Venous ulcers (defined as open lesions between the knee and ankle joint that remain unhealed after four weeks) are the most common type of leg ulceration, with almost 80% of suffers being over the age of 60.
Direct health costs in the UK associated with this condition are estimated at between £198 and £400 million annually. Therefore financially-viable treatments for this patient group are important, especially when taking into consideration Britain’s aging population.
Compression therapy delivered through multi-layer compression bandaging or stockings together with leg elevation is the most common treatment leading to high initial healing rates, these however are not sustained and one year venous ulcer recurrence rates remain as high as 56%.
It has been hypothesised that this may be associated with poor longer-term compliance with compression stockings and lack of lifestyle adjustment.
Exercise training could form part of the solution. Recent studies have suggested that exercise training can increase calf muscle pump function and improve lower-limb haemodynamics.
This initial feasibility study will investigate various parameters that will be required for a full scale randomised control trial, including determining the optimal output measures, the suitability of the exercise programme for people with leg ulceration and patients attitudes towards being on the exercise trial.
Completion of the study will allow us to determine whether a randomised control trial would be a feasible design to help us find out whether a supervised exercise programme in conjunction with compression therapy, is more effective than compression therapy alone in patients with venous ulceration.
If feasibility is proven, the next stage will be to explore whether exercise has the potential to form part of a holistic treatment strategy for leg ulceration, improving quality of life of patients, reduce healing time and minimise recurrence of ulceration.
This study is funded by the National Institute for Health Research (NIHR) Research for Patient Benefit Programme.
Institutions / organisations and researchers
The qualitative element of the study, which has been completed, revealed that:
- Participants found the exercises manageable and acceptable.
- Participants did not have a strong preference for trial allocation; only one participant reported that ‘usual care’ was their preference.
- Exercise built positivity and physical resilience, which is important for coping with venous leg ulceration.
- Exercise therapy has the potential to holistically improve wellbeing in patients with venous leg ulcers by addressing both their leg ulceration and existing co-morbidities.
- Approximately 36% of all screened eligible patients with venous ulcers were recruited in the study from the Sheffield and Lincoln areas.
- Attendance in the exercise group was 79% – with 72% of randomised patients in the exercise group attending all of their training sessions.