Effectiveness of therapeutic exercises for improving the quality of life of patients with chronic venous insufficiency: a systematic review

Silva, Josicléia Leôncio da; Lima Neta, Ana Gonçalves; Diniz, Natália Ramos; Leite, Jéssica Costa

Josicléia Leôncio da Silva

Centro Universitário Unifacisa – UNIFACISA, Campina Grande, PB, Brasil.

http://orcid.org/0000-0001-7620-186X

Ana Gonçalves Lima Neta

Centro Universitário Unifacisa – UNIFACISA, Campina Grande, PB, Brasil.

http://orcid.org/0000-0001-6684-1900

Natália Ramos Diniz

Universidade Estadual da Paraíba – UEPB, Campina Grande, PB, Brasil.

http://orcid.org/0000-0002-5473-3213

Jéssica Costa Leite

Centro Universitário Unifacisa – UNIFACISA, Campina Grande, PB, Brasil.

http://orcid.org/0000-0002-4726-9416

Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

Correspondence Jéssica Costa Leite Centro Universitário Unifacisa – UNIFACISA Av. Senador Argemiro de Figueiredo, 1901 - Itararé CEP 58411-020 - Campina Grande (PB), Brasil Tel.: +55 (83) 2101-8877 E-mail: jessica.leite@maisunifacisa.com.br

Author information JLS - Physical therapist; Postgraduate student, Fisioterapia em Terapia Intensiva Adulto e Infantil, Centro Universitário Unifacisa (UNIFACISA).AGLN - Physical therapist, Centro Universitário Unifacisa (UNIFACISA). NRD - Undergraduate student, Curso de Fisioterapia, Universidade Estadual da Paraíba (UEPB).JCL - Physical therapist; MSc in Fisioterapia; PhD candidate, Programa de Pós-graduação em Fisioterapia, Universidade Federal do Rio Grande do Norte (UFRN); Professor, Curso de Fisioterapia; Coordinator, Pós-graduação em Fisioterapia em UTI Adulto e Infantil; Coordinator, Liga de Fisioterapia Cardiovascular (LIFICAR), Centro Universitário Unifacisa (UNIFACISA).

Author contributions Conception and design: JLS, JCL. Analysis and interpretation: JLS, AGLN, NRD, JCL. Data collection: JLS, AGLN. Writing the article: JLS, NRD, JCL. Critical revision of the article: JLS, JCL. Final approval of the article*: JLS, AGLN, NRD, JCL. Statistical analysis: N/A.Overall responsibility: JLS, JCL *All authors have read and approved of the final version of the article submitted to J Vasc Bras.

PICO Strategy	Corresponding keyword
P (venous insufficiency)	“Venous Insufficiency”
I (therapeutic exercises)	“Therapeutic Exercise”, “Exercise Therapy”, “Exercise Therapy”
C (control group)
O (QoL, pain, and functionality)	“Quality of Life”, “Pain”, “Physical Functional Performance”, “Physical Performance”

Database	Strategy	Search strings used in searches
CINAHL^* * Databases for which search strings had to be adapted.	#1	“Venous Insufficiency” AND “Therapeutic Exercise” AND “Quality of Life”
	#2	“Venous Insufficiency” AND “Therapeutic Exercise” AND Pain
	#3	“Venous Insufficiency” AND “Therapeutic Exercise” AND “Physical Performance”
	#4	“Venous Insufficiency” AND “Therapeutic Exercise”
CENTRAL, Google Scholar, LILACS, MEDLINE, SciELO, Science Direct, Scopus, Web of Science	#1	“Venous Insufficiency” AND “Exercise Therapy” AND “Quality of Life”
	#2	“Venous Insufficiency” AND “Exercise Therapy” AND Pain
	#3	“Venous Insufficiency” AND “Exercise Therapy” AND “Physical Functional Performance”
	#4	“Venous Insufficiency” AND “Exercise Therapy” OR Exercise
PEDro*	-	Venous Insufficiency AND Clinical Trial

