Effects of Exercise in Chronic Venous Insufficiency Patients: Randomized Controlled Study

Year 2024, , 631 - 643, 20.06.2024

Sıla Çelik , Ömer Şevgin , Burak Buğday

https://doi.org/10.33715/inonusaglik.1401590

Abstract

The aim of this study is to compare the effects of combined exercise and calf muscle exercise training on physical activity, fatigue and quality of life in patients with chronic venous insufficiency. 60 individuals with chronic venous insufficiency, aged between 30-60, were randomly divided into two groups: combined exercise and calf muscle exercise groups. While pumping exercises were given to all individuals participating in the study, breathing exercises, hamstring stretching exercises and self-massage training were given in addition to the combined exercise group. The exercises were planned as a home exercise program to last 6 weeks. SF-36 Short Form, Freiburg Quality of Life Assessment Questionnaire Short Form, Visual analogue scale, Fatigue Severity Scale and International Physical Activity Questionnaire Short Form evaluation scales were applied to all participants before and after treatment. At the end of the six-week exercise program, the difference between physical activity and disease-specific quality of life scale scores in both groups was statistically significant compared to before and after treatment (p<0.05); No significant difference was found between fatigue severity scale scores and VAS values (p>0.05). Adding breathing exercises and self-massage to the exercise program prescription in patients with Chronic Venous Insufficiency may increase the effectiveness of the treatment. Longer-term studies are needed to ensure that the effects of these methods are permanent in the long term.

Keywords

Exercise, Fatigue, Pain, Physical activity, Venous insufficiency

KRONİK VENÖZ YETMEZLİK HASTALARINDA EGZERSİZİN ETKİLERİ: RANDOMİZE KONTROLLÜ ÇALIŞMA

Abstract

Bu çalışmanın amacı kronik venöz yetmezliği olan hastalarda kombine egzersiz ve kalf kası egzersizi eğitiminin fiziksel aktivite, yorgunluk ve yaşam kalitesi üzerine etkilerini karşılaştırmaktır. Yaşları 30-60 arasında değişen kronik venöz yetmezliği olan 60 birey rastgele kombine egzersiz ve kalf kası egzersiz grubu olarak 2 gruba ayrıldı. Çalışmaya katılan tüm bireylere pompalama egzersizi verilirken, kombine egzersiz grubuna ek olarak solunum egzersizleri, hamstring germe egzersizleri ve self masaj eğitimi verildi. Egzersizler 6 hafta sürecek şekilde ev egzersiz programı olarak planlandı. Tüm katılımcılara tedavi öncesi ve sonrası SF-36 Kısa Formu, Freiburg Yaşam Kalitesi Değerlendirme Anketi Kısa Formu, Görsel analog skala, Yorgunluk Şiddet Ölçeği ve Uluslararası Fiziksel Aktivite Anketi Kısa Formu değerlendirme ölçekleri uygulandı. Altı haftalık egzersiz programı sonunda her iki grupta fiziksel aktivite ve hastalığa özgü yaşam kalitesi ölçekleri puanları arasındaki fark tedavi öncesi ve sonrasına göre istatistiksel olarak anlamlı iken (p<0.05); Yorgunluk şiddeti ölçeği puanları ve VAS değerleri arasında anlamlı bir fark bulunamadı (p>0.05). Kronik Venöz Yetmezliği bulunan hastalarda egzersiz programı reçetesine solunum egzersizleri ve self masajın eklenmesi tedavinin etkinliğini arttırabilir. Bu yöntemlerin etkilerinin uzun vadede kalıcı olması adına daha uzun süreli çalışmalara ihtiyaç vardır.

Keywords

Ağrı, Egzersiz, Fiziksel aktivite, Venöz yetmezlik, Yorgunluk

Ethical Statement

Çalışma Üsküdar Üniversitesi Girişimsel Olmayan Araştırmalar Etik Kurulu Başkanlığının 61351342/Haziran 2021-07 sayılı etik kurulu onay kararı alınarak yapılmıştır.

