Effects of exercise in treating patients with venous leg ulcers: An umbrella review

Abstract

Venous leg ulcers (VLUs) represent a substantial challenge within the healthcare landscape, thereby necessitating efficacious therapeutic strategies. Exercise has been investigated as a prospective intervention to bolster the management of VLUs. The objective of this comprehensive review is to systematically scrutinize and appraise the extant body of evidence pertaining to the impact of exercise on the treatment of patients diagnosed with VLUs. A comprehensive literature search was executed across multiple databases, encompassing PubMed, the Cochrane Library, Web of Science, Embase, and Google Scholar. The methodological rigour was evaluated utilizing the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) instrument, while the quality of the evidence was appraised via the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification system. The relative efficacy of exercise interventions on outcomes related to VLUs, including rates of wound healing, total range of motion in the ankle joint, and adherence rates, was synthesized. Data were consolidated employing fixed-effects models, and the impact of exercise on these outcomes was visually represented through the use of forest plots. The methodological foundation of this investigation comprised four systematic reviews and meta-analyses, each characterized by an intermediate level of methodological rigour and evidence quality. Subsequent analyses revealed that exercise interventions exert a multifaceted and favourable impact on the therapeutic landscape of VLUs. These interventions distinctly contribute to the enhancement of wound healing rates (risk difference 0.17, 95% confidence interval [CI]: 0.06–0.28) and the extension of ankle range of motion (mean difference [MD] 6.10, 95% CI: 4.61–7.59). Furthermore, Pooled adherence rate was 0.70 (95% CI: 0.20–2.45) with no significant heterogeneity. In conclusion, although existing evidence supports the positive impact of exercise training on VLUs, higher-quality research is still needed to deepen our understanding of its effects and provide more specific guidance for clinical practice.