Lifestyle Medicine and Chronic Venous Disease in Viet Nam: Calf Muscle Function, Compression Safety, and Venous Ulcer Care

Lifestyle Medicine and Chronic Venous Disease in Viet Nam: Calf Muscle Function, Compression Safety, and Venous Ulcer Care

Primary category: Evidence & Clinical Practice

Secondary category: Lifestyle Medicine in Viet Nam

Article type: VLMA Perspective

Last reviewed: October 30, 2026

By the end of a working day, someone who spends hours standing may notice that their legs feel heavy and their shoes have become uncomfortably tight. Another person may have prominent varicose veins but experience little discomfort. For someone with more advanced venous disease, the problem may be persistent swelling, changes in the skin around the ankle, or an open wound that has not healed despite repeated dressing changes.

These presentations can arise from chronic venous disease, but they do not necessarily share the same underlying mechanisms, clinical risks, or treatment needs.

Walking, calf muscle exercises, leg elevation, weight management, and compression stockings are commonly recommended for venous problems. Some of these measures can improve symptoms or support physical function, but their benefits depend on the patient's condition. Exercise may improve the efficiency of the calf muscle pump without correcting damaged venous valves. Compression can help control swelling and promote ulcer healing, but it may cause harm when arterial circulation is severely impaired.

Evidence-based Lifestyle Medicine has a supporting role through appropriate physical activity, management of relevant health risks, and assistance with sustainable self-care. These interventions are most useful when integrated with vascular assessment, established treatment, and specialist care when indicated.

For healthcare professionals in Viet Nam, the challenge is to understand where lifestyle-related interventions can contribute, recognize their limitations, and ensure that conservative management does not delay necessary investigation or treatment.

Understanding the Spectrum of Chronic Venous Disease

Chronic venous disease describes a broad range of structural and functional abnormalities affecting venous circulation, particularly in the lower limbs. These abnormalities may involve venous reflux, obstruction, or a combination of both.

Under normal circumstances, one-way venous valves limit backward blood flow, while contractions of the lower-limb muscles assist blood returning toward the heart. When venous function is impaired, pressure within the leg veins may remain elevated during standing and walking. Persistent venous hypertension can contribute to discomfort, edema, skin changes, and, in more advanced cases, ulceration.

The Clinical–Etiological–Anatomical–Pathophysiological classification, commonly known as CEAP, provides an internationally recognized framework for describing chronic venous disorders.

Its clinical component ranges from C0, indicating no visible or palpable signs of venous disease, to C6, indicating an active venous ulcer. The intermediate categories include telangiectasias and reticular veins, varicose veins, edema, skin changes, and healed ulcers.

Chronic venous insufficiency is generally used to describe more advanced manifestations of chronic venous disease, broadly corresponding to clinical classes C3 through C6. The terms are related but should not be used interchangeably without considering the clinical context.

A patient with visible varicose veins does not necessarily have advanced venous insufficiency. Conversely, someone may experience symptoms or have abnormalities detected through vascular investigation despite having few visible signs.

Lower-limb swelling also has causes beyond venous disease. Heart failure, kidney disease, lymphatic disorders, medication effects, and other conditions may produce edema. Sudden swelling or pain can raise concern for acute conditions, including deep vein thrombosis, which require a different diagnostic approach.

Clinical assessment should therefore consider the pattern and duration of symptoms, relevant medical conditions, examination findings, and possible alternative diagnoses.

Although CEAP helps describe disease characteristics, it does not independently measure symptom severity, treatment response, or quality of life. Two patients with the same clinical classification may experience different functional limitations and require different treatment approaches.

The Calf Muscle Pump and the Role of Exercise

The calf muscles make an important contribution to venous return, particularly during walking.

As the calf muscles contract, they compress the deep veins and help move blood upward. Venous valves normally limit backward flow when the muscles relax. Movement at the ankle contributes to this mechanism, commonly described as the calf muscle pump.

Its effectiveness depends on several interacting factors, including calf muscle function, ankle mobility, venous valve competence, and the presence of venous obstruction.

Someone with reduced calf strength, restricted ankle movement, or prolonged immobility may have less effective venous emptying. This provides a physiological reason to consider walking and appropriately selected calf or ankle exercises.

However, strengthening the calf muscles does not necessarily correct the underlying venous abnormality. Exercise cannot reliably restore damaged venous valves, eliminate established reflux, or resolve significant venous obstruction.

A patient may experience better mobility or less discomfort even when the anatomical cause of venous hypertension remains.

The European Society for Vascular Surgery's 2022 clinical practice guideline recommends considering exercise to reduce symptoms in patients with symptomatic chronic venous disease. [1]

The evidence supporting particular exercise programs, however, remains less certain than the physiological rationale.

