An Integrated Approach to Pressure Ulcer Prevention and Treatment: The Role of Physical Activity, Nutrition, Care and Modern Technologies.
DOI:
https://doi.org/10.12775/JEHS.2025.80.59520Keywords
pressure ulcers, physical activity, nutrition, wound care, prevention, modern technologiesAbstract
Introduction: Pressure ulcers represent a significant healthcare challenge affecting patient outcomes and quality of life. This comprehensive review examines the integrated approach to pressure ulcer prevention and treatment, focusing on physical activity, nutrition, modern wound care technologies, and emerging therapeutic strategies.
Materials and Methods: Literature review was conducted using databases such as PubMed, NCBI, and Google Scholar, with search terms including "pressure ulcers", "physical activity", "nutrition", "wound care", "prevention", "modern technologies"
State of knowledge: Pressure ulcers develop when sustained pressure exceeds critical capillary pressures (arterial: ~32 mmHg; venous: 8-12 mmHg), leading to tissue ischemia and necrosis. Physical activity demonstrates significant benefits in wound healing through immune modulation, improved circulation, and enhanced tissue regeneration. Nutritional interventions, particularly protein supplementation (24% vs. 14% protein), show improved healing rates. Modern wound care technologies, including specialized dressings and emerging therapies like hyperbaric oxygen and stem cell treatments, demonstrate promising results. Prevention strategies incorporating risk assessment tools, proper positioning techniques, and skin care protocols significantly reduce pressure ulcer incidence.
Conclusions: An integrated approach combining physical activity, proper nutrition, and advanced wound care technologies offers the most effective strategy for pressure ulcer prevention and treatment. Novel diagnostic and therapeutic approaches, including electrical impedance analysis and stem cell therapy, show promise for improving outcomes. Further research is needed to validate emerging technologies and establish standardized treatment protocols.
References
1. Mervis JS, Phillips TJ. Pressure ulcers: Pathophysiology, epidemiology, risk factors, and presentation. J Am Acad Dermatol. 2019 Oct;81(4):881-890. doi: 10.1016/j.jaad.2018.12.069. Epub 2019 Jan 18. PMID: 30664905.
2. Lima Serrano M, González Méndez MI, Carrasco Cebollero FM, Lima Rodríguez JS. Risk factors for pressure ulcer development in Intensive Care Units: A systematic review. Med Intensiva. 2017 Aug-Sep;41(6):339-346. English, Spanish. doi: 10.1016/j.medin.2016.09.003. Epub 2016 Oct 22. PMID: 27780589.
3. Amlung SR, Miller WL, Bosley LM. The 1999 National Pressure Ulcer Prevalence Survey: a benchmarking approach. Adv Skin Wound Care. 2001 Nov-Dec;14(6):297-301. doi: 10.1097/00129334-200111000-00012. PMID: 11794440.
4. Gao MM, Wang LP, Zhang LL, Li YY. The effects of evidence-based nursing interventions on pressure ulcers in patients with stroke: a meta-analysis. Int Wound J. 2023 Dec;20(10):4069-4076. doi: 10.1111/iwj.14298. Epub 2023 Jul 12. Retraction in: Int Wound J. 2025 Mar;22(3):e70308. doi: 10.1111/iwj.70308. PMID: 37438328; PMCID: PMC10681431.
5. Peko L, Ovadia-Blechman Z, Hoffer O, Gefen A. Physiological measurements of facial skin response under personal protective equipment. J Mech Behav Biomed Mater. 2021 Aug;120:104566. doi: 10.1016/j.jmbbm.2021.104566. Epub 2021 Apr 29. PMID: 33945938.
6. Gould LJ, Alderden J, Aslam R, Barbul A, Bogie KM, El Masry M, Graves LY, White-Chu EF, Ahmed A, Boanca K, Brash J, Brooks KR, Cockron W, Kennerly SM, Livingston AK, Page J, Stephens C, West V, Yap TL. WHS guidelines for the treatment of pressure ulcers-2023 update. Wound Repair Regen. 2024 Jan-Feb;32(1):6-33. doi: 10.1111/wrr.13130. Epub 2023 Dec 20. PMID: 37970711; PMCID: PMC11403384.
7. Klitzman B, Kalinowski C, Glasofer SL, Rugani L. Pressure ulcers and pressure relief surfaces. Clin Plast Surg. 1998 Jul;25(3):443-50. PMID: 9696904.
8. Bergstrom N, Demuth PJ, Braden BJ. A clinical trial of the Braden Scale for Predicting Pressure Sore Risk. Nurs Clin North Am. 1987 Jun;22(2):417-28. PMID: 3554150.
