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Exercise Programmes in the Management of Venous Leg Ulceration—A Systematic Review and Meta-Analysis
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DOI：10.1111/wrr.70176.png)
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Abstract
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Venous leg ulcers (VLUs) are a chronic condition with significant healthcare costs. UK clinical guidelines recommend regular physical activity for VLU management, but evidence on its efficacy in promoting healing and preventing recurrence remains limited. This systematic review aimed to evaluate the effectiveness of exercise interventions, in addition to standard care, on VLU outcomes. A comprehensive search of databases was conducted up to May 22, 2025. The review followed PRISMA guidelines and registered on PROSPERO (CRD420251057818). Eligible studies included adults with VLUs and an ankle–brachial pressure index greater than 0.8. Only randomised controlled trials comparing exercise plus standard care with standard care alone and reporting ulcer-related outcomes were included. Nine trials were included, with 133 patients receiving exercise interventions and 137 receiving standard care. All studies combined exercise with compression therapy. Intervention duration ranged from 4 to 12 weeks. A meta-analysis of eight studies showed a significantly higher healing rate in the exercise group (RR = 1.35). Subgroup analysis revealed statistically non-significant higher effect sizes for hospital-based programmes (RR = 1.69) compared to home-based ones (RR = 1.22). Five studies reported ulcer area reduction, with a non-significant pooled standardised mean difference (SMD) of 0.72. No studies reported ulcer recurrence. Both home- and hospital-based exercise programmes appear to improve VLU healing rates when added to standard care, although current evidence is limited by small sample sizes, methodological variability, and lack of recurrence data. Future trials should standardise protocols and include long-term follow-up to guide clinical practice.
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