A Cochrane systematic review published in June 2023 examined five randomized controlled trials involving 146 participants with chronic venous insufficiency without active ulcers. [2]

The studies evaluated different exercise interventions and measured outcomes such as venous hemodynamics, symptoms, muscle strength, ankle mobility, exercise capacity, and quality of life.

Some individual trials reported improvements, but most findings were based on small studies and evidence assessed as very low certainty. Differences in intervention protocols and outcome measurements also limited the ability to combine results reliably.

The reviewers concluded that the available evidence was insufficient to determine confidently the benefits and harms of structured exercise programs for non-ulcerated chronic venous insufficiency.

This should not be interpreted as evidence that physical activity has no value. Walking and other appropriate activities have established benefits for cardiovascular health, mobility, and general physical functioning.

The remaining uncertainty concerns how much additional benefit specific exercise programs provide for venous disease itself.

For clinical practice, exercise can reasonably be considered as supportive management when appropriate, without promising that it will correct venous reflux or prevent disease progression.

What New Research in 2026 Adds

A randomized controlled trial published in Healthcare in April 2026 provides more recent evidence concerning structured calf muscle strengthening. [3]

Conducted at Ramathibodi Hospital in Bangkok, Thailand, the study included 50 patients with chronic venous insufficiency classified as CEAP C3 through C5.

Participants were assigned to graduated compression therapy alone or compression combined with a structured home-based calf muscle strengthening program.

Over 12 weeks, the combined-intervention group demonstrated greater improvements in clinical severity, calf muscle strength, ankle range of motion, and disease-related quality of life.

These findings are relevant because the study examined exercise as an addition to established conservative management rather than as an alternative to compression therapy.

The results suggest that targeted calf muscle training may provide additional benefits for selected patients, particularly when impaired muscle function or restricted ankle movement contributes to symptoms and functional limitations.

Nevertheless, the trial was small, conducted at a single hospital, and followed participants for a relatively short period. Its retrospective registration is another methodological consideration when interpreting the evidence.

The findings also apply to the selected population enrolled in the study. They should not automatically be extended to patients with active venous ulcers, severe peripheral artery disease, or other conditions excluded from participation.

The study does not establish a universally optimal exercise program or demonstrate that improvements persist over the long term.

Further research is needed to clarify which patients benefit most, how exercise intensity and duration should be selected, and whether improvements in muscle function translate into sustained clinical outcomes.

Making Physical Activity Practical and Safe

For someone with uncomplicated symptomatic varicose veins who remains independently mobile, regular walking and opportunities to move the ankles during prolonged periods of sitting or standing may be reasonable supportive measures.

Patients with reduced calf strength or ankle mobility may benefit from a more structured strengthening program following appropriate assessment. Others may need rehabilitation support because of pain, neurological conditions, balance impairment, or reduced mobility.

The appropriate approach depends on the patient's physical condition, treatment goals, and ability to participate safely.

A person recovering from hospitalization may initially need assistance with walking or basic movements. Someone who remains physically active but experiences discomfort after prolonged standing may have different needs.

Occupational circumstances are particularly relevant in Viet Nam, where many people work in retail, manufacturing, healthcare, hospitality, and other occupations involving extended periods of standing or sitting.

Regular opportunities to change position and move the ankles may be practical, although workplace arrangements can limit how often these activities are possible.

A recommendation to walk more or elevate the legs may be difficult for someone who cannot leave a workstation or take unscheduled breaks. Healthcare professionals should therefore consider the patient's working environment rather than assume that the same advice is equally feasible for everyone.

Leg elevation may temporarily reduce swelling or discomfort in selected patients, but it does not correct persistent venous reflux or obstruction.

Weight management may also be relevant when overweight or obesity contributes to increased venous pressure and broader health risks. However, evidence that weight reduction alone reverses established chronic venous disease remains limited.

Exercise planning must also take account of coexisting medical conditions, including heart failure, peripheral artery disease, neuropathy, significant joint disease, balance impairment, and active wounds.

New, unexplained, or rapidly worsening leg symptoms require clinical evaluation. Sudden painful swelling, particularly when affecting one leg, should not simply lead to advice to increase walking or begin exercising.

Compression Therapy: Benefits Depend on the Clinical Indication

Compression therapy is an important component of conservative management for chronic venous disease, although the strength of the supporting evidence differs according to the condition being treated.

Properly selected external compression can influence venous hemodynamics, reduce edema, and help manage symptoms. In patients with venous leg ulcers, it also plays an established role in promoting healing.

The 2025 clinical practice guideline from the Society for Cardiovascular Angiography and Interventions distinguishes between compression for symptomatic varicose veins and compression for venous ulceration. [4]

For patients with symptomatic varicose veins, the guideline suggests compression rather than no compression. This is a conditional recommendation supported by very-low-certainty evidence.

For patients with venous leg ulcers, the same guideline recommends compression rather than no compression. This is a strong recommendation supported by moderate-certainty evidence.

The difference reflects the degree of confidence in the available research, rather than suggesting that compression has identical benefits across all presentations of venous disease.

