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Exercise interventions for diabetic foot complications

Discussion in 'Diabetic Foot & Wound Management' started by NewsBot, May 10, 2014.

  1. NewsBot

    NewsBot The Admin that posts the news.

    Calf muscle stretching is ineffective in increasing ankle range of motion or reducing plantar pressures in people with diabetes and ankle equinus: A randomised controlled trial
    AngelaSearle et al
    Clinical Biomechanics 5 July 2019
  2. NewsBot

    NewsBot The Admin that posts the news.

    Relationship between range of motion of foot joints and amount of physical activity in middle-aged male diabetic patients.
    Matsui N et al
    J Phys Ther Sci. 2019 Jul;31(7):540-544
  3. NewsBot

    NewsBot The Admin that posts the news.

    These two clinical trials were just registered:
    Exercise for People With Peripheral Neuropathy and Diabetic Foot Ulcers - a Case Series on Feasibility and Safety
    Effectiveness of Foot Exercise People With Type 2 Diabetes
  4. NewsBot

    NewsBot The Admin that posts the news.

    Short-term strength and balance training does not improve quality of life but improves functional status in individuals with diabetic peripheral neuropathy: a randomised controlled trial.
    Venkataraman K et al
    Diabetologia. 2019 Aug 29
  5. NewsBot

    NewsBot The Admin that posts the news.

    The Effects of Foot Exercise to Distal Sensorimotor on Diabetic Peripheral Neuropathy
    Awaluddin Sri Wahyuni, Ardi Muhammad, Zabitha Ridzka Ayyanun
    Indian Journal of Forensic Medicine & Toxicology Year : 2019, Volume : 13, Issue : 4
  6. scotfoot

    scotfoot Well-Known Member

    "In conclusion, the research results are diabetic foot exercise has effect on distal sensory and peripheral neuropathy."

    What short of effect ? I would guess a positive effect ie a heightening of distal sensory capabilities .

    If so , we now have studies showing that supervised foot exercise can help foot ulcers heal more quickly , restore sensory abilities and restore atrophied intrinsic foot muscles . Exercise as a medicine or what ?
    Last edited: Dec 5, 2019
  7. scotfoot

    scotfoot Well-Known Member

    Actually , if foot exercise can;

    1 Help foot ulcers heal more quickly
    2 Restore sensory capabilities
    3 Restore atrophied intrinsic foot muscles

    then shouldn't such exercise be used as a preventative measure as soon after the diagnosis is made , as possible .
  8. While I generally concur, the problem you have is that many who develop diabetes are in the proportion of the population who are unlikely to adhere to exercise and healthy living which is why they develop diabetes in the first place! The chances of getting these people to adhere to an exercise program is highly variable, some might, but many, probably the vast majority will not.

    It’s a bit like prescribing inter-dental brushing to those with advanced gum disease and tooth decay.
  9. scotfoot

    scotfoot Well-Known Member

    When you start talking about exercise as a medicine , compliance is always going to be a problem . However , if exercise is helping to solving an immediate problem ,such as a diabetic ulcer ,then compliance is likely to be very high . Similarly , if foot exercise ( stretching and strengthening ) reduces neuropathic pain or pain caused by other conditions such as arthritis ,then again compliance is likely to be high .
    The big hurdle is getting people to exercise where there are no immediate benefits .

    Foot Exercise programes should be short ,easy to accomplish ( done whilst watching television would be ideal ) and focused . Which brings us to Hohne .

    From earlier in the thread-
    " There is now a growing body of research which demonstrates we can indeed reverse muscle atrophy in the forefoot, improve mobility of toes and when we do so we can reduce plantar pressures which crush the tissues under the foot (Allet et al., 2010; Sartor et al., 2014; Kanchanasamut and Pensri, 2017).
    An excellent example of such research was published by Höhne et al in Cologne, Germany (Höhne et al., 2012). "

    And ( about the Hohne 2012 paper)

    "All patients improved strength, with the average increase being a staggering 55% increase in just 8 weeks. The intervention took only 10 minutes roughly 3 times per week and could be performed at home with little difficulty. In addition, there were no instructions to utilise their strength in everyday activities. So the strength gains can only be attributed to intervention of a total of 30 minutes per subject per week. Furthermore, the MRI results showed an average increase of 5% muscle bulk in just those 8 weeks. "

