The impact of exercise training on calf pump function, muscle strength, ankle range of motion, and health-related quality of life in patients with chronic venous insufficiency at different stages of severity: a systematic review

Silva, Keity Lamary Souza; Figueiredo, Eduardo Augusto Barbosa; Lopes, Cíntia Pimenta; Vianna, Marcus Vinicius Accetta; Lima, Vanessa Pereira; Figueiredo, Pedro Henrique Scheidt; Costa, Henrique Silveira

doi:10.1590/1677-5449.200125

Acessibilidade / Reportar erro

Brasil

Jornal Vascular Brasileiro

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

REVIEW ARTICLE • J. Vasc. Bras. 20 • 2021 • https://doi.org/10.1590/1677-5449.200125 copy

The impact of exercise training on calf pump function, muscle strength, ankle range of motion, and health-related quality of life in patients with chronic venous insufficiency at different stages of severity: a systematic review

O impacto do treinamento físico na função da bomba da panturrilha, força muscular, amplitude de movimento do tornozelo e qualidade de vida relacionada à saúde em diferentes estágios de gravidade da insuficiência venosa crônica: uma revisão sistemática

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Exercise training (ET) is an important tool in the management of patients with chronic venous insufficiency (CVI). The objective of this article was to discuss the effects of ET on the calf pump, functional parameters, and quality of life of patients with mild and advanced CVI. A systematic review was conducted and eleven studies were included. In patients with mild CVI, ET was effective for improving venous reflux, muscle strength, ankle range of motion, and quality of life. In advanced CVI patients, ET increased ejection fraction, reduced residual volume fraction, and improved muscle strength and ankle range of motion, but did not change venous reflux indices or quality of life. It is concluded that ET is effective for improving calf pump function, muscle strength, and ankle range of motion in CVI. In patients with mild CVI, additional benefits were observed in quality of life.

Keywords:
venous insufficiency; exercise; muscle strength; articular range of motion; quality of life