Compression may be a reasonable option for symptom control in uncomplicated disease, particularly when patients prefer conservative management or have reasons to avoid intervention.

For a confirmed venous ulcer with adequate arterial perfusion, appropriately delivered compression is a central component of treatment.

However, the guideline does not establish that everyone with visible varicose veins must wear compression stockings indefinitely. Nor does it mean that a patient with treatable venous reflux must always complete a fixed period of compression before another appropriate treatment can be considered.

Treatment decisions should reflect symptoms, vascular anatomy, potential complications, expected benefits, patient preferences, and available treatment options.

Arterial Assessment Is Essential to Compression Safety

Compression is sometimes regarded as a simple and relatively harmless intervention. That assumption can be dangerous when venous disease coexists with impaired arterial circulation.

Peripheral artery disease reduces blood supply to the tissues. When significant arterial impairment is present, external compression may increase the risk of ischemic injury.

The European Society for Vascular Surgery's 2022 guideline identifies severe lower-extremity arterial disease as an important contraindication to sustained compression therapy. [1]

For patients with active venous ulceration, its Recommendation 72 advises against sustained compression when the ankle–brachial index is below 0.6, ankle systolic pressure is below 60 mmHg, or toe systolic pressure is below 30 mmHg.

These thresholds require professional interpretation alongside the clinical examination and other vascular findings. They are not intended as instructions for patients to choose compression garments or pressure levels independently.

Arterial assessment is particularly important in patients with leg ulcers, reduced peripheral pulses, symptoms suggesting ischemia, or relevant risk factors for peripheral artery disease.

The ankle–brachial index is commonly used to assess lower-limb arterial circulation, but it has limitations. In people with diabetes, chronic kidney disease, or other conditions associated with arterial calcification, ankle arteries may be difficult to compress, producing falsely elevated measurements.

Toe pressure assessment or other vascular investigations may therefore be necessary when the initial findings are unreliable or inconsistent with the clinical presentation.

Heart failure is another important consideration. The European guideline identifies New York Heart Association class IV heart failure as a contraindication to compression and cautions against routine compression in class III heart failure without appropriate clinical and hemodynamic monitoring.

Severe sensory neuropathy, particularly when associated with diabetes, may increase the risk of pressure-related skin injury because patients may not recognize excessive pressure or developing tissue damage.

Not every patient with peripheral artery disease must avoid all forms of compression. In selected patients with mixed arterial and venous ulcers, modified compression may be considered under close specialist supervision when arterial perfusion meets appropriate safety criteria.

The European guideline describes modified compression using lower pressure in selected patients with mixed disease, but emphasizes the need for adequate arterial perfusion and careful monitoring. Treatment should be reconsidered promptly if pain increases substantially or the wound deteriorates.

The decision involves more than selecting a lower-pressure stocking. Clinicians must consider the compression system, actual pressure applied, arterial findings, limb anatomy, skin condition, and overall clinical status.

For patients, the important message is that compression should follow appropriate assessment rather than begin solely because swelling or visible varicose veins are present.

Choosing Compression That Patients Can Use

Compression stockings, multilayer bandages, adjustable wraps, and intermittent pneumatic compression devices differ in their design, application, and clinical purpose.

They should not be considered interchangeable simply because each applies external pressure.

The appropriate system depends on whether the primary objective is symptom relief, edema management, wound healing, or another clinically defined outcome.

Correct sizing and application are essential. Poorly fitted compression may cause discomfort, uneven pressure, or localized skin injury, while inadequate compression may fail to deliver the intended benefit.

Practical difficulties often determine whether patients can continue treatment.

Viet Nam's hot and humid conditions may make compression garments uncomfortable, particularly for people who work outdoors or in environments with limited ventilation.

Older adults and patients with arthritis, obesity, reduced hand strength, or impaired mobility may struggle to apply or remove tight stockings.

Some patients require assistance from family members, while others may benefit from application aids or alternative compression designs.

Cost may also influence treatment continuity when garments require replacement or patients face repeated appointments for wound care.

When someone reports difficulty maintaining compression treatment, healthcare professionals should explore the underlying reasons rather than assume that the patient is unwilling to cooperate.

Discomfort, unsuitable sizing, skin irritation, difficulty applying the garment, financial constraints, and limited caregiver support may all contribute.

A compression system should be selected for its clinical appropriateness, safety, and feasibility. A higher compression level may offer greater benefit for some outcomes, but that advantage can be undermined when the patient cannot use the treatment consistently.

Venous Leg Ulcers Require More Than Dressings

Venous leg ulcers are among the more serious manifestations of chronic venous disease. They commonly develop in the lower leg, particularly around the ankle, and may be associated with longstanding edema, pigmentation, venous eczema, or other changes caused by persistent venous hypertension.

However, not every lower-leg ulcer has a venous origin.

