Exercise therapy aimed at increasing calf muscle pressure can effectively prevent and improve chronic venous insufficiency. However, as the ‘frequency, intensity, time, and type’ model that is critical in prescribing exercise has not been identified, determining the exact amount and quality of exercise to be prescribed is challenging. Therefore, we conducted a scoping review of exercise therapy for chronic venous insufficiency and mapped the exercise therapy prescriptions provided to these patients. The CENTRAL, CINAHL, MEDLINE, and PEDro databases were searched. Data charting was conducted to categorise the types of exercise into aerobic and resistance exercises, light exercise, and aquatic activity. The intensity, duration, and frequency of each exercise were mapped and summarised as narrative syntheses. Of 594 articles, 27 met the eligibility criteria. Aerobic exercise comprised a frequency of 2–3 times/week; intensity, 12–16 on the Borg scale or 40–70% of the maximum heart rate; time, 20–40 min; and type, walking, treadmill, or ergometer. Resistance exercise comprised a frequency of two times per week to every day; intensity: 8–12 repetition maximum; time: 10–25 times × 2–5 sets; and type: elastic band or more. Aquatic activity comprised a frequency of two times per week to every day, time: 15–60 min, and type: balneotherapy; exercise intensity could not be specified. In conclusion, these results provide useful information for planning exercise therapy for chronic venous insufficiency and can be used for improving patients’ physical performance and quality of life.
BerganJJSchmid-SchönbeinGWSmithPDC, et al.Chronic venous disease. N Engl J Med2006; 355: 488–498.
3.
PannierFRabeE. Progression in venous pathology. Phlebology2015; 30: 95–97.
4.
WronaMJöckelKHPannierF, et al.Association of venous disorders with leg symptoms: results from the bonn vein study 1. Eur J Vasc Endovasc Surg2015; 50: 360–367.
5.
EvansCJFowkesFGRRuckleyCV, et al.Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh vein study. J Epidemiol Community Health1999; 53: 149–153.
6.
CallamMJ. Epidemiology of varicose veins. Br J Surg1994; 81: 167–173.
7.
Beebe-DimmerJLPfeiferJREngleJS, et al.The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol2005; 15: 175–184.
RokaFBinderMBohler-SommereggerK. Mid-term recurrence rate of incompetent perforating veins after combined superficial vein surgery and subfascial endoscopic perforating vein surgery. J Vasc Surg2006; 44: 359–363.
10.
McDanielHBMarstonWAFarberMA, et al.Recurrence of chronic venous ulcers on the basis of clinical, etiologic, anatomic, and pathophysiologic criteria and air plethysmography. J Vasc Surg2002; 35: 723–728.
11.
CallamMJHarperDRDaleJJ, et al.Chronic ulcer of the leg: clinical history. Br Med J (Clin Res Ed)1987; 294: 1389–1391.
12.
ChangSLHuangYLLeeMC, et al.Association of varicose veins with incident venous thromboembolism and peripheral artery disease. JAMA2018; 319: 807–817.
13.
ProchaskaJHArnoldNFalckeA, et al.Chronic venous insufficiency, cardiovascular disease, and mortality: a population study. Eur Heart J2021; 42: 4157–4165.
CetinCSerbestMOErcanS, et al.An evaluation of the lower extremity muscle strength of patients with chronic venous insufficiency. Phlebology2016; 31: 203–208.
16.
RabeEStückerMEsperesterA, et al.Efficacy and tolerability of a red-vine-leaf extract in patients suffering from chronic venous insufficiency--results of a double-blind placebo-controlled study. Eur J Vasc Endovasc Surg2011; 41: 540–547.
17.
KanYMDelisKT. Hemodynamic effects of supervised calf muscle exercise in patients with venous leg ulceration: a prospective controlled study. Arch Surg2001; 136: 1364–1369.
18.
SimkaM. Calf muscle pump impairment and delayed healing of venous leg ulcers: air plethysmographic findings. J Dermatol2007; 34: 537–544.
19.
OrrLKlementKAMcCrossinL, et al.A systematic review and meta-analysis of exercise intervention for the treatment of calf muscle pump impairment in individuals with chronic venous insufficiency. Ostomy/Wound Manag2017; 63: 30–43.
20.
TriccoACLillieEZarinW, et al.PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med2018; 169: 467–473.
21.
KlonizakisMTewGAGumberA, et al.Supervised exercise training as an adjunct therapy for venous leg ulcers: a randomized controlled feasibility trial. Br J Dermatol2018; 178: 1072–1082.
22.
JullAParagVWalkerN, et al.The prepare pilot RCT of home-based progressive resistance exercises for venous leg ulcers. J Wound Care2009; 18: 497–503.
