This website is intended for healthcare professionals

Skip main navigation
Search
Quick Search in Books
Quick Search anywhere
Quick Search in Journals
Quick Search in Journals
Quick Search in Journals
Quick Search in Journals
Quick Search in Journals
Quick Search in Journals
Quick Search in Journals
Quick Search in Journals
Quick Search in Journals
Advanced Search
Research

An experimental study of prescribed walking in the management of venous leg ulcers

    Published Online:16 Aug 2013https://doi.org/10.12968/jowc.2012.21.9.421

    Abstract

    Objective:

    To determine the relationship between the level of patient activity in the form of walking and the rate of venous leg ulcer (VLU) healing.

    Method:

    Forty patients with newly diagnosed VLUs were recruited to the study and randomly allocated to either control or exercise groups. All patients were treated with multilayer compression bandaging for 12 weeks, or until their ulcer had fully healed. Daily stepping rate was recorded at initial assessment and following 4 weeks of treatment. Participants in the exercise group were encouraged to increase their daily steps with a target of 10 000 steps per day. The control group were not asked to change their daily steps.

    Results:

    In total, 33% of the exercise group achieved an average of 10 000 steps per day. Participants who took more steps at both the baseline and 4-week assessment healed more quickly than those who took fewer steps (p=0.052 and p=0.008 for baseline and week 4, respectively). Sixty-seven per cent of the participants who increased their daily steps had venous ulcers, which were healed by week 8, compared with 35% of those who did not.

    Conclusion:

    Participants who took more steps per day showed faster venous ulcer healing times when compared with those who took fewer steps, emphasising the benefit of walking in this patient group. Further studies are necessary to confirm these early findings.

    Declaration of interest:

    There were no external sources of funding for this study. The authors have no conflict of interest to declare.

