According to an editorial, given the faulty calf muscle pump seen in patients with venous leg ulceration (VLU) and its component elements of diminished muscle strength, reduced ankle range of motion, poor balance, and altered gait, exercise would seem to be a logical approach to addressing these issues, and over the past decade several small studies have attempted to demonstrate benefit. Unfortunately, because of patient and wound complexity and comorbidities, the sample sizes required to show benefit are large and, in combination with the needed duration of the trial for wounds to heal, costs are high to perform a high-quality VLU trial. It notes that though meta-analysis cannot control all study limitations—for example, the intervention groups were not blinded to the intervention they received—or control for all biases such as publication bias, it still allows drawing conclusions despite potential inherent limitations. As a result, it suggests from these findings that exercise should be recommended for patients with VLUs, while awaiting further studies that better elucidate how to best target this intervention.