Study	Population	Intervention	Comparison	Outcomes	PEDro Score
Hartmann et al.¹⁴14 Hartmann BR, Drews B, Kayser T. Physical therapy improves venous hemodynamics in cases of primary varicosity: results of a controlled study. Angiology. 1997;48(2):157-62. http://dx.doi.org/10.1177/000331979704800209. PMid:9040271. http://dx.doi.org/10.1177/00033197970480...	12 patients (CEAP C2) with varicose veins in both extremities.	24-weeks of physiotherapy, twice a week, 60 minutes each session. The sessions consisted of bathing and 25 minutes of exercise for muscle and joint activation with compression stockings. Additionally, home-based exercises once a day for 15 minutes, wearing compression stockings	Usual care (n=12)	In the experimental group, ET reduced venous capacity (p<0.005) and venous refilling time in the lower limbs (p<0.001).	4/10
			Usual care (n=12)	There were no changes in the control group.	4/10
Zajkowsk et al.²⁴24 Zajkowski PJ, Draper T, Bloom J, Henke PK, Wakefield TW. Exercise with compression stockings improves reflux in patients with mild chronic venous insufficiency. Phlebology. 2006;21(2):100-4. http://dx.doi.org/10.1258/026835506777304764. http://dx.doi.org/10.1258/02683550677730...	11 patients (mean age 60 years), comprising CEAP C2 (n=6) and C4 and C5 (n=5).	18 sessions (1h per session), 2-3 times a week, of calf muscle strengthening with compression stockings.	Single group.	For patients with CEAP C2: venous reflux decreased.	1/10
Leal et al.¹²12 Leal FJ, Couto RC, Silva TP, Tenório VO. Fisioterapia vascular no tratamento da doença venosa crônica. J Vasc Bras. 2015;14(3):224-30. http://dx.doi.org/10.1590/1677-5449.0029. http://dx.doi.org/10.1590/1677-5449.0029...	10 patients (43.1±9.4 years, CEAP C2-C3)	10 sessions of 60 minutes, 3 times a week. Each session comprised therapeutic exercises (stretching the lower limbs, strengthening the calf with 2-3 sets of 10 repetitions), walking on the treadmill for 10 minutes and manual lymph drainage.	Single group.	ET increased range of motion in dorsiflexion, plantar flexion, adduction, and abduction (p<0.05 for all) and improved quality of life in all domains of the SF-36 and the Aberdeen Varicose Veins Questionnaire (AVVQ) (p<0.05 for all domains).	1/10
Ercan et al.¹¹11 Ercan S, Çetin C, Yavuz T, Demir HM, Atalay YB. Effects of isokinetic calf muscle exercise program on muscle strength and venous function in patients with chronic venous insufficiency. Phlebology. 2018;33(4):261-6. PMid:28954574.	27 patients (48±9 years, CEAP C3-C4)	12-weeks of ET, 3 days per week. The ET comprised 3 sets of 10rep of range of motion and stretching exercises, Theraband exercises, isokinetic exercise. Additionally, stability exercise on a balance board (10 min), walking on treadmill (60% HR max, 20 min) and intermittent pneumatic compression (20 min).	Single group.	Improved range of motion in dorsiflexion (p=0.018) and plantar flexion (p=0.004), increased peak torque, peak initial torque, and total dorsiflexion and plantar flexion work (p=0.001 for all), health-related quality of life by EQ-5D (p=0.001) and venous return time (p=0.001).	1/10
Elsisi et al.²³23 Elsisi HFEM, Mahmoud TH, Serry ZMH, Rahmy AF, Osman NMM. Effect of strengthening exercise versus intermittent pneumatic compression device to calf muscle on blood flow in patients with varicose Veins. Biosci Res. 2019;16(2):2360-8.	25 patients with bilateral varicose veins (43.88±6.73 years, CEAP C2)	3 months of ET, including gluteal and quadriceps isometric exercises, active hip and knee flexion/extension, ankle dorsiflexion/ plantar flexion, and straight leg rising in conjunction with use of an intermittent pneumatic compression device.	ET associated with tip-toe strengthening, ergometer exercise with elastic compression stockings (n=25, 44.52±6.23 years).	Both groups had improvements in maximum blood flow, mean blood flow; and venous refilling time (p<0.05). Improvements in the experimental group were significantly higher than in the control group.	7/10

