EXERCISE

The calf muscles have been called the body's"second heart,"improving blood circulation when exercised, usually by walking. Structured exercise training (SET) increases calf muscle pump function, lower limb circulation, and walking capacity for those with limited ambulation due to peripheral arterial disease (PAD)1 or venous insufficiency.2 This resulted in the Centers for Medicare and Medicaid Services (CMS) decision to reimburse up to thirty-six 30- to 60-minute, properly supervised hospital outpatient or office-based SET sessions over 12 weeks to treat intermittent claudication for patients with PAD. Exercise improves acute wound healing in diabetic mice3 and healthy elderly humans,4 but insufficient evidence supports its healing efficacy on ischemic ulcers,1 venous leg ulcers (VLUs),5 and diabetic foot ulcers (DFUs).6 This month's Evidence Corner examines 2 recent randomized controlled trials (RCTs) testing the effects of foot exercises that activate calf muscles on chronic VLUs7 and DFUs.8.