O-232 - SYSTEMATIC REVIEW AND META-ANALYSIS OF EXERCISE THERAPY FOR VENOUS LEG ULCER HEALING AND RECURRENCE

TOPIC:
Wound healing
AUTHORS:
Turner B. (Academic Section of Vascular Surgery, Charing Cross Hospital, Imperial College London ~ London ~ United Kingdom) , Jasionowska S. (Academic Section of Vascular Surgery, Charing Cross Hospital, Imperial College London ~ London ~ United Kingdom) , Machin M. (Academic Section of Vascular Surgery, Charing Cross Hospital, Imperial College London ~ London ~ United Kingdom) , Javed A. (Academic Section of Vascular Surgery, Charing Cross Hospital, Imperial College London ~ London ~ United Kingdom) , Onida S. (Academic Section of Vascular Surgery, Charing Cross Hospital, Imperial College London ~ London ~ United Kingdom) , Davies A. (Academic Section of Vascular Surgery, Charing Cross Hospital, Imperial College London ~ London ~ United Kingdom)
Introduction:
National guidelines recommend regular exercise for individuals with venous leg ulceration(1), yet data for the effect of exercise on ulcer healing and recurrence are sparse. This study aimed to quantify the evidence for exercise in venous ulcer healing with respect to the primary outcomes of proportion of healed ulcers and rate of ulcer recurrence. Secondary outcomes were improvement in ulcer symptoms, ulcer healing time, quality of life, compliance and reported adverse events.
Methods:
The review followed PRISMA guidelines using a registered protocol (CRD42021220925). Databases were searched on 15th March 2021 and included articles comparing exercise therapy and compression to compression alone. Data were pooled with meta-analysis. The MEDLINE and Embase databases, as well as the Cochrane Controlled Trials Register, Clinicaltrials.gov, European Union Clinical Trials, International Standard Randomised Controlled Trial Number registries were all systematically searched.
Results:
After screening 994 articles, six reports were included with 109 participants allocated to exercise and 113 to compression. All articles were randomised-controlled trials and reported ulcer healing at 12 weeks, with a pooled relative risk of ulcer healing of 1.35 for exercise versus compression (95% CI 1.07 - 1.71). Only one article reported on recurrence and data pooling was not performed; no difference between exercise and usual care was demonstrated. Adverse events were adequately reported in one trial and were seen to be more frequent in the exercise arm. Compliance with exercise ranged from 33-81% but was unsuitable for meta-analysis.
Conclusion:
There is increasing evidence for exercise as an adjunct to ulcer healing, however, trials were low quality with high risk of bias. There is paucity of evidence examining leg ulcer recurrence after exercise programmes and currently no evidence to show exercise is beneficial. Further randomised-controlled trials are required to examine the safety of exercise for venous leg ulcers and design of the exercise intervention should be considered to optimise compliance.
References:
1. (NICE) National Institute for Health and Care Excellence. Leg ulcer - venous. https://cks.nice.org.uk/topics/leg-ulcer-venous/#:~:text=,ankle to mid-calf).
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