Exercise interventions for diabetic foot complications

NewsBot · Jun 8, 2025

Effects of a 12-week lower limb resistance training with breathing regulation in patients with diabetes-related foot ulcers: A randomized controlled trial
Jia-Ling Wu et al
Appl Nurs Res. 2025 Apr:82:151911.

Patients with diabetes-related foot ulcers may require hospitalization and face an increased risk of amputation, which can significantly impact their quality of life. One potential solution is exercise, which can regulate blood glucose levels, improve wound healing, and enhance overall well-being. This randomized controlled trial aimed to evaluate the impact of a lower limb resistance training program combined with breathing-regulation techniques on glycemic control, wound healing, and quality of life in patients with diabetes-related foot ulcers. Patients hospitalized for type 2 diabetes-related foot ulcers were recruited from a single medical center and randomly divided into two groups. The control group (n = 31) received standard treatment, while the exercise group (n = 28) received standard treatment along with lower limb resistance training and breathing-regulation techniques. Assessments of fasting blood glucose levels, hemoglobin A1c (HbA1c) levels, wound healing, and quality of life were carried out at the start of the study and week 4, week 8, and week 12 of the intervention. The exercise group demonstrated significant improvements in fasting blood glucose and HbA1c levels, as well as in physical health, psychological well-being, social relationships, and environmental aspects of quality of life over the 12 weeks compared to both the control group and the baseline (p < .05). However, no significant change was observed in wound healing (p > .05). The resistance training program for the lower limbs, combined with breathing-regulation techniques, is recommended for improving blood glucose levels and quality of life over 12 weeks.
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NewsBot · Jun 13, 2025

The effect of health promotion on compliance with diabetic foot exercises in increasing foot sensitivity and controlling blood sugar levels
Sigit Priyanto et al
Vol. 2 (2025): The 6th BIS-STE 2024 in conjunction with The 2nd INTERCONNECTS 2024

The increasing global prevalence of diabetes mellitus and its severe complications, particularly diabetic neuropathy, necessitate effective interventions. Management of neuropathy typically involves patient education, pain management, and meticulous foot care. To prevent foot sensitivity disorders, robust health promotion initiatives focused on blood glucose control are crucial, especially diabetic foot exercises which prevent injuries and enhance peripheral circulation. This study utilized a quasi-experimental design with pre- and post-tests and a control group (n=124 total, 62 in each group via proportional random sampling) to assess the impact of health promotion on adherence to diabetic foot exercises, foot sensitivity, and blood sugar control among individuals with diabetes in Magelang Regency. Results showed a highly significant difference (p<0.001) in both adherences to exercises and foot sensitivity in both groups. These findings conclusively demonstrate that health promotion significantly improves compliance with diabetic foot exercises, leading to enhanced foot sensitivity and better blood sugar control, underscoring the need for appropriate health promotion models in diabetes management.
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NewsBot · Jun 18, 2025

The Effect of Exercise Program on Musculoskeletal Changes in Individuals with Diabetic Foot Syndrome
Source

Introduction Diabetic Foot Syndrome (DFS) is one of the most serious complications of Type 2 Diabetes Mellitus (T2DM) with severe health and socioeconomic consequences. It is defined as ulceration, infection, or tissue destruction of the foot associated with chronic angiopathy or neuropathy. Physical activity is considered an important part of treatment with positive impacts on all mentioned aspects and complications of DFS [1-7].

Methodology 12-weeks multicomponent movement intervention program examined changes in the musculoskeletal system (dynamometry, goniometry), fitness (Senior Fitness Test) and physical activity (IPAQ) in 38 patients with DFS in remission. The research population was divided into two groups (Based on stratified randomization): the experimental group (n = 19), which received the intervention program and the control group (n = 19), which was not instructed to do any physical activity.

