Considering the Impact of Exercise on Wound Healing

Stephanie Woelfel, PT, DPT, CWS:

I'm Stephanie Woelfel, a doctor of physical therapy and a certified wound specialist through both the American Board of Wound Management and the American Board of Physical Therapy Specialties. And I'm an associate professor of clinical physical therapy and surgery at the University of Southern California, and I also am the primary physical therapist in the Southwestern Academic Limb Salvage Alliance.

That's interesting because there are those global exercise benefits which still pertain if you have a wound, so all of those cardiovascular benefits, the health benefits overall are still going to help that person as a whole. And wounds are always attached to people, right, so anything that fixes or works on improving the health of the system is going to help the wound inadvertently as well. But a lot of the wounds that we deal with, especially lower extremity wounds, have some level of ischemia associated with that. So whether it's strictly due to peripheral artery disease, whether that's due to diabetes, even with venous wounds that excess edema can create an ischemic state in the limb.

So doing exercise can really help to not only improve the circulation to the area, but in the case of a wound that has a lymphedema or some type of edema component, it can usually help move some of that fluid out of the area and help the wound healing that way. So it's helping bring the good stuff, the blood nutrients, oxygens into the area, and then also removing some of maybe the stagnant fluid and those types of things. So getting us moving is really a great way to be healthier overall, but also to help the wound environment be a little bit more conducive to healing.

I think there's a couple of things. There's always the safety component because a lot of patients that have chronic wounds have other chronic medical conditions or comorbidities. So you have to think about those in the context of, "Is it safe for the patient to exercise?" And the answer is usually, "Yes." It's just, at what level can they exercise? So sometimes we're starting them a lower level of intensity and we're going to work them up to that moderate intensity, which is what's recommended. That's fine. They're still doing something, they're still improving in some way.

And I think the safety component also looks at medications because certain medications that the patient's on, especially for cardiac comorbidities, just means we need to monitor their response to exercise a little bit differently. So if someone's on a beta-blocker, I'm not going to rely on heart rate to tell if they're tolerating an exercise program, I'm going to use a rating of perceived exertion instead because that is something that isn't going to be impacted by that medication.

I think the other thing for us to consider is what do our patients really want to do? What do they enjoy doing? I am not a runner, so if my exercise plan that I get from a trainer is to run every day, I'm not doing it. So I think we have to remember that our patients are similar. We have to link in or key in to activities they like to do, activities they want to get back to doing, and then work that into their plan and their program for them.

I think just looking at walking is usually a very simple one to integrate into an exercise plan. Just parking a little bit further away from the entrance at a grocery store can add, all of a sudden, an extra thousand steps to your day by the time you get into the store and out. So looking for little ways like that to really increase activity throughout your day instead of necessarily setting aside 30 minutes to do an exercise program, let's say.

But I think the other thing that gets overlooked a lot is, really, strength training and how important that is not just for our overall health, but for function. A lot of patients with chronic wounds end up feeling like they can't move as well, they can't get up off of a low chair, or maybe they can't get down on the ground with grandkids, something like that. Strength training is really the key to being able to do some of those activities safely, and it also helps a lot with balance, and that tends to be another issue that we see with their patients. So I definitely would say make sure you're incorporating some type of strength training program with your patients.

I think the closing comments I would make is just don't underestimate the impact that exercise can have, and even beyond exercise, just increasing activity. So think about a physical therapy referral for your patients because I think it can really help them not only with mood healing goals that they might have, but with just life goals that they might have, and if they're happier and healthier in their life, then a lot of times that's going to overlap and we're going to see better outcomes with their wounds too.