References

• Alimi, Y. S., Barthelemy, P. ve Juhan, C. (1994). Venous pump of the calf: a study of venous and muscular pressures. Journal of vascular surgery, 20(5), 728-735.
• Armutlu, K., Korkmaz, N. C., Keser, I., Sumbuloglu, V., Akbiyik, D. I., Guney, Z. ve Karabudak, R. (2007). The validity and reliability of the Fatigue Severity Scale in Turkish multiple sclerosis patients. International Journal of Rehabilitation Research. Internationale Zeitschrift Fur Rehabilitationsforschung. Revue Internationale de Recherches de Readaptation, 30(1), 81–85. https://doi.org/10.1097/MRR.0b013e3280146ec4
• Augustin, M., Debus, E. S., Bruning, G., Faubel, R., Lohrberg, D., Goepel, L., Herberger, K. ve Blome, C. (2015). Development and validation of a short version of the freiburg life quality assessment for chronic venous disease (FLQA-VS-10). Wound Medicine, 8, 31–35. https://doi.org/10.1016/j.wndm.2015.01.002
• Beebe-Dimmer, J. L., Pfeifer, J. R., Engle, J. S. ve Schottenfeld, D. (2005). The epidemiology of chronic venous ınsufficiency and varicose veins. Annals of Epidemiology, 15(3), 175–184. https://doi.org/10.1016/j.annepidem.2004.05.015
• Beckitt, T. A., Day, J., Morgan, M. ve Lamont, P. M. (2012). Calf muscle oxygen saturation and the effects of supervised exercise training for intermittent claudication. Journal of Vascular Surgery, 56(2), 470-475.
• Bergan, J. J., Schmid-Schönbein, G. W., Smith, P. D. C., Nicolaides, A. N., Boisseau, M. R. ve Eklof, B. (2006). Chronic venous disease. The New England Journal of Medicine, 355(5), 488–498. https://doi.org/10.1056/NEJMra055289
• Bozkuş, T., Türkmen, M., Kul, M., …Özkan, A. (2013). Beden eğitimi ve spor yüksekokulunda öğrenim gören öğrencilerin fiziksel aktivite düzeyleri ile sağlikli yaşam biçimi davranışlarının belirlenmesi ve ilişkilendirilmesi. International Journal of Sport Culture and Science, 1(3), 49–65.
• Bayat, B. (2014). Uygulamalı sosyal bilim araştırmalarında ölçme, ölçekler ve “likert” ölçek kurma tekniği. Gazi Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi, 16(3), 1–24.
• Burnand, K. G., (2001). Handbook of venous disorders (2nd ed.). Arnold.
• Castor L, M., Maria, I. M. ve Maria, M. (2009). How to rehabilitate a vascular patient? Journal of Phlebology and Lymphology, 2, 1–7.
• Duque, M. I., Yosipovitch, G., Chan, Y. H., Smith, R. ve Levy, P. (2005). Itch, pain, and burning sensation are common symptoms in mild to moderate chronic venous insufficiency with an impact on quality of life. Journal of the American Academy of Dermatology, 53(3), 503–507. https://doi.org/10.1016/j.jaad.2005.04.079
• Ebben, J. M. (2003). Improved ergonomics for standing work. Occupational Health ve Safety (Waco, Tex.), 72(4), 72–76.
• Eklöf, B., Rutherford, R. B., Bergan, J. J., Carpentier, P. H., Gloviczki, P., Kistner, R. L., Meissner, M. H., Moneta, G. L., Myers, K., Padberg, F. T., Perrin, M., Ruckley, C. V., Smith, P. C. ve Wakefield, T. W. (2004). Revision of the CEAP classification for chronic venous disorders: Consensus statement. Journal of Vascular Surgery, 40(6), 1248–1252. https://doi.org/10.1016/j.jvs.2004.09.027
• Ercan, S., Çetin, C., Yavuz, T., Demir, H. M. ve Atalay, Y. B. (2018). Effects of isokinetic calf muscle exercise program on muscle strength and venous function in patients with chronic venous insufficiency. Phlebology: The Journal of Venous Disease, 33(4), 261–266. https://doi.org/10.1177/0268355517695401
• Gencay-Can, A. ve Can, S. S. (2012). Validation of the Turkish version of the fatigue severity scale in patients with fibromyalgia. Rheumatology International, 32(1), 27–31. https://doi.org/10.1007/s00296-010-1558-3
