Barriers and enablers to physical activity in people with venous leg ulcers: A systematic review of qualitative studies

Background: Venous leg ulceration is caused by chronic venous insufficiency and affects millions of adults world-wide who suffer prolonged healing episodes and due to underlying pathophysiology ulcer recurrence is common after healing. Compression therapy is the current best practice for managing venous leg ulcer since it provides constant pressure, which promotes circulation in the lower limbs. Nevertheless, the healing outcomes of venous leg ulcer vary considerably. Physical activity may be an effective adjunct treatment to improve ulcer healing out-comes. However, a low level of physical activity level is observed in this cohort.Objective: To identify the barriers and enablers that affect physical activity participation in people with venous leg ulcers.Design: A systematic review of qualitative studies using the mega-aggregation approach.Methods: We followed the Joanna Briggs Institute methodology for systematic reviews of qualitative evidence. We searched MEDLINE, CINAHL PLUS, PsycINFO and Emcare to identify relevant articles published in English from 1806 to January 2021. Two reviewers independently screened and selected articles against inclusion criteria. Eligible studies were appraised for methodological quality using Joanna Briggs Institute Critical Appraisal tool. Qualitative data were extracted manually. Theoretical Domain Framework was used to map barriers and en-ablers to physical activity participation. Results: Eighteen studies were included in this review. The main barriers and enablers identified in this review that influence physical activity engagement in people with venous leg ulcers are as follows: understanding the chronic nature of venous leg ulcers and the reasons for undertaking physical activities; specific beliefs that people hold about their own capabilities; pain related to wound and compression therapy; information and supports re-ceived from treating clinicians; feeling of fear and embarrassment. The confidence level for most of the synthesis findings was moderate to low.Conclusions: Our review identified people with venous leg ulcers experience significant challenges preventing them from engaging in physical activity. Factors such as knowledge of physical activity, availability of informa-tion, and self-belief may be particularly important for promoting physical activity in this cohort. Future interven-tions are recommended to provide educational information and clear instructions to improve participation. Further research is needed to explore potential interventions that may change physical activity behaviour in this population group. Registration: PROSPERO CRD42021238579 (c) 2022 Elsevier Ltd. All rights reserved.