Arterial disease, diabetes-related complications, pressure injury, inflammatory disorders, infection, and malignancy may produce wounds with different underlying mechanisms. Some ulcers have mixed causes.

Correctly identifying the cause is essential because inappropriate treatment may delay healing or worsen tissue injury.

A comprehensive assessment should consider the wound's history and characteristics, surrounding skin, arterial and venous circulation, pain, mobility, nutritional status, and associated medical conditions.

For a confirmed venous ulcer with adequate arterial perfusion, compression and appropriate wound care are central components of treatment.

Dressings can help manage exudate, protect surrounding skin, and maintain a suitable wound environment. However, their selection should reflect wound characteristics and clinical objectives rather than assumptions that newer or more expensive products are necessarily more effective.

Antibiotic treatment also requires careful judgment.

The United Kingdom's National Institute for Health and Care Excellence guideline on leg ulcer infection emphasizes that many ulcers are colonized with bacteria without being clinically infected. Antibiotics do not improve healing when clinical infection is absent. [5]

Spreading redness, increasing pain, localized warmth, fever, or other concerning findings may indicate infection requiring assessment and appropriate treatment.

Patients with suspected sepsis, rapidly progressing infection, severe ischemia, or other serious complications require urgent medical evaluation.

A wound that fails to improve as expected should prompt reassessment rather than repeated continuation of the same treatment without reconsideration.

The 2024 German guideline on venous leg ulcers recommends reviewing the diagnosis and treatment when there is no tendency toward healing after approximately six weeks of guideline-conforming care. [6]

Ulcers with unusual characteristics, atypical locations, or concerning progression may require earlier specialist assessment, including histological examination when appropriate.

Persistent ulceration should lead clinicians to reconsider possible venous hypertension, inadequate arterial supply, infection, treatment difficulties, or alternative diagnoses.

The goal is to address the underlying problem rather than focus exclusively on the wound surface.

Can Exercise Improve Venous Ulcer Healing?

A systematic review and meta-analysis published in Wound Repair and Regeneration in June 2026 provides additional evidence concerning exercise as part of venous ulcer management. [7]

The review included nine randomized controlled trials involving 270 participants. All included studies evaluated exercise alongside compression therapy rather than replacing compression with exercise.

A pooled analysis of eight trials found a higher proportion of healed ulcers among patients receiving additional exercise, with a relative risk of 1.35 and a 95% confidence interval of 1.04 to 1.74.

This suggests that exercise may contribute to ulcer healing when incorporated into established treatment.

However, the trials were relatively small, exercise protocols varied, and intervention durations generally ranged from four to twelve weeks.

The review included studies involving adults with venous ulcers and an ankle–brachial index above 0.8. Its findings should therefore not be generalized to patients with significant arterial impairment without further evidence.

The researchers also examined ulcer area reduction, but the pooled estimate did not demonstrate a statistically significant benefit. This illustrates why improvements in the proportion of ulcers healed should not automatically be interpreted as equivalent improvements across every wound-related outcome.

Importantly, none of the included trials reported ulcer recurrence.

The review therefore does not establish whether exercise prevents venous ulcers from returning or provides sustained benefits after the initial treatment period.

Nor does it demonstrate that exercise can replace compression, wound care, or appropriate venous intervention.

For suitable patients, individualized walking, ankle mobility exercises, or calf muscle strengthening may be useful additions to treatment. Their selection should account for pain, wound characteristics, balance, mobility, underlying conditions, and the safety of movement.

When Venous Intervention May Improve Outcomes

Conservative treatment is appropriate for many patients with chronic venous disease, but some have persistent symptoms or complications caused by anatomical abnormalities that may benefit from more targeted treatment.

Duplex ultrasonography is a principal investigation for evaluating venous reflux and relevant anatomy when such information is needed for clinical decisions.

Depending on the findings, endovenous ablation, sclerotherapy, phlebectomy, or other venous procedures may be appropriate.

The 2023 clinical practice guidelines from the Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society provide recommendations for patients with symptomatic varicose veins. The guidelines were published online in August 2023 and appeared in the January 2024 journal issue. [8]

For appropriate candidates with symptomatic axial reflux involving the great or small saphenous veins, the guidelines recommend superficial venous intervention over long-term compression stockings.

They also suggest against requiring a routine three-month compression trial before intervention in patients who are suitable for endovenous treatment and wish to proceed.

This does not mean that intervention is necessary for everyone with visible varicose veins. Conservative management remains appropriate for many patients, depending on symptoms, vascular findings, clinical risks, and individual preferences.

However, compression should not automatically delay further assessment or appropriate treatment when a clinically significant venous abnormality is present.

The value of timely intervention is particularly relevant in venous ulcer management.

The Early Venous Reflux Ablation trial, published in The New England Journal of Medicine in 2018, included 450 patients with venous ulcers of less than six months' duration and superficial venous reflux. [9]

Participants received compression therapy combined with either early endovenous ablation or deferred intervention.

