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

person Keity Lamary Souza Silva

schoolUniversidade Federal dos Vales do Jequitinhonha e Mucuri – UFVJM, Faculdade de Ciências Biológicas e da Saúde, Departamento de Fisioterapia, Diamantina, MG, Brasil.

0000-0001-6237-0566

person Eduardo Augusto Barbosa Figueiredo

schoolUniversidade Federal dos Vales do Jequitinhonha e Mucuri – UFVJM, Faculdade de Ciências Biológicas e da Saúde, Departamento de Fisioterapia, Diamantina, MG, Brasil.

0000-0002-0850-855X

person Cíntia Pimenta Lopes

schoolUniversidade Federal dos Vales do Jequitinhonha e Mucuri – UFVJM, Faculdade de Ciências Biológicas e da Saúde, Departamento de Fisioterapia, Diamantina, MG, Brasil.

0000-0002-8379-6846

person Marcus Vinicius Accetta Vianna

schoolUniversidade Federal dos Vales do Jequitinhonha e Mucuri – UFVJM, Faculdade de Medicina, Diamantina, MG, Brasil.

0000-0001-5914-7312

person Vanessa Pereira Lima

schoolUniversidade Federal dos Vales do Jequitinhonha e Mucuri – UFVJM, Faculdade de Ciências Biológicas e da Saúde, Departamento de Fisioterapia, Diamantina, MG, Brasil.schoolUniversidade Federal dos Vales do Jequitinhonha e Mucuri – UFVJM, Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Diamantina, MG, Brasil.

0000-0002-0349-3248

person Pedro Henrique Scheidt Figueiredo

schoolUniversidade Federal dos Vales do Jequitinhonha e Mucuri – UFVJM, Faculdade de Ciências Biológicas e da Saúde, Departamento de Fisioterapia, Diamantina, MG, Brasil.schoolUniversidade Federal dos Vales do Jequitinhonha e Mucuri – UFVJM, Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Diamantina, MG, Brasil.

0000-0002-6748-3081

person Henrique Silveira Costa

schoolUniversidade Federal dos Vales do Jequitinhonha e Mucuri – UFVJM, Faculdade de Ciências Biológicas e da Saúde, Departamento de Fisioterapia, Diamantina, MG, Brasil.schoolUniversidade Federal dos Vales do Jequitinhonha e Mucuri – UFVJM, Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Diamantina, MG, Brasil.

0000-0002-1426-7246

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

Correspondence Henrique Silveira Costa Universidade Federal dos Vales do Jequitinhonha e Mucuri – UFVJM Rodovia MGT 367, Km 583, 5000 - Alto da Jacuba CEP 39100-000 - Diamantina (MG), Brasil Tel.: +55 (38) 3532-1200 E-mail:
henriquesilveira@yahoo.com.br

Author information KLSS and EABF - Physical therapists; Residents, Programa de Residência em Fisioterapia na Saúde Coletiva, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM). CPL - Fisioterapia student, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM). MVAV - Cardiologist; Assistant professor, Faculdade de Medicina, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM); Postgraduate student, Programa de Pós-graduação em Reabilitação e Desempenho Funcional, UFVJM. VPL, PHSF and HSC - Adjunct professors, Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM); Professors, Programa de Pós-graduação em Reabilitação e Desempenho Funcional, UFVJM.

Author contributions Conception and design: HSC, VPL, PHSF, CPL Analysis and interpretation: KLSS, EABF, CPL Data collection: KLSS, CPL, HSC Writing the article: KLSS, EABF, MVAV Critical revision of the article: HSC, VPL, PHSF Final approval of the article*: KLSS, EABF, CPL, MVAV, VPL, PHSF, HSC Statistical analysis: N/A. Overall responsibility: HSC *All authors have read and approved of the final version of the article submitted to J Vasc Bras.

Study	Population	Intervention	Comparison	Outcomes	PEDro Score
Hartmann et al.¹⁴	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
Hartmann et al.¹⁴			Usual care (n=12)	There were no changes in the control group.	4/10
Zajkowsk et al.²⁴	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.¹²	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.¹¹	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.²³	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.²²	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.²¹	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.²⁴	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.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.¹⁹	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.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.¹³	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

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

Abstract