Results In the experimental group, statistically significant improvements were found in joint flexibility (p = 0.012), dynamometry (plantar flexion strength) of lower right limb (p = 0.043) and lower left limb (p = 0.013), fitness and general physical activity after intervention (moderate PA (p = 0.06) and heavy PA (p = 0.03)). The change in weight distribution of the individual between forefoot and rearfoot of lower left limb (LLL) and lower right limb (LRL) was statistically significant in the experimental group (p = 0.04 LLL and p = 0.05 LRL).

Conclusions Research has demonstrated the possibility of positively influencing multiple factors directly associated with diabetic foot syndrome and thus highlighted the importance of physical therapy in T2DM, with key impacts on both individual health and treatment costs.
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NewsBot · Jun 18, 2025

Multifactorial balance rehabilitation in diabetic neuropathy elders: Randomized controlled trial
Garima Gupta et al
J Bodyw Mov Ther. 2025 Jun:42:736-744.

Objectives: Diabetic peripheral neuropathy (DPN) is a common complication of diabetes, particularly affecting the elderly and increasing their risk of falls due to impaired balance. This study investigates the effect of a multifactorial balance rehabilitation program on postural stability, fall risk, and quality of life in elderly individuals with DPN.

Methods: In a randomized controlled trial, 150 elderly participants (aged 60-80) diagnosed with DPN were enrolled. Comprehensive demographic data were collected, diabetic foot assessments were performed, and key outcome measures included postural sway parameters, fall risk, and quality of life. Participants were randomly assigned to two groups: the study group underwent a 12-week multifactorial balance rehabilitation program (3-5 days a week), while the control group received standard medical care and advice.

Results: The study identified statistically significant improvements in postural sway parameters (AP sway Z = -3.16, ML sway Z = -2.20, COP length Z = -6.27, COP area Z = -2.25), a substantial reduction in fall risk (F (1, 134) = 263.42), and enhanced quality of life, as measured by physical health domain of WHOQOL-BREF (D1F (1, 134) = 3.94) and MDQoL 17 (F (1, 134) = 7.67), among the study group participants (p < .05).

Conclusion: Following the 12-week multifactorial balance rehabilitation program, participants in the study group demonstrated notable improvements in postural stability, reduced risk of falls, and improved quality of life compared to the control group.
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NewsBot · Jul 9, 2025

To Train or not to Train: Exercise in Diabetic Foot Ulceration. A Brief Narrative Review
Dimitrios Pantazopoulos, MD et al
Source

Diabetic foot ulcers (DFUs) are a serious and common complication of diabetes mellitus, contributing substantially to patient morbidity, reduced quality of life, and healthcare costs. Accumulating evidence highlights the potential benefits of exercise across various stages of DFUs. This review summarises current evidence on the role of exercise in DFUs management and emphasises the need for well-designed clinical trials to inform future rehabilitation guidelines. Exercise has been shown to improve glycaemic control, promote cardiovascular health, ameliorate neuropathic symptoms, and improve well-being. Importantly, appropriately selected and supervised physical activity may be safely implemented before ulcer onset, during the active ulceration phase, and following wound healing. Data show that exercise provides stage-specific benefits in DFUs by improving risk factors, reducing plantar pressures and foot pain prior to ulceration; enhancing wound healing as adjunctive therapy during ulceration; and lowering the risk of recurrence in the post-healing period. However, current research is limited by heterogeneity in exercise protocols, lack of consensus on training parameters, and exclusion of high-risk populations from trials.
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NewsBot · Jul 20, 2025

Interventional effects of exercise on neuropathy in patients with diabetes: a systematic review with meta-analysis
Vanphuc Nguyen, Quangngoc Dinh, Fen Yu, Shuqi Jia & Xing Wang
BMC Sports Science, Medicine and Rehabilitation volume 17, Article number: 82 (2025)

Objective

This study aims to systematically evaluate the effects of exercise interventions on neurological dysfunction in diabetic patients, addressing inconsistencies in existing research. It seeks to clarify the impact of different exercise parameters and patient characteristics on nerve function improvements, providing evidence for optimized intervention strategies.
Methods