Study	Population	Intervention	Comparison	Outcomes	PEDro Score
Yang et al.²²22 Yang D, Vandongen YK, Stacey MC. Effect of exercise on calf muscle pump function in patients with chronic venous disease. Br J Surg. 1999;86(3):338-41. http://dx.doi.org/10.1046/j.1365-2168.1999.00993.x. PMid:10201775. http://dx.doi.org/10.1046/j.1365-2168.19...	20 patients with venous leg ulcers. Median age of 68 (range: 34 to 88) years.	6 weeks of ET comprising tip-toe exercises associated with walking and calf stretch exercises.	Single group.	Increase in ejection fraction and decrease in residual volume fraction (p<0.05). No changes in venous volume, venous filling index, peak torque, or total work	1/10
Padberg et al.²¹21 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....	Patients with skin changes (n=17, mean age of 71 years, CEAP C4- C6)	6 months of stockings combined with lower limb and trunk stretching and strengthening, with active gravity strengthening and resistive weights in two sessions per week (1 hour duration).	Usual care in addition to compression (n=13, mean age of 70 years, CEAP C4- C6).	Experimental group improved residual volume fraction (p<0.029), mean ejection fraction (p<0.026), isokinetic peak torque/body weight at both slow speed (p<0.05), and fast speed (p<0.03). No changes in venous filling index, venous volume, or ejected volume. No changes were observed health-related quality of life (according to the Aberdeen Varicose Vein Survey, the CIVIQ, and the physical function items of the SF-36).	5/10
Zajkowsk et al.²⁴24 Zajkowski PJ, Draper T, Bloom J, Henke PK, Wakefield TW. Exercise with compression stockings improves reflux in patients with mild chronic venous insufficiency. Phlebology. 2006;21(2):100-4. http://dx.doi.org/10.1258/026835506777304764. http://dx.doi.org/10.1258/02683550677730...	11 patients (mean age 60 years), comprising CEAP C2 (n=6) and C4 and C5 (n=5).	18 sessions (1h per session), 2-3 times a week, of calf muscle strengthening with compression stockings.	Single group.	For CEAP C4-C5 patients: residual volume fraction decreased (p<0.05).	1/10
Jull et al.¹⁸18 Jull A, Parag V, Walker N, Maddison R, Kerse N, Johns T. The prepare pilot RCT of home-based progressive resistance exercises for venous leg ulcers. J Wound Care. 2009;18(12):497-503. http://dx.doi.org/10.12968/jowc.2009.18.12.45606. PMid:20081574. http://dx.doi.org/10.12968/jowc.2009.18....	20 patients (54.6±19.9 years) with venous leg ulcers.	12-week home-based progressive resistance exercise program using heel rises in addition to compression.	Usual care in addition to compression (n=19, 53.3±19.9 years).	Experimental group improved ejection fraction (p<0.05). There were no significant differences between groups in venous volume, ejection volume, venous filling index, residual volume, or residual volume fraction.	7/10
Szewczyk et al.¹⁹19 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...	Patients with venous leg ulcers (n=16, 77.2±7.66 years, CEAP C6).	9-week supervised program of exercises (circular foot movements, lifting the body weight while standing on the toes, alternate performance of foot dorsiflexion and plantar flexion). The exercises were performed 3 times a day, in series of 15 repetitions. Moreover, all patients walked 3 km daily and additionally exercised on training bikes.	Performance of exercise without supervision (n=16, 72.3±10.13 years, CEAP C6).	Experimental group increased ankle joint mobility in dorsiflexion and plantar flexion (p<0.05 for both). The control group also increased ankle joint mobility in dorsiflexion and plantar flexion (p<0.05 for both), but improvements were greater in the experimental group (p<0.05).	5/10
O’Brien et al.²⁰20 O’Brien J, Edwards H, Stewart I, Gibbs H. A home-based progressive resistance exercise programme for patients with venous leg ulcers: a feasibility study. Int Wound J. 2013;10(4):389-96. http://dx.doi.org/10.1111/j.1742-481X.2012.00995.x. PMid:22697811. http://dx.doi.org/10.1111/j.1742-481X.20...	4 patients (66±6 years) with active venous ulceration.	12 weeks of high-compression bandaging, leg elevation and performing leg and/or ankle exercises.	Usual care (n=3, 63.6±20 years)	Experimental group increased ejection fraction (p=0.03) and decreased residual volume fraction (p=0.03). No changes in the venous filling index (p=0.17). There were also changes in ankle range of motion (p=0.01).	5/10
Kravtsov et al.¹³13 Kravtsov PF, Katorkin SA, Volkovoy VV, Sizonenko YV. The influence of the training of the muscular component of the musculo-venous pump in the lower extremities on the clinical course of varicose vein disease. Vopr Kurortol Fizioter Lech Fiz Kult. 2016;93(6):33-6. http://dx.doi.org/10.17116/kurort2016633-36. PMid:28091490. http://dx.doi.org/10.17116/kurort2016633...	22 patients with varicose veins, CEAP C3 (n=6) and C4 (n=16).	60 days of specially designed complex of 7 exercises intended to strengthen the posterior muscle group of the lower legs and correct the step cycle.	Single group.	ET improved health-related quality of life by CIVIQ (p<0.05).	1/10

Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV) Rua Estela, 515, bloco E, conj. 21, Vila Mariana, CEP04011-002 - São Paulo, SP, Tel.: (11) 5084.3482 / 5084.2853 - Porto Alegre - RS - Brazil
E-mail: secretaria@sbacv.org.br

Acompanhe os números deste periódico no seu leitor de RSS

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