Can Exercise Expedite Wound Healing In Older Patients?

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By Brian McCurdy, Associate Editor

The benefits of exercise in preventing diabetes and improving general health are well established. Can exercise also facilitate improved wound healing among older adults? A recent study in the Journal of Gerontology: Medical Sciences found that wounds healed faster for patients who exercised compared to those who engaged in no activity. The study involved 28 healthy adults with a mean age of 61. The patients were assigned either to an exercise or non-exercise group. Researchers created small wounds on patients and conducted wound measurement three times a week to calculate the healing rate. In the exercise group, wounds healed at a mean of 29.2 days as compared to a mean of 38.9 days in the group that did not exercise, according to the study. Nicholas Romansky, DPM, touts the benefits of cardiovascular exercise, noting that it increases blood flow, especially among patients with diabetes. He notes that exercise functions the same way as insulin by moving sugar from the blood into the muscles and lowered blood sugar will generally lead to less sugar and more endurance. “In the elderly and especially patients with diabetes, increasing blood flow to the foot is going to make them heal because it is going to drop the sugar,” says Dr. Romansky, a Fellow of the American College of Foot and Ankle Surgeons. “If you do not have blood flow, nothing is going to heal.” Emphasizing A Degree Of Caution With Exercise Recommendations When recommending exercise, Dr. Romansky cautions DPMs to beware if patients have had a previous ulcer, deformity (which one may have to offload) or other problem that patients may be sensitized to again if they exercise. Tamara Fishman, DPM, calls exercise a “catch-22” for patients with wounds. “To be honest, exercise is the last thing I think about with wound patients,” says Dr. Fishman, the Chairman of the Wound Care Institute in North Miami Beach, Fla. “Most of the time, the wound patient needs to be off his or her feet for a period of time.” However, some patients who have undergone heart surgery may need to exercise if advised to do by their cardiologist. In those cases, Dr. Fishman recommends specialized shoes with inserts. If patients can exercise, their routines should include cardiovascular activity, strength and flexibility, according to Dr. Romansky, who is in private practice in Media and Phoenixville, Pa. He notes that patients should exercise slowly and regularly, and that older people should not increase their exercise by more than 10 percent from one week to the next. For example, if they walk 20 minutes one week, they should only walk 22 minutes the next week. If patients do not recover from an exercise routine in 24 to 36 hours, he says they should reassess if the program is working and also should re-evaluate their exercise routines every six weeks. If patients do not want to exercise or can only participate in limited exercise, Dr. Romansky suggests blending exercise into life activities. For example, they could park in a spot farther from a store, take the stairs instead of an elevator, and do activities like household chores or gardening. If patients treat exercise like an appointment, Dr. Romansky says they are more likely to stick to a routine. Study Examines More Accurate Test For Autonomic Neuropathy By Brian McCurdy, Associate Editor It may be difficult to distinguish Charcot’s neuroarthropathy from other conditions but an emerging test may yield clearer results. A recent study in the Journal of the American Podiatric Medical Association examined the efficacy of using short-term power spectral analysis (PSA) of heart rate variability (HRV) to assess autonomic neuropathy. Researchers studied 17 patients with acute Charcot’s neuroarthropathy and compared PSA of HRV to standard Ewing’s cardiovascular reflex tests. Using the PSA of HRV test diagnosed 92 percent of patients with autonomic neuropathy while Ewing’s tests diagnosed 82 percent, according to the study. How does PSA of HRV work? As study co-author Stephanie Wu, DPM, explains, the HRV spectrum has two main spectral components, low frequency (0.03 and 0.15 Hz) and high frequency (0.18 and 0.40 Hz). In general, the high-frequency component is considered a marker for vagal activity although some have advocated a sympathetic influence as well, according to Dr.

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