The median time to ulcer healing was 56 days in the early-ablation group compared with 82 days in the deferred-intervention group.

These findings demonstrated that early treatment of suitable superficial venous reflux can accelerate ulcer healing in appropriately selected patients.

Longer-term follow-up, published in JAMA Surgery in 2020, found a lower overall rate of recurrent ulcer episodes among patients assigned to early intervention. However, the difference in time to the first recurrence was not statistically significant. [10]

These outcomes should be distinguished when describing the effectiveness of treatment. Early intervention improved healing and reduced the overall burden of recurrent episodes, but it did not guarantee that ulcers would never return.

More recent evidence has explored additional venous procedures.

The FINNULCER randomized controlled trial, published online in the European Journal of Vascular and Endovascular Surgery in July 2026, investigated ultrasound-guided foam sclerotherapy targeting the venous plexus beneath venous ulcers. [11]

The multicenter Finnish trial enrolled 73 patients and compared conventional treatment with the same treatment plus immediate sub-ulcer foam sclerotherapy.

Median ulcer healing time was 55 days in the additional-treatment group and 91 days in the conventional-treatment group.

The findings suggest that treatment directed at the sub-ulcer venous plexus may accelerate healing in selected patients.

However, the trial enrolled fewer participants than originally planned. Its results should not be interpreted as establishing that this procedure is necessary or appropriate for every patient with venous ulceration.

Together, these studies reinforce the importance of evaluating whether treatable venous abnormalities are contributing to persistent disease.

Exercise, compression, and wound care can remain valuable alongside specialist intervention. For some patients, better outcomes depend on combining approaches that address different aspects of the condition.

Preventing Venous Ulcer Recurrence

Healing a venous ulcer does not necessarily mean that the underlying venous disorder has resolved.

Persistent reflux, venous hypertension, edema, skin vulnerability, and limited mobility may continue after the wound closes, creating conditions that favor recurrence.

A 2024 Cochrane review examined compression therapy for preventing recurrent venous ulcers. [12]

The review included eight studies involving 1,995 participants with healed ulcers. It found low-certainty evidence that higher-compression hosiery may reduce recurrence compared with no compression or lower levels of compression in some comparisons.

However, higher compression may also make long-term adherence more difficult.

This creates a practical trade-off. A compression system associated with a lower recurrence rate in a clinical study may be less useful for someone who cannot wear it regularly because of discomfort, difficulty applying it, or other barriers.

Long-term management should therefore consider both clinical effectiveness and treatment feasibility.

Patients may require reassessment of compression needs after healing. Some may also benefit from further investigation of persistent venous reflux or other abnormalities contributing to recurrence risk.

Skin care, maintenance of mobility, education, and appropriate follow-up can support ongoing management, although the strength of evidence for individual measures varies.

The 2026 systematic review of exercise for active venous ulcers did not provide evidence on long-term recurrence prevention. Exercise should therefore not be presented as a proven substitute for compression or other appropriate preventive measures.

A practical prevention plan should address the patient's ongoing vascular condition, ability to maintain treatment, and access to follow-up care.

What Research From Viet Nam Tells Us

Research conducted in Vietnamese healthcare facilities provides useful observations about chronic venous disease, although available findings must be interpreted according to their study designs and populations.

A cross-sectional study published in the Vietnam Journal of Community Medicine on May 25, 2026, examined clinical and Doppler ultrasound characteristics among 342 outpatients diagnosed with chronic lower-limb venous insufficiency at Duc Giang General Hospital. [13]

Women accounted for 76% of participants, while 78.3% were aged 60 years or older.

Leg heaviness was reported by 31.9% of patients, followed by numbness or tingling in 29.8%.

Notably, 52.9% of participants were classified as C0 according to the clinical component of CEAP.

This finding requires careful interpretation because C0 indicates the absence of visible or palpable signs of venous disease. It does not necessarily exclude symptoms or venous abnormalities identified through vascular investigation.

However, the relatively high proportion of C0 patients in a study described using the terminology of chronic venous insufficiency also highlights the importance of consistent diagnostic definitions and disease classification.

The researchers reported frequent involvement of the great saphenous vein and identified associations between selected ultrasound measurements and clinical classification.

These observations are relevant to understanding diagnostic findings in the study population, but they do not establish the prevalence or severity distribution of chronic venous disease in the general Vietnamese population.

Another Vietnamese study, published in the Vietnam Medical Journal on February 3, 2026, examined early outcomes of conservative treatment among 30 patients with superficial venous insufficiency at Nam Can Tho University Hospital. [14]

The researchers used a prospective descriptive case-series design.

All participants received a venoactive medication containing micronized purified flavonoid fraction, while half also used compression stockings.

