes with or without nicotine or prescription nicotine replacement therapy: Impact on cardiovascular function (ISME-NRT) - a study protocol. BMC Public Health 2017; 17:293. [PMID: 28376818 PMCID: PMC5379660 DOI: 10.1186/s12889-017-4206-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 03/29/2017] [Indexed: 11/29/2022] Open
Abstract
Background The estimated number of cigarette smokers in the world is 1.3 billion, expected to rise to 1.7 billion by 2025, with 10 million smokers living in the U.K. Smoking is the leading, preventable death-cause worldwide, being responsible for almost 650,000 deaths in the E.U. annually. A combination of pharmacological interventions, including nicotine replacement therapy, bupropion and varenicline, and behavioural support is the most effective approach to smoking cessation. However, even the best methods have high relapse rates of approximately 75% within 6 months. Electronic (or “e-“) cigarettes use battery power to disperse a solution that usually contains propylene glycol or glycerine, water, flavouring and nicotine. E-cigarettes have become the most popular smoking cessation aid in England, however, information on their effects on cardiovascular function is limited and contradictory. As e-cigarettes are not solely nicotine-based products, existing research exploring the effects of nicotine on the cardio-vasculature provides only limited information, while their extensive uptake urges the need of evidence to inform the general public, smokers and policy-makers. Methods This is a pragmatic, 3-group, randomised, assessor-blinded, single-centre trial exploring the cardiovascular physiological effects of the use of e-cigarettes (nicotine-free and nicotine-inclusive, assessed separately) combined with behavioural support as a smoking cessation method in comparison to the combination of NRT and behavioural support. The primary outcome will be macro-vascular function, determined by a Flow Mediated Dilatation ultrasound assessment, 6 months following participants’ “quit date”. Discussion Participants will be assessed at baseline, 3 days following their self-determined “quit date”, at intervention end (3 months) and 6 months following their “quite date”. Findings are expected to give an indication of the cardiovascular effects of e-cigarettes both in the short- and in the medium-term period, informing the general public, policy holders and researchers, helping to define the future role of e-cigarettes as a smoking cessation aid. Trial registration Clinicaltrials.gov NCT03061253. Registered 17th February 2017.
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Affiliation(s)
- Markos Klonizakis
- Centre for Sport and Exercise Science, Collegiate Hall, Collegiate Crescent, Sheffield Hallam University, Sheffield, S10 2BP, UK.
| | - Helen Crank
- Centre for Sport and Exercise Science, Collegiate Hall, Collegiate Crescent, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Anil Gumber
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Leonie S Brose
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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