23.
O’BrienJEdwardsHStewartI, et al.A home-based progressive resistance exercise programme for patients with venous leg ulcers: a feasibility study. Int Wound J2013; 10: 389–396.
24.
O’BrienJFinlaysonKKerrG, et al.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 J2017; 14: 130–137.
25.
ErcanSÇetinCYavuzT, et al.Effects of isokinetic calf muscle exercise program on muscle strength and venous function in patients with chronic venous insufficiency. Phlebology2018; 33: 261–266.
26.
TewGAGumberAMcIntoshE, et al.Effects of supervised exercise training on lower-limb cutaneous microvascular reactivity in adults with venous ulcers. Eur J Appl Physiol2018; 118: 321–329.
27.
JonkerLTodhunterJSchutterJ, et al.A multi-centre, prospective, randomised controlled feasibility study of plantar resistance exercise therapy for venous leg ulcers – results of the PREVUE study. Phlebology2020; 35: 237–246.
28.
KulprachakarnKNantakoolSRojawatC, et al.Effectiveness of combined conventional treatment with a tailored exercise training program on wound healing in patients with venous leg ulcer: a randomized controlled trial. J Tissue Viability2022; 31: 190–196.
29.
PadbergFTJohnstonMVSistoSA. Structured exercise improves calf muscle pump function in chronic venous insufficiency: a randomized trial. J Vasc Surg2004; 39: 79–87.
30.
ZajkowskiPJDraperTBloomJ, et al.Exercise with compression stockings improves reflux in patients with mild chronic venous insufficiency. Phlebology2006; 21: 100–104.
31.
Gürdal KarakelleSIpekYTulinO, et al.The efficiency of exercise training in patients with venous insufficiency: a double blinded, randomized controlled trial. Phlebology2021; 36: 440–449.
32.
DaviesJABullRHFarrellyIJ, et al.A home-based exercise programme improves ankle range of motion in long-term venous ulcer patients. Phlebology2007; 22: 86–89.
33.
Ramos-GonzálezEMoreno-LorenzoCMatarán-PeñarrochaGA, et al.Comparative study on the effectiveness of myofascial release manual therapy and physical therapy for venous insufficiency in postmenopausal women. Compl Ther Med2012; 20: 291–298.
34.
SchmidtACGomesLPOZMarinelliCM, et al.Effects of strengthening the surae triceps muscle on venous pump function in chronic venous insufficiency. J Vasc Bras2021; 20: e20200197.
35.
AydinGYeldanIAkgulA, et al.Effects of inspiratory muscle training versus calf muscle training on quality of life, pain, venous function and activity in patients with chronic venous insufficiency. J Vasc Surg Venous Lymphat Disord2022; 10: 1137–1146.
36.
MenegattiEMandiniSPaganiA, et al.The effect of active stretching training in patients with chronic venous insufficiency monitored by raster-stereography. Sensors2022; 22: 8509.
37.
CioconJOGalindo-CioconDGalindoDJ. Raised leg exercises for leg edema in the elderly. Angiology1995; 46: 19–25.
38.
MutlakOAslamMStandfieldN. The influence of exercise on ulcer healing in patients with chronic venous insufficiency. Int Angiol2018; 37: 160–168.
39.
ManciniSPiccinettiANappiG, et al.Clinical, functional and quality of life changes after balneokinesis with sulphurous water in patients with varicose veins. Vasa2003; 32: 26–30.
40.
CarpentierPHSatgerB. Randomized trial of balneotherapy associated with patient education in patients with advanced chronic venous insufficiency. J Vasc Surg2009; 49: 163–170.
41.
CarpentierPHBlaiseSSatgerB, et al.A multicenter randomized controlled trial evaluating balneotherapy in patients with advanced chronic venous insufficiency. J Vasc Surg2014; 59: 447–454.
42.
ForestierRJBrianconGFranconA, et al.Balneohydrotherapy in the treatment of chronic venous insufficiency. Vasa2014; 43: 365–371.
43.
GianesiniSTessariMBacciglieriP, et al.A specifically designed aquatic exercise protocol to reduce chronic lower limb edema. Phlebology2017; 32: 594–600.
44.
MenegattiEPaganiAAvruscioG, et al.The effects of thermal water physical exercise in patients with lower limb chronic venous insufficiency monitored by bioimpedance analysis. Diagnostics2020; 10: 26–30.
45.
MenegattiEMasieroSZamboniP, et al.Randomized controlled trial on dryland and thermal aquatic standardized exercise protocol for chronic venous disease (DATA study). J Vasc Surg Venous Lymphat Disord2021; 9: 1226–1234.e2.