After one month, the mean Venous Clinical Severity Score decreased from 3.9 to 3.17. The mean score on the 14-item Chronic Venous Insufficiency Questionnaire decreased from 32 to 29, indicating improvement in the measured aspects of disease-related quality of life.

The investigators reported statistically significant changes.

However, the study did not include an untreated or appropriately matched comparison group. Because all participants received medication and only some used compression, the findings cannot establish the independent contribution of either intervention.

The sample was also small, and follow-up lasted only one month. Changes in symptoms may have been influenced by the combined treatment, natural variation, patient expectations, or other factors.

The study does not provide evidence concerning prevention of venous ulcers, long-term recurrence, or reduced need for future procedures.

Both Vietnamese studies contribute useful clinical observations, but neither demonstrates that a particular lifestyle intervention prevents chronic venous disease or reverses established venous insufficiency.

Further research in Viet Nam would benefit from standardized diagnostic definitions, larger and more representative samples, controlled comparisons, consistent outcome measures, and longer follow-up.

These improvements would help determine which interventions are effective, safe, and feasible in different healthcare settings and patient populations.

Building Practical Care Pathways in Viet Nam

International guidelines provide a scientific foundation for chronic venous disease management, but their application must reflect local healthcare resources and patients' circumstances.

Patients may first seek care through primary care, internal medicine, rehabilitation medicine, dermatology, or specialist vascular services.

Not every healthcare facility has immediate access to specialized duplex ultrasonography, advanced wound management, or the full range of venous interventions.

A practical care pathway should therefore begin with appropriate clinical assessment, recognition of concerning findings, and referral arrangements that reflect the patient's needs.

Patients with uncomplicated symptoms may benefit from education, appropriate physical activity, and selected conservative interventions following clinical assessment.

Those with significant edema, skin changes, recurrent symptoms, or suspected venous reflux may need more detailed vascular evaluation.

Patients with leg ulcers require assessment of arterial and venous circulation, wound characteristics, and possible complications.

Treatment planning should then consider the patient's ability to access and maintain appropriate care.

Some patients may struggle with transportation costs, repeated wound appointments, purchasing compression garments, or time away from work. Others may depend on family members for assistance with compression or wound care at home.

These circumstances can influence treatment continuity and outcomes. They should be identified during care planning rather than interpreted simply as a lack of motivation.

Collaboration among physicians, nurses, vascular specialists, rehabilitation professionals, wound care teams, and other appropriately qualified healthcare practitioners can help coordinate different aspects of treatment.

For healthcare organizations, opportunities for quality improvement include more consistent documentation of vascular findings, appropriate arterial assessment before compression, standardized wound evaluation, clear referral criteria, and follow-up systems that identify wounds failing to progress toward healing.

These improvements may provide greater clinical value than introducing additional products, devices, or procedures without a clear clinical purpose.

Measuring Outcomes That Matter to Patients

The effectiveness of chronic venous disease management should be evaluated according to the patient's condition and treatment goals.

For someone with symptomatic varicose veins, reduced heaviness, pain, itching, or swelling may represent meaningful improvement.

Another patient may value being able to stand throughout a working day with less discomfort or return to walking without significant limitations.

Standardized instruments can support a more consistent assessment of these outcomes.

The revised Venous Clinical Severity Score provides a structured measure of clinical severity, while the Chronic Venous Insufficiency Questionnaire can help evaluate disease-related quality of life.

These tools complement clinical examination and vascular investigations rather than replace them.

For patients with venous ulcers, important outcomes include wound area, progression toward complete healing, time to healing, complications, and recurrence.

Treatment feasibility should also be assessed. A compression prescription cannot be considered successful solely because it was issued if the patient cannot apply or tolerate the garment.

Improvement in symptoms does not necessarily demonstrate that venous reflux or obstruction has resolved. Similarly, wound closure does not establish that the underlying risk of recurrence has disappeared.

When expected improvement does not occur, follow-up should prompt reconsideration of the diagnosis, treatment adequacy, potential safety concerns, adherence barriers, and whether specialist intervention is required.

Counting exercise recommendations, compression prescriptions, or dressing changes may describe healthcare activity, but these figures do not independently establish better outcomes.

More useful evaluation asks whether symptoms have improved, wounds are healing, complications are recognized, and patients can maintain appropriate treatment in their everyday circumstances.

Professional and Regulatory Considerations in Viet Nam

Chronic venous disease management may involve clinical examination, diagnosis, vascular investigation, treatment prescriptions, wound management, rehabilitation, and specialist procedures.

These activities must be performed within the applicable legal and professional framework.

In Viet Nam, the Law on Medical Examination and Treatment No. 15/2023/QH15, effective January 1, 2024, as amended, provides the principal legal framework for clinical examination and treatment. Its consolidated text is reflected in Consolidated Document No. 26/VBHN-VPQH issued by the Office of the National Assembly on February 26, 2026. [15]

Healthcare professionals and facilities must comply with relevant requirements concerning qualifications, professional authorization, clinical responsibilities, and legally permitted scopes of practice.

