Latihan jasmani untuk rawatan kelemahan vena kronik bukan ulser.
Abstract
Background
Chronic venous insufficiency (CVI) is a common disease that causes discomfort and impairs the quality of life of affected persons. Treatments such as physical exercise that aim to increase the movement of the ankle joint and strengthen the muscle pump in the calf of the leg may be useful to reduce the symptoms of CVI.
Objectives
To assess and summarise the existing clinical evidence on the efficacy and safety of physical exercise programmes for the treatment of individuals with non‐ulcerated CVI.
Search methods
The Cochrane Vascular Information Specialist (CIS) searched the Cochrane Vascular Specialised Register (May 2016). In addition, the CIS searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 4) and trial databases for details of ongoing or unpublished studies.
Selection criteria
Randomised controlled trials (RCTs) comparing exercise with no exercise programmes.
Data collection and analysis
Two review authors independently assessed the search results and selected eligible studies. We resolved disagreements by discussion. We summarised and double‐checked details from included studies. We attempted to contact trial authors for missing data, but obtained no further information.
Main results
We included two trials involving 54 participants with CVI. Many of our review outcomes were not reported or reported by only one of the two studies. The intensity of disease signs and symptoms was measured in both studies but using different scales; we were therefore unable to pool the data. One study reported no difference between the exercise and control groups whereas the second reported a reduction in symptoms in the exercise group. In one study, increases in change in ejection fraction compared with baseline (mean difference (MD) 4.88%, 95% confidence interval (CI) 3.16 to 6.60; 30 participants; P < 0.00001), half venous refilling time (MD 4.20 seconds, 95% CI 3.28 to 5.12; 23 participants; P < 0.00001) and total venous refilling time (MD 9.40 seconds, 95% CI 7.77 to 11.03; 23 participants; P < 0.00001) were observed in the exercise group compared with the control group. One study reported no difference between the exercise and control groups with regard to quality of life or ankle range of motion. Although muscle strength assessed by dynamometry at slow speed did not differ between the two groups in this study, variable peak torque at fast speed was lower in the control group than in the exercise group (2.8 ± 0.9 compared with ‐0.3 ± 0.6, P < 0.03). The incidence of venous leg ulcers, incidence of surgical intervention to treat symptoms related to CVI and exercise capacity were not assessed or reported in either of the included trials. We rated both included studies as at high risk of bias; hence, these data should be interpreted carefully. Due to the small number of studies and small sample size, we were not able to verify indirectness and publication bias. Therefore, we judged the overall quality of evidence as very low according to the GRADE approach.
Authors' conclusions
There is currently insufficient evidence available to assess the efficacy of physical exercise in people with CVI. Future research into the effect of physical exercise should consider types of exercise protocols (intensity, frequency and time), sample size, blinding and homogeneity according to the severity of disease.
PICO
Plain language summary
Bolehkah latihan jasmani meningkatkan pengaliran darah melalui vena?
Latar belakang
Vena adalah sejenis salur darah yang membawa darah daripada badan kembali ke jantung (juga dipanggil darah vena pulangan ). Proses ini dibantu oleh pengecutan beberapa pam otot di bahagian kaki. Masalah vena atau pam otot di bahagian kaki dalam sesetengah orang boleh mengganggu proses tersebut boleh, dan mengakibatkan keadaan yang dikenali sebagai kelemahan vena kronik (CVI). CVI boleh menyebabkan kesakitan, edema (retensi cecair dan bengkak) dan ulser kaki,dan boleh menjejaskan kualiti hidup seseorang. Kajian menunjukkan rawatan, seperti latihan jasmani yang bertujuan untuk meningkatkan pergerakan sendi buku lali dan mengukuhkan pam otot pada betis kaki boleh membantu mencegah penyakit serta konsekuennya menjadi bertambah buruk. Kami telah meneliti bukti yang menyokongan latihan jasmani sebagai rawatan untuk CVI.
Ciri‐ciri kajian dan keputusan utama
Ulasan ini memasukkan dua kajian klinikal, melibatkan seramai 54 peserta, yang membandingkan secara langsung kesan latihan jasmani dengan intervensi kawalan (bukti adalah terkini sehingga Mei 2016). Satu kajian melaporkan bahawa tiada perbezaan antara kumpulan senaman dan kumpulan kawalan manakala kajian kedua melaporkan pengurangan gejala dalam kumpulan senaman. Pada penghujung kajian, terdapat peningkatan pulangan darah vena dalam kumpulan senaman berbanding dengan kumpulan kawalan. Kajian terlibat tidak melaporkan kes baru ulser kaki vena. Tiada perbezaan di antara kumpulan senaman dan kumpulan kawalan dari aspek kualiti hidup peserta, julat pergerakan sendi buku lali atau kekuatan otot keseluruhan. Peningkatan pulangan darah vena dalam kumpulan senaman secara keseluruhan mencadangkan bahawa latihan jasmani dapat meningkatkan pengaliran darah dalam kalangan pesakit CVI, namun kami mendapati risiko bias yang tinggi akibat bias perawakan atau 'blinding' dalam kedua‐dua kajian. Oleh itu, kami berpendapat bahawa maklumat pada masa kini tidak mencukupi untuk menentukan keberkesanan latihan jasmani dalam pengurusan CVI.
Kualiti bukti
Kami menilai kualiti bukti keseluruhan sebagai sangat rendah: kedua‐dua kajian yang terlibat adalah kecil (dengan jumlah 54 peserta) dan berisiko bias tinggi berdasarkan kaedah 'blinding' atau perawakan.