A search was conducted using PubMed, Web of Science, The Cochrane Library, and Embase databases for randomized controlled trials related to exercise interventions for neurological dysfunction in diabetic patients. The quality of the included studies was assessed according to the Cochrane Handbook for Systematic Reviews. The study utilized RevMan 5.3 to determine effect sizes and assess heterogeneity. Stata 17.0 was employed to evaluate publication bias in the included studies.
Results

The analysis incorporated 9 randomized controlled trials. The meta-analysis demonstrated that exercise leads to improvements in neurological dysfunction among diabetes patients (SMD = 0.61). Subgroup analysis revealed that an 8-week exercise regimen with moderate intensity was particularly effective in enhancing neurological function (SMD = 1.82, 1.58). Improvements were more pronounced in lower limb nerve conduction velocity (SMD = 0.60), peroneal nerve conduction velocity (SMD = 0.86), and sensory nerve conduction velocity (SMD = 0.59). Patients with a disease duration of 5 years or less showed significant improvement (SMD = 0.62).
Conclusion

Exercise effectively improves neurological dysfunction in diabetic patients, with an 8-week, moderate-intensity program showing the greatest benefits, particularly in lower limb and sensory nerve conduction velocity. These findings offer evidence-based guidance for clinical intervention and future research.
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NewsBot · Oct 1, 2025

Physical activity as an adjunct therapy in the treatment of persons with diabetic foot ulcer; an umbrella review
Birgit Rasmussen et al
Source

Purpose
This umbrella review aims to appraise and summarize systematic reviews to support a recommendation of physical activity as an adjunct therapy in the treatment of persons with diabetic foot ulcers.

Methods
An a priori protocol guided the systematic search and inclusion process. We searched MEDLINE, Embase, and CINAHL for quantitative and qualitative systematic reviews investigating the effectiveness of physical activity on diabetic foot ulcer (DFU) healing and persons’ experiences with physical activity (PA). Study selection and data extraction were conducted independently by two reviewers. A critical appraisal of included reviews was performed using the Joanna Briggs Institute guidelines for umbrella reviews

Results
Six high- to moderate-quality systematic reviews were included representing primary studies with a total of 881 participants. Supervised exercise showed promising effects on wound healing; however, evidence was insufficient to conclude effectiveness. Low levels of activity with off-loading devices may be feasible. Evidence remains limited.

Conclusions
Even based on this study’s extensive literature search, there is no basis to conclude which physical activities promote or inhibit wound healing in or are valued by persons with DFUs. Future research should include high-quality, person-centred studies to explore how physical activity can be integrated into care without compromising wound healing.

Implications for Rehabilitation
Physical activity (PA) is fundamental to overall health and plays a crucial role in diabetes management, with guidelines recommending 150 minutes per week of moderate-to-vigorous intensity activity to improve health-related outcomes.

Any advice to limit PA contrasts with broader recommendations for diabetes management where PA is recognized for its broader health benefits.

PA should be integrated into a personalized rehabilitation plan.

Healthcare professionals should consider providing specific, personalized advice on daily step goals.
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NewsBot · Dec 19, 2025

Foot-specific exercise intervention for forefoot deformity in individuals with type 2 diabetes and peripheral neuropathy: A randomized controlled clinical trial with 3-year follow-up
J A Zellers et al
Braz J Phys Ther. 2025 Dec 17;30(1):101563.

Background: Diabetes with peripheral neuropathy can lead to metatarsophalangeal joint (MTPJ) deformity. The purpose of this study was to estimate the effect of a foot-specific intervention on MTPJ deformity. Secondary aims were determining MTPJ deformity progression over 3 years and predictors of MTPJ deformity progression.