Author, year, and country	Characteristics of the sample	Intervention and duration	Outcomes assessed and results
Padberg et al.,¹⁴14 Padberg FT Jr, Johnston MV, Sisto SA. Structured exercise improves calf muscle pump function in chronic venous insufficiency: a randomized trial. J Vasc Surg. 2004;39(1):79-87. http://dx.doi.org/10.1016/j.jvs.2003.09.036. PMid:14718821. http://dx.doi.org/10.1016/j.jvs.2003.09.... 2004, United States	Total (n = 30), male, CEAP (4, 5 and 6).	EG: compression therapy, individualized exercises and educational pamphlet.	Function, strength and resistance of the muscle pump; venous hemodynamics; AMA; functionality; and QoL.
	EG: (n = 17), mean age of 71 years.	CG: compression therapy only (30-40 mmHg).	There were no differences in QoL or functional mobility, but improvements were observed in hemodynamics, function, and muscle pump strength.
	CG: (n = 13), mean age of 70 years.	- 6 months.
Szewczyk et al.,¹⁵15 Szewczyk MT, Jawień A, Cwajda-Białasik J, Cierzniakowska K, Mościcka P, Hancke E. Randomized study assessing the influence of supervised exercises on ankle joint mobility in patients with venous leg ulcerations. Arch Med Sci. 2010;6(6):956-63. http://dx.doi.org/10.5114/aoms.2010.19308. PMid:22427773. http://dx.doi.org/10.5114/aoms.2010.1930... 2010, Poland	Total (n = 32), men (n = 11), women (n = 21), CEAP (6).	EG: compression therapy, special dressings, supervision and instructions on exercises to be performed at home.	AMA; ulcer area, pain, and clinical scores for patients with ulcerations.
	EG: (n = 16), men (n = 4), women (n = 12), age = 72.2±7.66 years.	CG: the same treatment, but unsupervised and with the exception of exercise on an exercise bicycle.	Pain associated with physical activity was observed in both groups, but intensity was not correlated with AMA. Ankle joint mobility improved in both groups, but was more significant in the experimental group. Ulcer area and lipodermatosclerosis exhibited a significant effect on AMA.
	CG: (n=16), Men (n=7), Women (n=9), Age= 72.3 ± 10.13 years.	- 9 weeks.
Ramos-González et al.,¹³13 Ramos-González E, Moreno-Lorenzo C, Matarán-Peñarrocha GA, Guisado-Barrilao R, Aguilar-Ferrándiz ME, Castro-Sánchez AM. Comparative study on the effectiveness of myofascial release manual therapy and physical therapy for venous insufficiency in postmenopausal women. Complement Ther Med. 2012;20(5):291-8. http://dx.doi.org/10.1016/j.ctim.2012.03.005. PMid:22863643. http://dx.doi.org/10.1016/j.ctim.2012.03... 2012, Spain	Total (n = 65), female, CEAP (1 and 2).	EG: kinesiotherapy, myofascial release (50 min., 2x per week) and instructions on exercises to be performed at home.	Arterial blood pressure, QoL, venous circulation; and pain.
	EG: (n = 33), age = 65.75±9.07 years.	CG: kinesiotherapy only.	The combination of these treatments improved symptoms of pain, QoL, arterial blood pressure, and venous return blood flow.
	CG: (n = 32), age = 62.15±11.23 years.	- 10 weeks.
O’Brien et al.,¹⁶16 O’Brien J, Finlayson K, Kerr G, Edwards H. Evaluating the effectiveness of a self-management exercise intervention on wound healing, functional ability and health-related quality of life outcomes in adults with venous leg ulcers: a randomised controlled trial. Int Wound J. 2017;14(1):130-7. http://dx.doi.org/10.1111/iwj.12571. PMid:26817648. http://dx.doi.org/10.1111/iwj.12571... 2017, Australia	Total (n = 62), men (n = 32), women (n = 30), CEAP (6).	EG: resisted exercises, compression therapy, wound care, educational pamphlet, telephone coaching, and instructions on exercises to be performed at home.	Ulcer healing and area, physical activity, functional capacity, QoL, and AMA.
	EG: (n = 32), age = 71.3±15.8 years.	CG: usual care and educational pamphlet on care for the feet.	All participants exhibited improvements in physical activity levels. Healing was significant in the exercises group. No differences were found in QoL or functional capacity, but there were good AMA results in the experimental group.
	CG: (n = 30), age = 71.7±13.4 years.	-12 weeks.