9. Jansen RCS, Silva KBA, Moura MES. Braden Scale in pressure ulcer risk assessment. Rev Bras Enferm. 2020;73(6):e20190413. Portuguese, English. doi: 10.1590/0034-7167-2019-0413. Epub 2020 Aug 10. PMID: 32785503.
10. Ahtiala MH, Kivimäki R, Laitio R, Soppi ET. The Association Between Pressure Ulcer/Injury Development and Short-term Mortality in Critically Ill Patients: A Retrospective Cohort Study. Wound Manag Prev. 2020 Feb;66(2):14-21. doi: 10.25270/wmp.2020.2.1421. PMID: 32294060.
11. Zaidi SRH, Sharma S. Pressure Ulcer. 2024 Jan 3. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 31971747.
12. Cichowitz, A., Pan, W. R., & Ashton, M. (2009). The Heel. Annals of Plastic Surgery, 62(4), 423–429. doi:10.1097/sap.0b013e3181851b55
13. Coleman S, Gorecki C, Nelson EA, Closs SJ, Defloor T, Halfens R, Farrin A, Brown J, Schoonhoven L, Nixon J. Patient risk factors for pressure ulcer development: systematic review. Int J Nurs Stud. 2013 Jul;50(7):974-1003. doi: 10.1016/j.ijnurstu.2012.11.019. Epub 2013 Feb 1. PMID: 23375662.
14. Fogerty MD, Abumrad NN, Nanney L, Arbogast PG, Poulose B, Barbul A. (2008). Risk factors for pressure ulcers in acute care hospitals. Wound Repair and Regeneration, 16(1), 11–18. doi:10.1111/j.1524-475x.2007.00327.x
15. Dantas A, Ferreira P, Valença C, Diniz K, Nunes J, Germano R. Complications of pressure ulcers in severely ill patients: A descriptive-exploratory study. Online Braz J Nurs. 2013;12. doi: 10.5935/1676-4285.20133794.
16. Jaul E, Barron J, Rosenzweig JP, Menczel J. An overview of co-morbidities and the development of pressure ulcers among older adults. BMC Geriatr. 2018 Dec 11;18(1):305. doi: 10.1186/s12877-018-0997-7. PMID: 30537947; PMCID: PMC6290523.
17. Goh J, Ladiges WC. Exercise enhances wound healing and prevents cancer progression during aging by targeting macrophage polarity. Mechanisms of Ageing and Development. 2014;139:41-48. doi: 10.1016/j.mad.2014.06.004
18. Emery CF, Kiecolt-Glaser JK, Glaser R, Malarkey WB, Frid DJ. Exercise Accelerates Wound Healing Among Healthy Older Adults: A Preliminary Investigation. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2005;60(11):1432-1436. doi: 10.1093/gerona/60.11.1432
19. Qiu Y, Osadnik CR, Brusco NK, et al. Association between physical activity levels and healing in people with venous leg ulcers: secondary analysis of prospective cohort data. Frontiers in Medicine. 2023;10:1305594. doi: 10.3389/fmed.2023.1305594
20. Pence BD, Woods JA. Exercise, Obesity, and Cutaneous Wound Healing: Evidence from Rodent and Human Studies. Advances in Wound Care. 2014;3(1):71-79. doi: 10.1089/wound.2012.0377
21. Fahlman M, Boardley D, Flynn MG, Braun WA, Lambert CP, Bouillon LE. Effects of Endurance Training on Selected Parameters of Immune Function in Elderly Women. Gerontology. 2000;46(2):97-104. doi: 10.1159/000022142
22. Stefater JA, Ren S, Lang RA, Duffield JS. Metchnikoff’s policemen: macrophages in development, homeostasis and regeneration. Trends in Molecular Medicine. 2011;17(12):743-752. doi: 10.1016/j.molmed.2011.07.009
23. Plowden J, Renshaw-Hoelscher M, Engleman C, Katz J, Sambhara S. Innate immunity in aging: impact on macrophage function. Aging Cell. 2004;3(4):161-167. doi: 10.1111/j.1474-9728.2004.00102.x
24. Frykberg RG. Diabetic foot ulcers: current concepts. J Foot Ankle Surg. 1998;37(5):440-446. doi:10.1016/s1067-2516(98)80055-0
25. Veves A, Murray HJ, Young MJ, Boulton AJ. The risk of foot ulceration in diabetic patients with high foot pressure: a prospective study. Diabetologia. 1992;35(7):660-663. doi:10.1007/BF00400259
26. Ferreira JSSP, Cruvinel-Júnior RH, da Silva EQ, et al. Effectiveness of a web-based foot-ankle exercise program for treating ulcer risk factors in diabetic neuropathy in a randomized controlled trial. Sci Rep. 2024;14(1):27291. Published 2024 Nov 8. doi:10.1038/s41598-024-78188-7