• Gürdal Karakelle S. (2019). Venöz yetmezlikte egzersiz eğitiminin etkinliği. (Yüksek Lisans Tezi). İstanbul Üniversitesi, İstanbul.
• Healey, K. C., Hatfield, D. L., Blanpied, P., Dorfman, L. R. ve Riebe, D. (2014). The Effects of Myofascial Release With Foam Rolling on Performance. Journal of Strength and Conditioning Research, 28(1), 61–68. https://doi.org/10.1519/JSC.0b013e3182956569
• Heinen, M. M., van der Vleuten, C., de Rooij, M. J. M., Uden, C. J. T., Evers, A. W. M. ve van Achterberg, T. (2007). Physical Activity and Adherence to Compression Therapy in Patients With Venous Leg Ulcers. Archives of Dermatology, 143(10), 1283-1288. https://doi.org/10.1001/archderm.143.10.1283
• Joseph, N., B, A., Thouseef, M. F., Devi, U. M., Abna, A. ve Juneja, I. (2016). A multicenter review of epidemiology and management of varicose veins for national guidance. Annals of Medicine ve Surgery, 8, 21–27. https://doi.org/10.1016/j.amsu.2016.04.024
• Kan, Y. M. (2001). Hemodynamic Effects of Supervised Calf Muscle Exercise in Patients With Venous Leg Ulceration. Archives of Surgery, 136(12), 1364. https://doi.org/10.1001/archsurg.136.12.1364
• Kaplan, R. M., Criqui, M. H., Denenberg, J. O., Bergan, J. ve Fronek, A. (2003). Quality of life in patients with chronic venous disease: San Diego population study. Journal of Vascular Surgery, 37(5), 1047–1053. https://doi.org/10.1067/mva.2003.168
• Keser, İ., Özdemir, K., Erer, D., Onurlu, İ. ve Bezgin, S. (2020). Differences in pain, fatigue, and quality of life in patients with chronic venous insufficiency based on physical activity level. Turk Gogus Kalp Damar Cerrahisi Dergisi, 28(1), 76–83. https://doi.org/10.5606/tgkdc.dergisi.2020.18068
• Koçyiğit, H., Aydemir, Ö., Fişek, G., Ölmez, N. ve Memiş, A. K. (1999). Form-36 (KF-36)’nın Türkçe versiyonunun güvenilirliği ve geçerliliği. Ilaç ve Tedavi Dergisi, 12(2), 102-116.
• Lee, A. J., Robertson, L. A., Boghossian, S. M., Allan, P. L., Ruckley, C. V., Fowkes, F. G. R. ve Evans, C. J. (2015). Progression of varicose veins and chronic venous insufficiency in the general population in the Edinburgh Vein Study. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 3(1), 18–26. https://doi.org/10.1016/j.jvsv.2014.09.008
• Karabulut M. M. (2019). Kronik Venöz yetmezlik için freiburg yaşam kalitesi değerlendirme anketi kısa formu” (FLQA-VS-10)’nun Türkçe’ye uyarlanması, geçerlik ve güvenirliği. (Yüksek Lisans Tezi). Bolu Abant İzzet Baysal Üniversitesi, Bolu.
• Miller, J. D., Pegelow, D. F., Jacques, A. J. ve Dempsey, J. A. (2005a). Effects of augmented respiratory muscle pressure production on locomotor limb venous return during calf contraction exercise. Journal of Applied Physiology, 99(5), 1802–1815. https://doi.org/10.1152/japplphysiol.00278.2005
• Miller, J. D., Pegelow, D. F., Jacques, A. J. ve Dempsey, J. A. (2005b). Skeletal muscle pump versus respiratory muscle pump: modulation of venous return from the locomotor limb in humans. The Journal of Physiology, 563(3), 925–943. https://doi.org/10.1113/jphysiol.2004.076422
• Moore, H. M., Lane, T. R. A., Thapar, A., Franklin, I. J. ve Davies, A. H. (2013). The European burden of primary varicose veins. Phlebology, 28 Suppl 1, 141–147. https://doi.org/10.1177/0268355512475118
• Nocon, M., Hiemann, T., Müller-Riemenschneider, F., Thalau, F., Roll, S. ve Willich, S. N. (2008). Association of physical activity with all-cause and cardiovascular mortality: a systematic review and meta-analysis. European Journal of Cardiovascular Prevention ve Rehabilitation, 15(3), 239–246. https://doi.org/10.1097/HJR.0b013e3282f55e09