International clinical guidelines and professional certifications can inform healthcare education and practice, but they do not independently authorize someone to perform clinical activities outside the applicable Vietnamese legal framework.

The same distinction applies to Lifestyle Medicine.

General education about physical activity, healthy behaviors, and relevant risk factors is different from diagnosing venous disease, determining individualized compression therapy, managing active ulcers, or deciding whether a vascular procedure is indicated.

These clinical decisions require appropriately qualified and authorized healthcare professionals.

Patient information also requires protection. Clinical histories, vascular findings, wound photographs, treatment records, and other identifiable health information may contain sensitive personal data.

The Law on Personal Data Protection No. 91/2025/QH15 and Decree No. 356/2025/NĐ-CP, both effective January 1, 2026, establish relevant requirements governing the processing and protection of personal data. [16]

Healthcare organizations must ensure that personal information is collected, used, accessed, stored, and shared through appropriate legal and professional arrangements.

For the Vietnam Lifestyle Medicine Alliance (VLMA), chronic venous disease is a relevant subject for evidence-based professional education and scientific knowledge exchange.

Educational content can help healthcare professionals understand the physiological role of the calf muscle pump, critically interpret exercise research, recognize compression safety considerations, and appreciate the importance of vascular assessment and specialist referral.

Such activities should remain within the organization's educational and professional knowledge-sharing role. They should not be presented as substitutes for clinical training, professional authorization, or individualized vascular care.

Bringing Lifestyle Medicine Into Comprehensive Venous Care

Chronic venous disease provides a useful example of how Lifestyle Medicine can contribute to clinical care without being expected to address every aspect of a medical condition.

Appropriate physical activity can support mobility and calf muscle function. Weight management may be beneficial for selected patients, while education and behavior-change support can help people participate more effectively in long-term treatment.

These contributions are valuable, but they are not equivalent to correcting venous reflux, treating significant obstruction, or managing an active ulcer.

The available evidence also requires careful interpretation. Research on structured exercise for non-ulcerated chronic venous insufficiency remains limited. More recent studies suggest that exercise may provide additional benefits when combined with compression, including improved ulcer healing in selected patients, but long-term effects and recurrence prevention remain uncertain.

Compression has a more established role in venous ulcer healing, although its safety depends on arterial circulation and other clinical factors. Patients with treatable venous abnormalities may benefit from appropriately timed specialist intervention.

For healthcare professionals in Viet Nam, effective management requires connecting these approaches through accurate assessment, individualized treatment decisions, and meaningful follow-up.

The clinical objective may be different for each patient. One person wants to complete a working day with less discomfort. Another needs support to maintain mobility, while someone with a venous ulcer hopes to achieve healing and avoid recurrence.

Meeting these goals requires treatment that addresses the underlying condition while remaining practical and safe for the person receiving it.

The contribution of Lifestyle Medicine lies in helping patients maintain mobility, manage relevant health risks, and sustain appropriate self-care within a comprehensive approach to venous disease.

For Viet Nam, strengthening this approach will depend on reliable professional knowledge, careful application of evidence, appropriate clinical collaboration, and greater attention to whether treatment improves outcomes that matter in everyday life.

Selected References

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2. Araujo DN, Ribeiro CTD, Maciel ACC, Bruno SS, Fregonezi GAF, Dias FAL. Physical Exercise for the Treatment of Non-ulcerated Chronic Venous Insufficiency. Cochrane Database of Systematic Reviews. 2023;(6). doi:10.1002/14651858.CD010637.pub3.

3. Sisayanarane K, Chaiviboontham S, Pokpalagon P, Kittitirapong N, Sonpee C. The Effects of Home-Based Strengthening Calf Muscle Exercise Program with Graduated Compression Stockings on Disease Severity, Muscle and Joint Function, and Quality of Life Among People with Chronic Venous Insufficiency: A Randomized Controlled Trial. Healthcare. 2026;14(8):1045. doi:10.3390/healthcare14081045.

4. Attaran RR, Edwards ML, Arena FJ, et al. 2025 SCAI Clinical Practice Guidelines for the Management of Chronic Venous Disease. Journal of the Society for Cardiovascular Angiography & Interventions. 2025;4(8):103729. doi:10.1016/j.jscai.2025.103729.

5. National Institute for Health and Care Excellence. Leg Ulcer Infection: Antimicrobial Prescribing. NICE Guideline NG152. Published February 11, 2020.

6. Valesky EM, Hach-Wunderle V, Protz K, et al. Diagnosis and Treatment of Venous Leg Ulcers: S2k Guideline of the German Society of Phlebology and Lymphology. Journal der Deutschen Dermatologischen Gesellschaft. 2024;22(7):1039–1051. doi:10.1111/ddg.15415.