Methods: Sixty people with type 2 diabetes and peripheral neuropathy were recruited for this randomized controlled clinical trial. Participants were assessed at baseline, 6 months (post-intervention), 1.5 years, and 3 years. A 6-month, foot-specific intervention in the experimental group was compared to a shoulder intervention in the control group. The primary outcome was change in 2nd MTPJ angle assessed with computed tomography (CT).

Results: There was no effect of intervention on 2nd MTPJ angle (main effect of group p = 0.56, main effect of visit p = 0.56, group*visit interaction p = 0.79). In combined experimental and control groups, 26 % and 9 % of participants met the cutoff threshold for MTPJ angle progression at 1.5 and 3 years, respectively. Change in 2nd metatarsal bone mineral density from baseline to 3 years predicted 2nd MTPJ angle progression at 3 years (Rescaled R2 = 0.22, p = 0.01).

Conclusion: The study intervention was unable to yield a detectible improvement in 2nd MTPJ angle. The intervention may not have been of sufficient intensity to induce positive changes or there may be limited capacity for the neuropathic foot to respond to traditional modes of exercise. While useful in improving other outcomes, exercise-based intervention may not be an effective method of reducing or delaying forefoot deformity progression.
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NewsBot · Dec 21, 2025

Rethinking diabetic foot ulcer care: Integrating exercise and physical activity
Jane E. Nakamura et al
Journal of Diabetes and its Complications 18 December 2025, 109252

Highlights

•
Exercise and physical activity show promise for promoting ulcer healing.
•
Heterogeneity limits conclusions but highlights research design priorities.
•
Safe reintroduction of movement may enhance healing and reduce recurrence.
•
The framework integrates exercise physiology, wound biology, and patient adherence.

Abstract
Because repetitive trauma and pressure contributes to diabetic foot ulcer (DFU) development and progression, offloading is one of the main therapies used in treatment. The term offloading has become conflated with a reduction in movement altogether, increasing sedentary time and, with it, the risk of associated adverse health outcomes. The aim of this narrative review is to evaluate the literature on movement-based interventions (reducing sedentary time, increasing physical activity (PA), or increasing exercise) in DFU patients. We found 16 articles that looked at the effect of exercise in individuals with a DFU. While many studies demonstrate the therapeutic potential of exercise, methodological inconsistencies between them prevent firm conclusions from being drawn regarding the efficacy of movement in promoting ulcer healing. The collected evidence underscores the need to address factors such as patient adherence, weight-bearing progression, and specifics surrounding movement programs (frequency, intensity, etc.) in future studies. Addressing these gaps, as well as determining barriers and facilitators to engaging in movement unique to those with a DFU, will advance research rigor and, with it, our understanding of how movement can be effectively leveraged to improve DFU care.
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NewsBot · Feb 4, 2026

Rethinking diabetic foot ulcer care: Integrating exercise and physical activity
Jane E. Nakamura et al
Journal of Diabetes and its Complications Volume 40, Issue 2, February 2026, 109252

Highlights
•
Exercise and physical activity show promise for promoting ulcer healing.
•
Heterogeneity limits conclusions but highlights research design priorities.
•
Safe reintroduction of movement may enhance healing and reduce recurrence.
•
The framework integrates exercise physiology, wound biology, and patient adherence.
Abstract
Because repetitive trauma and pressure contributes to diabetic foot ulcer (DFU) development and progression, offloading is one of the main therapies used in treatment. The term offloading has become conflated with a reduction in movement altogether, increasing sedentary time and, with it, the risk of associated adverse health outcomes. The aim of this narrative review is to evaluate the literature on movement-based interventions (reducing sedentary time, increasing physical activity (PA), or increasing exercise) in DFU patients. We found 16 articles that looked at the effect of exercise in individuals with a DFU. While many studies demonstrate the therapeutic potential of exercise, methodological inconsistencies between them prevent firm conclusions from being drawn regarding the efficacy of movement in promoting ulcer healing. The collected evidence underscores the need to address factors such as patient adherence, weight-bearing progression, and specifics surrounding movement programs (frequency, intensity, etc.) in future studies. Addressing these gaps, as well as determining barriers and facilitators to engaging in movement unique to those with a DFU, will advance research rigor and, with it, our understanding of how movement can be effectively leveraged to improve DFU care.
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NewsBot · Apr 20, 2026

