Effects of a 12-Week Interventional Exercise Programme on Muscle Strength, Mobility and Fitness in Patients With Diabetic Foot in Remission: Results From BIONEDIAN Randomised Controlled Trial

Abstract

ObjectivesDiabetic foot syndrome (DFS) is a serious late diabetic complication characterised by limited joint mobility and other biomechanical and muscle abnormalities.AimTo evaluate the effect of an interventional exercise programme on anthropometric parameters, muscle strength, mobility and fitness in patients with diabetic foot in remission.Data Sources and Study SelectionThirty-eight patients with type 2 diabetes and DFS without active lesions (mean age 65 ± 6.9 years, BMI 32 ± 4.7 kg.m-2, waist-hip ratio (WHR)1.02 ± 0.06) were enrolled in our randomised controlled trial. All subjects were randomised into two groups: an intervention group (I; n=19) and a control group (C; n=19). The 12-week exercise intervention focused on ankle and small-joint mobility in the foot, strengthening and stretching of the lower extremity muscles, and improvements in fitness. Changes (Δ=final minus initial results) in physical activity were assessed using the International Physical Activity Questionnaire (IPAQ), with joint mobility detected by goniometry, muscle strength by dynamometry, and fitness using the Senior Fitness Test (SFT).Data extractionDue to reulceration, 15.8% of patients from group I (3/19) and 15.8% of patients from group C were excluded. Based on the IPAQ, group I was more active when it came to heavy (p=0.03) and moderate physical activity (p=0.06) after intervention compared to group C. Group I improved significantly in larger-joint flexibility (p=0.012) compared to controls. In group I, dynamometric parameters increased significantly in both lower limbs (left leg; p=0.013, right leg; p=0.043) compared to group C. We observed a positive trend in the improvement of fitness in group I compared to group C. We also confirmed positive correlations between heavy physical activity and selected parameters of flexibility (r=0.47; p=0.007), SFT (r=0.453; p=0.011) and dynamometry (r=0.58; p<0.0025). Anthropometric parameters, such as BMI and WHR, were not significantly influenced by the intervention programme.ConclusionOur 12-week interventional exercise programme proved relatively safe, resulting in improved body flexibility and increased muscle strength in DF patients in remission.

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

“…In 1 other RCT, physical activity was measured using a questionnaire. 24 Vratna et al found a statistically significantly larger increase in high-and moderate-intensity physical activity in the intervention group, compared to the control group. 24 In secondary analyses, LeMaster et al 13 found in the 23 (29%)…”

“…Summary of the literature: We identified 5 RCTs with a combined total of 274 participants (Figure 2) reporting ulcer incidence during a foot-ankle exercise programme that met the criteria for metaanalysis. 5,10,13,14,24 In the meta-analysis (Figure 2 van NETTEN ET AL.…”

“…Furthermore, we limited this systematic review to a predefined set of outcomes, thereby excluding additional benefits of foot-ankle exercise programs, such as glucose control or BMI (e.g. 24,42 ). The predefined set of outcomes used in this systematic review was also a methodological strength.…”

“…5 In the RCTs of LeMaster et al, 13 Mueller et al, 5 and Monteiro et al, 10 an increase in weight-bearing activity of around 1000 steps was seen in the intervention group (898, 1178 and 914 respectively), with no difference in ulcer incidence compared to the control group (Figure 6). In the RCT from Vratna et al, 24 more high-intensity and moderate-intensity physical activity was seen in the intervention group as measured using a questionnaire; however, the increase in the weight-bearing activity was not quantified (Appendix 3).…”

“…With 5 RCTs reporting on foot ulceration, the evidence base is increasing. The 4 RCTs at low or very low risk of bias showed no effect of foot-ankle exercise programs on foot ulceration, 5,10,13,24 but none of these RCTs was powered for equivalence. One other RCT 14 demonstrated conflicting results, and suggested that foot-ankle exercise programs prevent foot ulcers.…”