• Öztürk M. (2005). Üniversitede eğitim-öğretim gören öğrencilerde uluslararası fiziksel aktivite anketinin geçerliliği ve güvenirliği ve fiziksel aktivite düzeylerinin belirlenmesi. (Yüksek Lisans Tezi).. Hacettepe Üniversitesi, Ankara.
• Padberg, F. T., Johnston, M. V. ve Sisto, S. A. (2004). Structured exercise improves calf muscle pump function in chronic venous insufficiency: a randomized trial. Journal of Vascular Surgery, 39(1), 79–87. https://doi.org/10.1016/j.jvs.2003.09.036
• Patel, K. C., Gross, A., Graham, N., Goldsmith, C. H., Ezzo, J., Morien, A. ve Peloso, P. M. J. (2012). Massage for mechanical neck disorders. The Cochrane Database of Systematic Reviews, 9, CD004871. https://doi.org/10.1002/14651858.CD004871.pub4
• Quilici, B., Gildo, C., de Godoy, J., Quilici, B. ve Augusto, C. (2009). Comparison of reduction of edema after rest and after muscle exercises in treatment of chronic venous insufficiency. International Archives of Medicine, 2(1), 18. https://doi.org/10.1186/1755-7682-2-18
• Rabe, E., Pannier-Fischer, F., Bromen, K., Schuldt, K., Stang, A., Poncar, Ch., Wittenhorst, M., Bock, E., Weber, S. ve Jöckel, K.-H. (2003). Bonner venenstudie der deutschen gesellschaft für phlebologie. Phlebologie, 32(01), 1–14. https://doi.org/10.1055/s-0037-1617353
• Research Randomizer. https://www.randomizer.org/ adresinden 28 Kasım 2019 tarihinde erişildi.
• Rossi, F. H., Volpato, M. G., Metzger, P. B., Beteli, C. B., Almeida, B. L. de, Rossi, C. B. O. ve Izukawa, N. M. (2015). Relationships between severity of signs and symptoms and quality of life in patients with chronic venous disease. Jornal Vascular Brasileiro, 14(1), 22–28. https://doi.org/10.1590/1677-5449.20140039
• Santler, B. ve Goerge, T. (2017). Chronic venous insufficiency – a review of pathophysiology, diagnosis, and treatment. JDDG: Journal Der Deutschen Dermatologischen Gesellschaft, 15(5), 538–556. https://doi.org/10.1111/ddg.13242
• Shabani Varaki, E., Gargiulo, G. D., Penkala, S. ve Breen, P. P. (2018). Peripheral vascular disease assessment in the lower limb: a review of current and emerging non-invasive diagnostic methods. Biomedical Engineering Online, 17(1), 61. https://doi.org/10.1186/s12938-018-0494-4
• Sheel, A. W., Derchak, P. A., Morgan, B. J., Pegelow, D. F., Jacques, A. J. ve Dempsey, J. A. (2001). Fatiguing inspiratory muscle work causes reflex reduction in resting leg blood flow in humans. The Journal of Physiology, 537(1), 277–289. https://doi.org/10.1111/j.1469-7793.2001.0277k.x
• van Uden, C. J., van der Vleuten, C. J., Kooloos, J. G., Haenen, J. H. ve Wollersheim, H. (2005). Gait and calf muscle endurance in patients with chronic venous insufficiency. Clinical Rehabilitation, 19(3), 339–344. https://doi.org/10.1191/0269215505cr809oa
• Williams, K. J., Ayekoloye, O., Moore, H. M. ve Davies, A. H. (2014). The calf muscle pump revisited. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2(3), 329–334. https://doi.org/10.1016/j.jvsv.2013.10.053
• Yang, D., Vandongen, Y. K. ve Stacey, M. C. (2003). Effect of exercise on calf muscle pump function in patients with chronic venous disease. British Journal of Surgery, 86(3), 338–341. https://doi.org/10.1046/j.1365-2168.1999.00993.x
• Yiğit, S. (2018). Kronik venöz yetmezlik tanılı hastalarda egzersiz eğitiminin yorgunluk ve uyku kalitesi üzerine etkisi. (Yüksek Lisans). Hasan Kalyoncu Üniversitesi, Gaziantep.
• Zhang, S. ve Melander, S. (2014). Varicose veins: Diagnosis, management, and treatment. The Journal for Nurse Practitioners, 10(6), 417–424. https://doi.org/10.1016/j.nurpra.2014.03.004