Studies	Outcomes	Assessment instruments	Assessments
Padberg et al.¹⁴14 Padberg FT Jr, Johnston MV, Sisto SA. Structured exercise improves calf muscle pump function in chronic venous insufficiency: a randomized trial. J Vasc Surg. 2004;39(1):79-87. http://dx.doi.org/10.1016/j.jvs.2003.09.036. PMid:14718821. http://dx.doi.org/10.1016/j.jvs.2003.09....	-QoL;	-AVVQ;	Baseline and after 6 months.
	-Functionality.	-CIVIC;
		-SF-36;
		-MFI.
Szewczyk et al.¹⁵15 Szewczyk MT, Jawień A, Cwajda-Białasik J, Cierzniakowska K, Mościcka P, Hancke E. Randomized study assessing the influence of supervised exercises on ankle joint mobility in patients with venous leg ulcerations. Arch Med Sci. 2010;6(6):956-63. http://dx.doi.org/10.5114/aoms.2010.19308. PMid:22427773. http://dx.doi.org/10.5114/aoms.2010.1930...	-Pain.	-10-point numerical scale^* * The authors did not provide a specific name for this instrument. ;	Baseline, every week, and after 9 weeks.
	-Pain.	-Clinical signs and symptoms scale for patients with ulcerations*.	Baseline, every week, and after 9 weeks.
Ramos-González et al.¹³13 Ramos-González E, Moreno-Lorenzo C, Matarán-Peñarrocha GA, Guisado-Barrilao R, Aguilar-Ferrándiz ME, Castro-Sánchez AM. Comparative study on the effectiveness of myofascial release manual therapy and physical therapy for venous insufficiency in postmenopausal women. Complement Ther Med. 2012;20(5):291-8. http://dx.doi.org/10.1016/j.ctim.2012.03.005. PMid:22863643. http://dx.doi.org/10.1016/j.ctim.2012.03...	-QoL;	-VAS;	Baseline and after 10 weeks.
	-Pain.	-SF-36.	Baseline and after 10 weeks.
O’Brien et al.¹⁶16 O’Brien J, Finlayson K, Kerr G, Edwards H. Evaluating the effectiveness of a self-management exercise intervention on wound healing, functional ability and health-related quality of life outcomes in adults with venous leg ulcers: a randomised controlled trial. Int Wound J. 2017;14(1):130-7. http://dx.doi.org/10.1111/iwj.12571. PMid:26817648. http://dx.doi.org/10.1111/iwj.12571...	-QoL;	-SF-8;	Baseline and after 12 weeks.
	-Functionality.	- Tinetti Gait and Balance Test.	Baseline and after 12 weeks.

Study	Exercises protocol
Padberg et al.¹⁴14 Padberg FT Jr, Johnston MV, Sisto SA. Structured exercise improves calf muscle pump function in chronic venous insufficiency: a randomized trial. J Vasc Surg. 2004;39(1):79-87. http://dx.doi.org/10.1016/j.jvs.2003.09.036. PMid:14718821. http://dx.doi.org/10.1016/j.jvs.2003.09....	Stretching and strength exercises for the trunk and lower limbs (primarily the triceps surae muscles) performed actively against gravity and weight resistance; walking on a treadmill.
	- One hour of exercises. Series and repetitions were increased progressively.
Szewczyk et al.¹⁵15 Szewczyk MT, Jawień A, Cwajda-Białasik J, Cierzniakowska K, Mościcka P, Hancke E. Randomized study assessing the influence of supervised exercises on ankle joint mobility in patients with venous leg ulcerations. Arch Med Sci. 2010;6(6):956-63. http://dx.doi.org/10.5114/aoms.2010.19308. PMid:22427773. http://dx.doi.org/10.5114/aoms.2010.1930...	Circular ankle movements; heel raises in standing position; dorsal flexion; plantar flexion. Exercise bicycle (twice a week) at moderate intensity for 20 min. and 3 km walking daily.
	- 3 times per day, in series of 15 repetitions each.
Ramos-González et al.¹³13 Ramos-González E, Moreno-Lorenzo C, Matarán-Peñarrocha GA, Guisado-Barrilao R, Aguilar-Ferrándiz ME, Castro-Sánchez AM. Comparative study on the effectiveness of myofascial release manual therapy and physical therapy for venous insufficiency in postmenopausal women. Complement Ther Med. 2012;20(5):291-8. http://dx.doi.org/10.1016/j.ctim.2012.03.005. PMid:22863643. http://dx.doi.org/10.1016/j.ctim.2012.03...	Flexion and extension of the metacarpophalangeal and interphalangeal joints, with participant sitting; flexion and extension of the ankle, with participant in standing position; isometric contraction of the quadriceps muscles with the knees extended and participant sitting; diaphragmatic respiration.
	- Twice a day, every day.
O’Brien et al.¹⁶16 O’Brien J, Finlayson K, Kerr G, Edwards H. Evaluating the effectiveness of a self-management exercise intervention on wound healing, functional ability and health-related quality of life outcomes in adults with venous leg ulcers: a randomised controlled trial. Int Wound J. 2017;14(1):130-7. http://dx.doi.org/10.1111/iwj.12571. PMid:26817648. http://dx.doi.org/10.1111/iwj.12571...	Heel raises, in sitting position, both lower limbs; heel raises, in standing position, both lower limbs; heel raises, one limb at a time, in standing position; stretches (for 20 seconds) of the triceps surae and hamstring muscles of both lower limbs, before and after exercises.
	- 3 times per day, every day. Series and repetitions were increased progressively.

[1] Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

Brasil

Brasil

Effectiveness of therapeutic exercises for improving the quality of life of patients with chronic venous insufficiency: a systematic review

Abstract