27. van Netten JJ, Sacco ICN, Lavery L, et al. Clinical and biomechanical effectiveness of foot-ankle exercise programs and weight-bearing activity in people with diabetes and neuropathy: A systematic review and meta-analysis. Diabetes Metab Res Rev. 2024;40(3):e3649. doi:10.1002/dmrr.3649
28. Nwankwo MJ, Okoye GC, Victor EA, Obinna EA. Effect of twelve weeks supervised aerobic exercise on ulcer healing and changes in selected biochemical profiles of diabetic foot ulcer subjects. Int J Diabetes Res. 2014;3(3):41-48. doi:10.5923/j.diabetes.20140303.03
29. Eraydin Ş, Avşar G. The Effect of Foot Exercises on Wound Healing in Type 2 Diabetic Patients With a Foot Ulcer: A Randomized Control Study. J Wound Ostomy Continence Nurs. 2018;45(2):123-130. doi:10.1097/WON.0000000000000405
30. Jørgensen TS, Schramm A, Leinum M, et al. Passive Movement Exercise of the Lower Limbs May Facilitate Wound Healing in Patients With Diabetic Foot Ulcers. Cureus. 2024;16(11):e73925. Published 2024 Nov 18. doi:10.7759/cureus.73925
31. Langer G, Wan CS, Fink A, Schwingshackl L, Schoberer D. Nutritional interventions for preventing and treating pressure ulcers. The Cochrane Database of Systematic Reviews. 2024;2(2):CD003216. doi: 10.1002/14651858.CD003216.pub3
32. Crowe T, Brockbank, CM. (2009). Nutrition therapy in the prevention and treatment of pressure ulcers. Wound Prac Res. 17. 90-99.
33. Stratton RJ, Ek AC, Engfer M, et al. Enteral nutritional support in prevention and treatment of pressure ulcers: A systematic review and meta-analysis. Ageing Research Reviews. 2005;4(3):422-450. doi: 10.1016/j.arr.2005.03.005
34. Breslow RA, Hallfrisch J, Guy DG, Crawley B, Goldberg AP. The Importance of Dietary Protein in Healing Pressure Ulcers. Journal of the American Geriatrics Society. 1993;41(4):357-362. doi: 10.1111/j.1532-5415.1993.tb06940.x
35. Ek AC ., Unosson M, Larsson J, Von Schenck H, Bjurulf P. The development and healing of pressure sores related to the nutritional state. Clinical Nutrition. 1991;10(5):245-250. doi: 10.1016/0261-5614(91)90002-t
36. Ohura T, Nakajo T, Okada S, Omura K, Adachi K, Oishi S. [Effects of nutrition intervention for pressure ulcer patients--healing rate and speed of wound size and nutrition--]. Nihon Ronen Igakkai Zasshi. 2013;50(3):377-83. Japanese. doi: 10.3143/geriatrics.50.377. PMID: 23979345.
37. Sugihara F, Inoue N, Venkateswarathirukumara S. Ingestion of bioactive collagen hydrolysates enhanced pressure ulcer healing in a randomized double-blind placebo-controlled clinical study. Scientific Reports. 2018;8(1). doi: 10.1038/s41598-018-29831-7
38. Banks MD, Ross LJ, Webster J, et al. Pressure ulcer healing with an intensive nutrition intervention in an acute setting: a pilot randomised controlled trial. Journal of Wound Care. 2016;25(7):384-392. doi: 10.12968/jowc.2016.25.7.384
39. Cereda E, Klersy C, Andreola M, et al. Cost-effectiveness of a disease-specific oral nutritional support for pressure ulcer healing. Nutrition. 2016;32(3):405-406. doi: 10.1016/j.nut.2015.12.022
40. Desneves KJ, Todorovic BE, Cassar A, Crowe TC. Treatment with supplementary arginine, vitamin C and zinc in patients with pressure ulcers: a randomised controlled trial. Clinical Nutrition (Edinburgh, Scotland). 2005;24(6):979-987. doi: 10.1016/j.clnu.2005.06.011
41. Westby MJ, Dumville JC, Soares MO, Stubbs N, Norman G. Dressings and topical agents for treating pressure ulcers. Cochrane Database Syst Rev. 2017 Jun 22;6(6):CD011947. doi: 10.1002/14651858.CD011947.pub2. PMID: 28639707; PMCID: PMC6481609
42. Walker RM, Gillespie BM, Thalib L, Higgins NS, Whitty JA. Foam dressings for treating pressure ulcers. Cochrane Database of Systematic Reviews 2017, Issue 10. Art. No.: CD011332. DOI: 10.1002/14651858.CD011332.pub2.