7. Pagani A, Tan KHM, Davies AH, Onida S. Exercise Programmes in the Management of Venous Leg Ulceration—A Systematic Review and Meta-Analysis. Wound Repair and Regeneration. 2026;34(3). doi:10.1111/wrr.70176.

8. Gloviczki P, Lawrence PF, Wasan SM, et al. The 2023 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society Clinical Practice Guidelines for the Management of Varicose Veins of the Lower Extremities. Part II. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2024;12(1):101670. Published online August 29, 2023. doi:10.1016/j.jvsv.2023.08.011.

9. Gohel MS, Heatley F, Liu X, et al. A Randomized Trial of Early Endovenous Ablation in Venous Ulceration. The New England Journal of Medicine. 2018;378:2105–2114. doi:10.1056/NEJMoa1801214.

10. Gohel MS, Mora J, Szigeti M, et al. Long-term Clinical and Cost-effectiveness of Early Endovenous Ablation in Venous Ulceration: A Randomized Clinical Trial. JAMA Surgery. 2020;155(12):1113–1121. doi:10.1001/jamasurg.2020.3845.

11. Pihlaja T, Pokela M, Ohtonen P, et al. Sub-ulcer Ultrasound Guided Foam Sclerotherapy for Venous Leg Ulcers: Results of the FINNULCER Randomised Controlled Trial. European Journal of Vascular and Endovascular Surgery. Published online July 2, 2026. doi:10.1016/j.ejvs.2026.06.051.

12. de Moraes Silva MA, Nelson A, Bell-Syer SEM, de Jesus-Silva SG, Miranda F Jr. Compression for Preventing Recurrence of Venous Ulcers. Cochrane Database of Systematic Reviews. 2024;(3). doi:10.1002/14651858.CD002303.pub4.

13. Nguyễn Thế Hợp, Nguyễn Mạnh Thắng, Nguyễn Phương Hoa. Đặc điểm lâm sàng, siêu âm Doppler của người bệnh suy tĩnh mạch chi dưới mạn tính tại Bệnh viện Đa khoa Đức Giang năm 2025. Tạp chí Y học Cộng đồng. 2026;67(5). doi:10.52163/yhc.v67i5.5203.

14. Nguyễn Lê Mỹ Hân, Nguyễn Quốc Cường, Lê Đức Tín. Kết quả sớm điều trị suy tĩnh mạch nông chi dưới tại Bệnh viện Đại học Nam Cần Thơ. Tạp chí Y học Việt Nam. 2026;558(3). doi:10.51298/vmj.v558i3.17291.

Vietnamese Regulatory References

15. National Assembly of Viet Nam. Law on Medical Examination and Treatment No. 15/2023/QH15, dated January 9, 2023, effective January 1, 2024, as amended. Office of the National Assembly. Consolidated Document No. 26/VBHN-VPQH, dated February 26, 2026.

16. National Assembly of Viet Nam. Law on Personal Data Protection No. 91/2025/QH15, dated June 26, 2025. Government of Viet Nam. Decree No. 356/2025/NĐ-CP, dated December 31, 2025, detailing certain provisions and implementation measures of the Law on Personal Data Protection. Both effective January 1, 2026.

Editorial and Medical Disclaimer

This article is published by the Vietnam Lifestyle Medicine Alliance (VLMA) for general professional education, scientific information, and knowledge exchange. It reflects selected scientific evidence and regulatory information reviewed as of October 30, 2026.

The article does not constitute individualized medical advice, a vascular diagnosis, an exercise or compression prescription, a wound treatment protocol, or an official clinical practice guideline issued by Vietnamese health authorities.

International guidelines and scientific studies discussed in this article should be interpreted according to their intended patient populations, methods, evidence quality, and clinical context. Their application in Viet Nam requires appropriate professional judgment and compliance with applicable laws and professional scope-of-practice requirements.

VLMA is a physician-led professional education and knowledge-sharing platform operated by Vietnam Lifestyle Medicine Alliance Company Limited. Publication of this article does not constitute the provision of medical examination, diagnosis, vascular treatment, individualized rehabilitation, or wound care services by VLMA.

Clinical decisions concerning vascular investigations, compression therapy, exercise, medication, wound management, and venous procedures must remain under the responsibility of appropriately qualified and authorized healthcare professionals and facilities.

Patients should not independently initiate or modify therapeutic compression when peripheral artery disease, severe heart failure, significant sensory impairment, or other relevant contraindications may be present.

Sudden painful leg swelling, suspected deep vein thrombosis, acute limb ischemia, rapidly worsening wounds, severe infection, or other concerning symptoms require prompt medical evaluation. Sudden shortness of breath or chest pain that may indicate pulmonary embolism requires emergency assessment.

This article does not endorse any specific compression garment, medical device, wound dressing, medication, exercise program, commercial product, or healthcare provider. References to research and international clinical recommendations do not imply that VLMA has independently tested, validated, certified, or clinically implemented the treatments or programs discussed.