    So three 10 min sessions will get large strength gains without even taking your socks off .
    One session might be enough for maintenance .
    Last edited: Dec 6, 2019
  10. I thought you said it should be used as a preventative measure as soon as diabetes is diagnosed. This is likely to be pre-ulceration and compliance will be low at this time, which was my point.
  11. This paper quotes adherence to exercise of 19%; I suspect the barriers are somewhat larger than you think:
  12. scotfoot

    scotfoot Well-Known Member

    19% is a low figure so how would you increase compliance ? Professional support is important as is ease of exercise completion . If an individual can do their weekly exercise dosage in 10 mins ,whilst sitting watching TV and not being out of breath , then it might have a greater chance of happening , particularly if week to week results are visible .

    Let's say a person , aged 60 ,who takes very little exercise ,is diagnosed as suffering from type 2 diabetes . My understanding is that ,going forwards , that person will have the option of being be screened by a podiatrist at regular intervals for signs of neuropathy and/ or foot ulcers . But what if the podiatrist were also in the position of screening for intrinsic muscle strength and of prescribing easy ,non sweat, exercises which might slow disease progression radically .

    Take the piece of kit used by Hohne et al for isometric exercise . Now imagine making it simpler by measuring toe flexor strength via a customised pressure mat over the toe plate and linked up to the users own personal computer ( ie an app on their smart phone ) . Week to week ,the patient can measure their own toe flexor strength . If they miss a session the phone can be set to give them a reminder and a dressing down as to long term consequences . The whole can be overseen a prescribing podiatrist .

    Granted , information on precise , foot specific , targeted exercise on diabetic disease progression is very thin on the ground , but the therapeutic door looks to be opening . 2x 10 mins exercise , with results to show for it , might see compliance rates far higher than 19% , especially if the insurance companies become involved .

    What I am saying therefore , is that although the ideal goal for diabetic patients well being might be more whole body exercise , better diet , and weight loss , the biggest effect with regard to the foot , might come from target exercises which are also easier to achieve than dietary change or a lifelong commitment to fitness .
  13. Call me cynical, but as someone who holds a patent for such an “exercise machine” your own financial vested interest here and inevitable bias that this brings cannot be ignored, but good luck with this. That dentists have been unable to persuade many to even brush their teeth for two minutes at a time in order to reduce the risk of dental problems and tooth loss suggests to me that you’re probably going to have your work cut out, but seriously- good luck with that future.
  14. scotfoot

    scotfoot Well-Known Member

    "That dentists have been unable to persuade many to even brush their teeth for two minutes at a time[/QUOTE]

    YouGov poll -

    Three in ten Brits only brush their teeth once a day | YouGov

    https://yougov.co.uk › topics › politics › articles-reports › 2017/10/23 › th...
    23 Oct 2017 - Most people (59%) follow the standard practice of brushing their ... in the C2DE socio-economic grade) are brushing less frequently than their ...

    So by far the majority of people brush at least once a day .
    Last edited: Dec 8, 2019
  15. NewsBot

    NewsBot The Admin that posts the news.

    Effectiveness Combination of Foot Care with Active Range of
    Motion (ROM) and Plantar Exercise for Reducing Diabetic
    Foot Ulcer Risk in Diabetes Mellitus Type II

    Normawati Ajeng Titah et al
    J Endocrinol Diab. 6(2): 1-4.
  16. NewsBot

    NewsBot The Admin that posts the news.

    Study protocol for a randomized controlled trial on the effect of the Diabetic Foot Guidance System (SOPeD) for the prevention and treatment of foot musculoskeletal dysfunctions in people with diabetic neuropathy: the FOotCAre (FOCA) trial I
    J. S. S. P. Ferreira, R. H. Cruvinel Junior, E. Q. Silva, J. L. Veríssimo, R. L. Monteiro, D. S. Pereira, E. Y. Suda, C. D. Sartor & I. C. N. Sacco
    Trials volume 21, Article number: 73 (2020)

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