43. Landriscina A, Rosen J, Friedman AJ. Systematic Approach to Wound Dressings. J Drugs Dermatol. 2015 Jul;14(7):740-4. PMID: 26151792
44. Broussard KC, Powers JG. Wound dressings: selecting the most appropriate type. Am J Clin Dermatol. 2013 Dec;14(6):449-59. doi: 10.1007/s40257-013-0046-4. PMID: 24062083.
45. Shi C, Wang C, Liu H, Li Q, Li R, Zhang Y, Liu Y, Shao Y, Wang J. Selection of Appropriate Wound Dressing for Various Wounds. Front Bioeng Biotechnol. 2020 Mar 19;8:182. doi: 10.3389/fbioe.2020.00182. PMID: 32266224; PMCID: PMC7096556.
46. Britto EJ, Nezwek TA, Popowicz P, et al. Wound Dressings. [Updated 2024 Jan 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-
47. Sood A, Granick MS, Tomaselli NL. Wound Dressings and Comparative Effectiveness Data. Adv Wound Care (New Rochelle). 2014 Aug 1;3(8):511-529. doi: 10.1089/wound.2012.0401. PMID: 25126472; PMCID: PMC4121107.
48. Narayanaswamy R, Torchilin VP. Hydrogels and Their Applications in Targeted Drug Delivery. Molecules. 2019 Feb 8;24(3):603. doi: 10.3390/molecules24030603. PMID: 30744011; PMCID: PMC6384686.
49. Westby MJ, Norman G, Dumville JC, Stubbs N, Cullum N. Protease‐modulating matrix treatments for healing venous leg ulcers. Cochrane Database of Systematic Reviews 2016, Issue 12. Art. No.: CD011918. DOI: 10.1002/14651858.CD011918.pub2.
50. Kloeters, O., Unglaub, F., de Laat, E., van Abeelen, M. and Ulrich, D. (2016), Prospective and randomised evaluation of the protease-modulating effect of oxidised regenerated cellulose/collagen matrix treatment in pressure sore ulcers. Int Wound J, 13: 1231-1236. doi: 10.1111/iwj.12449
51. Safalı S. What is the most effective topical method for preventing presacral pressure sores that occur after hip fractures? Journal of Cukurova Anesthesia and Surgical Sciences. 2023; 6; 3, 434 - 439. doi: 10.36516/jocass.1375669
52. Nowak M, Mehrholz D, Barańska-Rybak W, Nowicki RJ. Wound debridement products and techniques: clinical examples and literature review. Postepy Dermatol Alergol. 2022 Jun;39(3):479-490. doi: 10.5114/ada.2022.117572. Epub 2022 Jul 14. PMID: 35950126; PMCID: PMC9326937.
53. Choo J, Nixon J, Nelson A, McGinnis E. Autolytic debridement for pressure ulcers. Cochrane Database Syst Rev. 2019 Jun 17;2019(6):CD011331. doi: 10.1002/14651858.CD011331.pub2. PMCID: PMC6573093.
54. Melnychuk I. Sharp Wound Debridement. Adv Skin Wound Care. 2024 Sep 1;37(9):456-458. doi: 10.1097/ASW.0000000000000193. PMID: 39162376.
55. Mancini S, Cuomo R, Poggialini M, D'Aniello C, Botta G. Autolytic debridement and management of bacterial load with an occlusive hydroactive deressing impregnated with polyhexamethylene biguanide. Acta Biomed. 2018 Jan 16;88(4):409-413. doi: 10.23750/abm.v88i4.5802. PMID: 29350654; PMCID: PMC6166182.
56. Mayer DO, Tettelbach WH, Ciprandi G, Downie F, Hampton J, Hodgson H, Lazaro-Martinez JL, Probst A, Schultz G, Stürmer EK, Parnham A, Frescos N, Stang D, Holloway S, Percival SL. Best practice for wound debridement. J Wound Care. 2024 Jun 1;33(Sup6b):S1-S32. doi: 10.12968/jowc.2024.33.Sup6b.S1. PMID: 38829182.
57. Shoham Y,Snyder R, Levy Y, Zarbiv K, Klinger E, Kramer M, Dove C, Avrahami R,Reyzelman A, Sigal F,Tovmassian G, Shapira E, Harats M,M, Perez-Clavijo F, Lantis J, Cazzell S, ShaWN, Dhillon Y, Cuffy C, Egozi D, Rosenberg L. Once daily Bromelain-based enzymatic debridement of venous leg ulcers versus gel vehicle (placebo) and non-surgical standard of care: a three-arm multicenter, double blinded, randomized controlled study. 2024. eClinicalMedicine. 75. 102750. Doi: 10.1016/j.eclinm.2024.102750.