Effect of exercises on healing dynamics and physical activity levels in individuals with diabetic foot ulcer: a systematic review and meta-analysis of randomized controlled trials
Sohini Raje, et al
Source

Highlights
•
The present review highlighted that non-weight-bearing exercises significantly reduce wound area in individuals with diabetic foot ulcers (DFUs) (Wagner grades 1 and 2), although significant heterogeneity exists between studies.
•
There is a need for high-quality randomized controlled trials to translate evidence to clinical practice in individuals with DFUs.
Abstract:
Background
The burden of diabetic foot ulcers(DFUs) is increasing, causing morbidity and mortality. The management of DFUs involves surgical, pharmacological, offloading, and lifestyle interventions. Previous reviews suggest that exercise is safe in individuals with DFUs. However, the evidence is variable and limited. The objective of the present review was to examine the effect of exercises on diabetic foot ulcer healing and physical activity levels.
Methods
The review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Checklist 2020. Studies were included if they were randomized controlled trials(RCTs) in active DFUs with exercise intervention and measured DFU healing parameters and/or physical activity. The Cochrane ROB-2 Tool was used to assess the risk of bias. RevMan 5.4.1 was used to perform the meta-analysis, employing the random-effects model and suitable tests for heterogeneity.
Results
Six RCTs were included in the present review. The meta-analysis revealed that exercise intervention was effective in reducing the ulcer area in diabetic foot ulcers. However, the 12-week intervention is not sufficient to achieve a statistically significant difference(SMD = -0.56 cm2, 95% CI -1.35 to 0.22; participants = 280; studies = 5; I2 = 90%). The studies showed an overall ROB “some concerns”. None of the studies reported physical activity as an outcome.
Conclusion
The present review highlights that non-weight-bearing exercises reduce wound area in DFUs; however, 12-weeks of intervention are insufficient to produce a significant change(Wagner grades 1 and 2). A trend towards improvement could be observed. High-quality RCTs are the need of the hour to facilitate the evidence into clinical practice.
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NewsBot · Apr 22, 2026

Nurse-Led Foot-Ankle Exercises and Changes in Neuropathy Symptoms and Diabetic Foot Risk Indicators: A Quasiexperimental Study
Yasmin Ibrahim Abdelkader Khider et al
Nurs Res Pract. 2026 Apr 20:2026:9196936.

Aim: To examine whether a nurse-led foot-ankle flexibility and resistance exercise programme, delivered alongside usual care, was associated with changes in neuropathy symptoms and diabetic-foot risk/self-care indicators among adults with diabetes.

Background: Diabetic peripheral neuropathy (DPN) contributes to reduced protective sensation, limited joint mobility and impaired self-care, increasing DFU risk. Low-cost exercise programmes targeting foot-ankle mobility and strength may improve neuropathy-related symptoms and modifiable DFU risk factors, but practice-based evidence in routine nursing settings remains limited.

Design: Quasiexperimental, nonrandomized, nonequivalent control-group pre-post study.

Methods: Adults with Type 1 or Type 2 diabetes attending an outpatient diabetes clinic were recruited by convenience sampling (N = 60) and allocated to an intervention group (usual care plus structured exercise education and supervised practice; n = 30) or a control group (usual care; n = 30). Outcomes were assessed at baseline and 1 month using the Neuropathy Total Symptom Score-6 (NTSS-6) and the Diabetes Foot Assessment/Risk Screening scale. Because allocation was nonrandomized and outcomes were analysed in categories, inferential analyses were exploratory and based on chi-square/Fisher's exact tests with Cramer's V effect sizes.

