Foot–ankle therapeutic exercise program can improve gait speed in people with diabetic neuropathy: a randomized controlled trial

Abstract

This study sought to determine whether a foot–ankle therapeutic exercise program can improve daily physical activity (i.e. number of steps) and fast and self-selected gait speed in people with diabetic peripheral neuropathy (DPN). In this single-blind randomized controlled trial and intention-to-treat analysis, 78 volunteers with DPN were allocated into a control group, which received usual care, and an intervention group (IG), which received usual care plus a 12-week foot–ankle exercise program. The adherence at 12 weeks rate in the IG was 92.3% (36 participants) and the dropout was 5.1% in the control group (2 participants). The number of steps and self-selected gait speed did not change significantly in either group (p > 0.05), although a 1,365-step difference between groups were observed at 1-year followup. The 12-week foot–ankle therapeutic exercises improved significantly fast-gait speed (primary outcome) (p = 0.020), ankle range of motion (p = 0.048), and vibration perception (secondary outcomes) (p = 0.030), compared with usual-care at 12 weeks. At 24 weeks, the IG showed better quality of life than controls (p = 0.048). At 1-year, fast-gait speed and vibration perception remained higher in the IG versus controls. Overall, the program may be a complementary treatment strategy for improving musculoskeletal and functional deficits related to DPN.Trial registration ClinicalTrials.gov NCT02790931 (06/06/2016).

The Effects of a 12-Week-Long Sand Exercise Training Program on Neuromechanical and Functional Parameters in Type II Diabetic Patients with Neuropathy

“…In the present study, ankle ROM increased both in plantar- and dorsiflexion directions. A research study found similar results, where ankle dorsiflexion improved after a 12-week foot-ankle training carried out on a solid surface [ 17 ]. However, this training consisted a 2 + 2 times per week supervised and digitally supervised home-based program, 50 min per session.…”

“…Studies targeting improvements in ankle range of motion (ROM) found inconsistent results, showing no change after home-based stretching [ 8 ], but a favorable change after a supervised program [ 17 ]. The case was the same in studies investigating the effects of balance training; there was no improvement in balance after a home-based intervention [ 18 ], but supervised balance training programs improved balance [ 19 ] or developed transfer in walking ability [ 20 ].…”

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

“…With mixed outcomes reported in the various RCTs, 6 and new RCTs published since our previous systematic review (e.g., 9,10 ), a systematic review and meta-analysis of all studies and outcomes published to date is required to advance our understanding of the clinical and biomechanical effectiveness of foot-ankle exercise programs in people with diabetes-related neuropathy.…”

Systematic review and meta‐analysis of the effects of foot and ankle physical therapy, including mobilisations and exercises, in people with diabetic peripheral neuropathy on range of motion, peak plantar pressures and balance

“…Another limitation of this review was the predefined set of interventions which excluded studies that used gait training 50,51 or functional training 52 as an intervention. Similarly, our limited set of outcome measures excluded articles that measured improvements in physical activity, 53 foot ulcer incidence 54,55 and neuropathy signs. 52,53 However, the purpose of this review was to inform the intervention design of a proof-of-concept RCT which investigated the effects of mobilisations combined with stretches on ankle ROM, PPPs and balance.…”

“…Similarly, our limited set of outcome measures excluded articles that measured improvements in physical activity, 53 foot ulcer incidence 54,55 and neuropathy signs. 52,53 However, the purpose of this review was to inform the intervention design of a proof-of-concept RCT which investigated the effects of mobilisations combined with stretches on ankle ROM, PPPs and balance. 56 Lastly, the effects of exercise interventions on balance in people with diabetes have not been investigated.…”