58. Bazaliński D, Przybek-Mita J, Pytlak K, Kardyś D, Bazaliński A, Kucharzewski M, Więch P. Larval Wound Therapy: Possibilities and Potential Limitations-A Literature Review. J Clin Med. 2023 Oct 30;12(21):6862. doi: 10.3390/jcm12216862. PMID: 37959326; PMCID: PMC10647679.
59. Wilson MR, Nigam Y, Knight J, Pritchard DI. What is the optimal treatment time for larval therapy? A study on incubation time and tissue debridement by bagged maggots of the greenbottle fly, Lucilia sericata. Int Wound J. 2019 Feb;16(1):219-225. doi: 10.1111/iwj.13015. Epub 2018 Oct 31. PMID: 30379404; PMCID: PMC7948740.
60. Boyko TV, Longaker MT, Yang GP. Review of the Current Management of Pressure Ulcers. Adv Wound Care (New Rochelle). 2018 Feb 1;7(2):57-67. doi: 10.1089/wound.2016.0697. PMID: 29392094; PMCID: PMC5792240.
61. Stechmiller JK, Cowan L, Whitney JD, Phillips L, Aslam R, Barbul A, Gottrup F, Gould L, Robson MC, Rodeheaver G, Thomas D, Stotts N. Guidelines for the prevention of pressure ulcers. Wound Repair Regen. 2008 Mar-Apr;16(2):151-68. doi: 10.1111/j.1524-475X.2008.00356.x. PMID: 18318801.
62. Shi C, Dumville JC, Cullum N. Support surfaces for pressure ulcer prevention: A network meta-analysis. PLoS One. 2018 Feb 23;13(2):e0192707. doi: 10.1371/journal.pone.0192707. PMID: 29474359; PMCID: PMC5825032.
63. Moore, Z., Cowman, S. and Conroy, R.M. (2011), A randomised controlled clinical trial of repositioning, using the 30° tilt, for the prevention of pressure ulcers. Journal of Clinical Nursing, 20: 2633-2644. doi: 10.1111/j.1365-2702.2011.03736.x
64. Szewczyk, M., Kózka, M., Cierzniakowska, K., Cwajda-Białasik, J., Mościcka, P., & Jawień, A. et al. (2020). Prophylaxis of the pressure ulcers – recommendations of the Polish Wound Management Association. Part I. Leczenie Ran, 113-146. doi: 10.5114/lr.2020.101506
65. Qian L, Yan S, Ting ST, Han ZM, Qi T. Complications and psychological impact of pressure ulcers on patients and caregivers. Int Wound J. 2024 Apr;21(4):e14836. doi: 10.1111/iwj.14836. PMID: 38531386; PMCID: PMC10965270.
66. Moore Z, Patton D, Rhodes SL, O'Connor T. Subepidermal moisture (SEM) and bioimpedance: a literature review of a novel method for early detection of pressure-induced tissue damage (pressure ulcers). Int Wound J. 2017;14(2):331-337. doi:10.1111/iwj.12604
67. Ching CT, Chou MY, Jiang SJ, et al. Tissue electrical properties monitoring for the prevention of pressure sore. Prosthet Orthot Int. 2011;35(4):386-394. doi:10.1177/0309364611424614
68. Procházka V, Gumulec J, Jalůvka F, et al. Cell therapy, a new standard in management of chronic critical limb ischemia and foot ulcer. Cell Transplant. 2010;19(11):1413-1424. doi:10.3727/096368910X514170
69. Ma L, Li P, Shi Z, Hou T, Chen X, Du J. A prospective, randomized, controlled study of hyperbaric oxygen therapy: effects on healing and oxidative stress of ulcer tissue in patients with a diabetic foot ulcer. Ostomy Wound Manage. 2013;59(3):18-24.
70. Chen C, Hou WH, Chan ES, Yeh ML, Lo HL. Phototherapy for treating pressure ulcers. Cochrane Database Syst Rev. 2014;2014(7):CD009224. Published 2014 Jul 11. doi: 10.1002/14651858.CD009224.pub2
71. Zhang X, Zhang Q, You J, et al. Effect of a self-developed fixation device on preventing endotracheal intubation-related pressure injury: a randomised controlled trial. Crit Care. 2024;28(1):87. Published 2024 Mar 19. doi:10.1186/s13054-024-04874-7
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