Results: At 1 month, neuropathy symptom severity categories differed significantly between groups (χ 2 = 34.236 and p < 0.001; V = 0.76), with a greater proportion of participants in the intervention group shifting to lower symptom-severity categories. Diabetes Foot Assessment/Risk Screening categories also favoured the intervention group (χ 2 = 30.762 and p < 0.001; V = 0.72). Given the quasiexperimental design and unadjusted categorical analyses, these findings should be interpreted as associations rather than causal estimates.

Conclusions: In this practice-based quasiexperimental study, a brief nurse-led foot-ankle flexibility and resistance exercise programme was associated with improved neuropathy symptom categories and more favourable diabetic-foot risk/self-care indicators over 1 month. The findings support feasibility within nursing practice, but causal inference is limited by nonrandom allocation, the use of categorical unadjusted analyses and the use of a study-specific foot-risk/self-care measure.

Relevance to clinical practice: Nurses can integrate brief foot screening with structured foot-ankle exercise education and demonstration during outpatient diabetes visits as an adjunct to, not a replacement for, standard diabetic-foot surveillance and self-management support.
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NewsBot · Apr 26, 2026

Targeted foot muscle strengthening reverses atrophy and reduces plantar peak pressure in diabetic neuropathic feet
Angela Höhne et al
Foot (Edinb). 2026 Apr 20:67:102253.

Introduction: Ulcer formation poses a serious clinical problem and has been associated with muscle function and tissue loss in diabetic feet and increased plantar peak pressures during walking. Reduced intrinsic and extrinsic foot muscle strength has been considered to increase the plantar peak pressure at the most affected metatarsal region. We aimed to investigate if a targeted strength training of the toe flexor muscles 1) enhances muscle strength and volume in the diabetic foot, and 2) improves plantar pressure distribution during walking in diabetic patients.

Research design and methods: Fourteen non-ulcerated diabetic patients performed a monitored toe flexor strength training at 70% of the maximal voluntary isometric contraction on a custom-made dynamometer for eight weeks. The maximal plantarflexion moment at the metatarsophalangeal joints on the dynamometer, the intrinsic foot muscle volume and the plantar pressure distribution during walking were quantified before and after the intervention.

Results: Right and left maximal plantarflexion moments increased significantly by 62% (p < 0.001) and 49% (p < 0.001), the intrinsic muscle volume increased by 6.4% (p = 0.018) and the peak pressures decreased at the second (p < 0.001) and lateral (p < 0.01) metatarsal region each by 11% following the training.

Conclusions: Muscle function and tissue loss in diabetic feet can be counteracted by a targeted strength training program. Improved toe flexor muscle strength reduces plantar peak pressure at common ulceration sites.
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scotfoot · May 3, 2026

NewsBot said: ↑

Targeted foot muscle strengthening reverses atrophy and reduces plantar peak pressure in diabetic neuropathic feet
Angela Höhne et al
Foot (Edinb). 2026 Apr 20:67:102253.
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Bullet points from the paper referenced above -

Highlights

•
Limited knowledge exists on interventions targeting functional adaptability of toe flexor muscles in diabetes.

•
Strength training inducing MPJ plantarflexion moments can counteract muscle loss in diabetic feet.

•
Despite atrophied muscles and severe weakness, toe flexor strength increased continuously and was linked to MRI-detected muscle gain.

•
Strength gains were associated with reduced plantar peak pressure at common ulceration sites.

•
We recommend incorporating targeted strength training of intrinsic foot muscles into diabetic care at an early stage.

Exercise interventions for diabetic foot complications

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scotfoot Well-Known Member

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Exercise interventions for diabetic foot complications

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scotfoot Well-Known Member

Exercise interventions for the treatment of chronic low back pain

Effectiveness of exercise interventions to prevent sports injuries

Exercise for the rheumatoid foot

Aquatic Exercise Program for Flat Feet

Best Exercises to Target Lower Lats for Muscle Growth?

Which exercises for which presentation.

Teaching foot strengthening exercises the easy way

Share This Page

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