46.
SharifiMBayRCKarandishK, et al.The randomized, controlled ATLANTIS trial of aquatic therapy for chronic venous insufficiency. J Vasc Surg Venous Lymphat Disord2021; 9: 961–970.
47.
MenegattiEMandiniSChiY-W, et al.Physical fitness changes induced by thermal aquatic standardized exercise in chronic venous disease patients. Phlebology2022; 37: 134–142.
48.
MeulendijksAMFranssenWMASchoonhovenL, et al.A scoping review on chronic venous disease and the development of a venous leg ulcer: the role of obesity and mobility. J Tissue Viability2020; 29: 190–196.
49.
LeeD-CBrellenthinAGLanningham-FosterLM, et al.Aerobic, resistance, or combined exercise training and cardiovascular risk profile in overweight or obese adults: the CardioRACE trial. Eur Heart J2024; 45: 1127–1142.
50.
HoSSDhaliwalSSHillsAP, et al.The effect of 12 weeks of aerobic, resistance or combination exercise training on cardiovascular risk factors in the overweight and obese in a randomized trial. BMC Public Health2012; 12: 704.
51.
ZavorskyGSHoffmanSL. Pulmonary gas exchange in the morbidly obese. Obes Rev2008; 9: 326–339.
52.
McIntoshTHunterDJRoyceS. Barriers to physical activity in obese adults: a rapid evidence assessment. J Res Nurs2016; 21: 271–287.
53.
ThomsonRLBuckleyJDBrinkworthGD. Perceived exercise barriers are reduced and benefits are improved with lifestyle modification in overweight and obese women with polycystic ovary syndrome: a randomised controlled trial. BMC Womens Health2016; 16: 14.
54.
Torres-RondaLDel AlcázarXSIdel AlcázarX. The properties of water and their applications for training. J Hum Kinet2014; 44: 237–248.
55.
MasieroSVittadiniFFerroniC, et al.The role of thermal balneotherapy in the treatment of obese patient with knee osteoarthritis. Int J Biometeorol2018; 62: 243–252.
56.
MusumeciAPranoviGMasieroS. Patient education and rehabilitation after hip arthroplasty in an Italian spa center: a pilot study on its feasibility. Int J Biometeorol2018; 62: 1489–1496.
57.
ThibertABricheNVernizeauBD, et al.Systematic review of adapted physical activity and therapeutic education of patients with chronic venous disease. J Vasc Surg Venous Lymphat Disord2022; 10: 1385–1400.
58.
AraujoDNRibeiroCTMacielAC, et al.Physical exercise for the treatment of non-ulcerated chronic venous insufficiency. Cochrane Database Syst Rev2023; 12: CD010637.
59.
BackTLPadbergFTArakiCT, et al.Limited range of motion is a significant factor in venous ulceration. J Vasc Surg1995; 22: 519–523.
60.
RobertsonLLeeAJGallagherK, et al.Risk factors for chronic ulceration in patients with varicose veins: a case control study. J Vasc Surg2009; 49: 1490–1498.
61.
SinikumpuSPKeränenM-HHJokelainenJ, et al.The association between chronic venous disease and measures of physical performance in older people: a population-based study. BMC Geriatr2021; 21: 556.
62.
LabropoulosNPatelPJTiongsonJE, et al.Patterns of venous reflux and obstruction in patients with skin damage due to chronic venous disease. Vasc Endovasc Surg2007; 41: 33–40.
63.
O’BrienJAEdwardsHEFinlaysonKJ, et al.Understanding the relationships between the calf muscle pump, ankle range of motion and healing for adults with venous leg ulcers: a review of the literature. Wound Pract Res2012; 20: 80–85.
64.
Núñez de Arenas-ArroyoSCavero-RedondoIAlvarez-BuenoC, et al.Effect of eHealth to increase physical activity in healthy adults over 55 years: a systematic review and meta-analysis. Scand J Med Sci Sports2021; 31: 776–789.
65.
LeeSPatelPMyersND, et al.A systematic review of eHealth interventions to promote physical activity in adults with obesity or overweight. Behav Med2023; 49: 213–230.
66.
KimHJKimSMShinH, et al.A mobile game for patients with breast cancer for chemotherapy self-management and quality-of-life improvement: randomized controlled trial. J Med Internet Res2018; 20: e273.
67.
SilvaKLSFigueiredoEABLopesCP, et al.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. J Vasc Bras2021; 20: e20200125–e20200128.
68.
de Moraes SilvaMANakanoLCCisnerosLL, et al.Balneotherapy for chronic venous insufficiency. Cochrane Database Syst Rev2023; 8: CD013085.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