    References

    • 1 Ennis, W.J., Meneses, P. Standard, appropriate and advanced care and medico-leal considerations: Part two — venous ulcerations. Wounds. 2003; 15: 4, 107–122. Google Scholar
    • 2 Eberhardt, R.T., Rafetto, J.D. Chronic venous insufficiency. Circulation. 2005; 111: 18, 2398–2409. Crossref, Medline, Google Scholar
    • 3 White, J.V., Ryjewski, C. Chronic venous insufficiency. Perspect Vasc Surg Endovasc Ther. 2005; 17: 4, 319–327. Crossref, Medline, Google Scholar
    • 4 Bergan, J.J., Pascarella, M.D., Schmid-Schonbein, G.W. Pathogenesis of primary chronic venous disease: Insights from animal models of venous hypertension. J Vasc Surg. 2008; 47: 1, 183–192. Crossref, Medline, Google Scholar
    • 5 Marieb, E.N. Essentials of Human Anatomy and Physiology (8th edn). Pearson Education Inc., 2006. Google Scholar
    • 6 Doughty, D.B., Holbrook, R. Lower extremity ulcers of vascular etiology. In: Bryant, R.A.Nix, D.P. (eds). Acute and Chronic Wounds (3rd edn). Mosby, 2007. Google Scholar
    • 7 Kalra, M., Gloviczki, P. Surgical treatment of venous ulcers: role of subfascial endoscopic perforator vein ligation. SurgClin North Am. 2003; 83: 3, 671–675. Crossref, Medline, Google Scholar
    • 8 Christopoulos, D., Nicolaides, A.N., Cook, A.et al. Pathogenesis of venous ulceration in relation to the calf muscle pump function. Surgery. 1989; 106: 5, 829–835. Medline, Google Scholar
    • 9 Gross, E.A., Wood, C.R., Lazarus, G.S.et al. Venous ulcers: an analysis of underlying venous disease. Br J Dermatol. 1993; 129: 3, 210–174. Crossref, Google Scholar
    • 10 Araki, C.T., Back, T.L., Padberg, F.T. The significance of calf muscle pump function in venous ulceration. J Vasc Surg. 1994; 20: 6, 872–879. Crossref, Medline, Google Scholar
    • 11 Back, T.L., Padberg, F.T., Araki, C.T., Thompson, P.N., Hobson, R.W. Limited range of motion is a significant factor on venous ulceration. J. Vasc. Surg. 1995; 22: 5, 519–523. Google Scholar
    • 12 Palfreyman, S.J., Lochiel, R., Michaels, J.A. A systemic review of compression therapy for venous leg ulcers. Vasc Med. 1998; 3: 4, 301–313. Crossref, Medline, Google Scholar
    • 13 Stacey, M., Falanga, V., Marston, W.et al. The use of compression therapy in the treatment of venous leg ulcers: a recommended management pathway. EWMA J. 2002; 2: 1, 9–13. Google Scholar
    • 14 Moffatt, C. Compression Therapy in Practice. Wounds UK, 2007. Google Scholar
    • 15 O' Meara, S., Cullum, N.A., Nelson, E.A., Compression for venous leg ulcers. Cochrane Database Syst Rev. 2009; 2: CD000265. Google Scholar
    • 16 Castineira, F., Fisher, H., Coleman, D.et al. The Limerick Leg Ulcer Project: early results. Ir J Med Sci. 1999; 168: 1, 17–20. Crossref, Medline, Google Scholar
    • 17 Margolis, D.J., Berlin, J.A., Strom, B.L. Which venous ulcers will heal with limb compression bandages? Am. J. Med. 2000; 15: 1, 15–19. Crossref, Google Scholar
    • 18 Iglesias, C., Nelson, E.A., Cullum, N.A., Torgerson, D.J. VenUS I: a randomised controlled trial of two types of bandage for treating venous leg ulcers. Health Technol Assess. 2004; 8: 29, iii, 1–105. Crossref, Medline, Google Scholar
    • 19 Clarke Moloney, M., Godfrey, A., O'Connor, V.et al. Mobility in patients with venous leg ulceration. Eur J Vasc Endovasc Surg. 2007; 33: 4, 488–493. Crossref, Medline, Google Scholar
    • 20 Yang, D., Vandongen, Y.K, Stacey, M. Effect of exercise on calf muscle pump function in patients with chronic venous disease. Br J Surg. 1999; 86: 3, 338–341. Crossref, Medline, Google Scholar
    • 21 Kan, Y.M., Delis, K.T. Haemodynamic effects of supervised calf muscle exercise in patients with venous leg ulceration. Arch Surg. 2001; 136; 2, 1364–1369. Crossref, Medline, Google Scholar
    • 22 Padberg, F., Johnston, M., Sisto, S. Structured exercise improves calf muscle pump function in chronic venous insufficiency: A randomised trial. J Vasc Surg. 2004; 39: 1, 79–87. Crossref, Medline, Google Scholar
    • 23 Garcia, M.C., Lund, C. Venous ulcers and motorised ankle dorsiflexion: an introduction to a new approach. World Wide Wounds. 2004; Available from: http://tinyurl.com/d7elhmj [Accessed August 2012]. Google Scholar
    • 24 Sumner, D. Haemodynamics and pathophysiology of venous disease. In: Rutherford, R. (ed) Vascular Surgery Vol. 2 (4th edn.) Saunders, 1995. Google Scholar
    • 25 Falanga, V. Venous ulceration. J. Dermatol Surger Oncol. 1993; 19: 8, 764–771. Crossref, Medline, Google Scholar
    • 26 Capeheart, J.K. Chronic venous insufficiency: a focus on prevention of venous ulceration. J Wound Ostomy Continence Nurs. 1996; 23: 4, 227–234. Medline, Google Scholar
    • 27 Orsted, H.L., Radke, L., Gorst, R. The impact of musculoskeletal changes on the dynamics of the calf muscle pump. Ostomy Wound Manage. 2001; 47: 10, 18–24. Medline, Google Scholar
    • 28 Lippman, H.L., Fishman, L.M., Farrar, R.H.et al. Edema control in the management of chronic venous insufficiency. Arch Phys Med Rehabil. 1994; 75, 4, 431–436. Crossref, Medline, Google Scholar
    • 29 Tudor-Locke, C., Bassett, D. How many steps/day are enough? Preliminary pedometer indices for public health Sports Med. 2004; 34: 1, 1–8. Google Scholar
    • 30 Culhane, K.M., O'Connor, M., Lyons, D., Lyons, G.M. Accelerometers in rehabilitation medicine for older adults. Age Ageing. 2005; 34; 6, 556–560. Crossref, Medline, Google Scholar
    • 31 Godfrey, A., Culhane, K.M., Lyons, G.M. Comparison of the performance of the ActivPal Professional activity logger to a discrete accelerometer-based activity monitor. Med Eng Phys. 2007; 29: 8, 930–934. Crossref, Medline, Google Scholar
    • 32 Tudor-Locke, C., Myers, A. Methodological considerations for researchers and practitioners using pedometers to measure physical (ambulatory) activity. Res Q Exer Sport. 2001; 71: 1, 1–20. Crossref, Google Scholar
    • 33 Meaume, S., Couilliet, D., Vin, F. Prognostic factors for venous ulcer healing in a non selected population of ambulatory patients. J Wound Care. 2005; 14: 1, 31–34. Link, Google Scholar
    • 34 Flanagan, M. Wound measurement: can it help us to monitor progression to healing? J Wound Care. 2003; 12: 5, 189–194. Link, Google Scholar
    • 35 Prince, S., Dodds, S.R. Use of ulcer size and initial responses to treatment to predict the healing time of leg ulcers. J Wound Care. 2006; 15: 7, 299–303. Link, Google Scholar
    • 36 Williams, D.M., Matthews, C.E., Rutt, C.et al. Interventions to increase walking behaviour. Med Sci Sports Exerc. 2008; 40: 7 (Suppl.), S567–573. Crossref, Medline, Google Scholar
    • 37 Nasr, M.K., McCarthy, R.J., Walker, R.A., Horrocks, M. The Role of pedometers in the assessment of intermittent claudication. Eur J Vasc Endovasc Surg. 2002; 23; 4, 317–320. Crossref, Medline, Google Scholar

    This website is intended for healthcare professionals