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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.

    Articles:
    1
    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.

    Articles:
    1
    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.

    Articles:
    1
    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.

    Articles:
    1
    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.

    Articles:
    1
    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:
    https://clinical.diabetesjournals.org/content/24/2/71.full-text.pdf
     
  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.

    Articles:
    1
    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.

    Articles:
    1
    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)
     
  17. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    IS PHYSICAL EXERCISE RECOMMENDED IN DIABETIC FOOT
    SYNDROME?

    Rucsandra Elena Dănciulescu MIULESCU et al
    Journal of Sport and Kinetic Movement No. 33,Vol. I/2019
     
  18. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Prediction of post-interventional physical function in diabetic foot ulcer patients using patient reported outcome measurement information system (PROMIS)
    Stephanie P.Hao et al
    Foot and Ankle Surgery; 11May 2020
     
  19. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Prediction of Post-Interventional Physical Function in Diabetic Foot Ulcer Patients Using Patient Reported Outcome Measurement Information System (PROMIS)
    Stephanie P Hao et al
    Foot Ankle Surg. 2020 May
     
  20. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Benefits and Harms of Exercise Therapy for Patients With Diabetic Foot Ulcers: A Systematic Review
    Thomas Vedste Aagaard et al
    Int J Low Extrem Wounds. 2020 Sep 14
     
  21. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Effectiveness of Diabetic Foot Exercise in Preventing the Risk of Diabetic Foot Ulcers in Type 2 Diabetes Mellitus Patients: Literature Review
    Vol 2 No 2 (2021): Journal for Research in Public Health
     
  22. scotfoot

    scotfoot Well-Known Member

    From above -

    "after the intervention the risk of diabetic foot ulcers decreased by 82% (p = 0.001). Diabetic foot exercise is effective in preventing the risk of diabetic foot ulcers, and can reduce and accelerate wound healing in DM patients with diabetic foot ulcers ".

    This is really what you would expect since exercising a specific part of the body increase blood flow in that part , both during exercise and for a period afterwards .

    So blood flow into the foot via arteries /arterioles bringing oxygen , immune cells , building blocks for tissue maintenance etc , and blood and lymph flow out ,greatly facilitated by local muscular activity , moving away spent materials .

    Why on earth would this not be encouraged by prescribing physicians ?

    A note on compliance . My understanding is that research indicates that those who are prone to diabetic foot ulceration fear this and subsequent amputation more than they fear death . Sobering thought .
     
    Last edited: Feb 6, 2021
  23. scotfoot

    scotfoot Well-Known Member

    Question ; can you reverse diabetic foot neuropathy with foot exercises ? Apparently you can .

    Original Research The Influence of Diabetic Foot Exercise in Sensory Peripheral Neuropathy with Monofilament Test on Diabetes Mellitus Clients Tintin Sukartini, Candra Panji Asmoro and Putri Nandani Alifah Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia

    ABSTRACT Background: Peripheral neuropathy is a long-term complication that attacks the nerves and loses the sensation of protection which affects about 50% of people with diabetes mellitus (DM). Diabetic foot exercises can help blood circulation, especially in the legs or lower limbs. This researched aimed to analyze the effect of diabetic foot exercise on sensory peripheral neuropathy in DM clients.

    Method: The study design used quasi-experimental pre-post test with control group. Samples were 28 respondents using purposive sampling and divided into two groups of 14 respondents each. The independent variable is diabetic foot training, and the dependent variable is peripheral sensory neuropathy. Interventions are carried out 3 times a week for 4 weeks. The research instrument was Weinstein Monofilament 10 g Semmes and a diabetic foot training checklist. Data analysis using the Wilcoxon-signed rank test and Mann Whitney test with α≤0.05.

    Result: The Wilcoxon-signed rank test in the treatment group showed differences in sensory peripheral neuropathy after treatment (p=0,000) and no difference in the control group (p=0.564). The Mann Whitney test results showed differences in sensory peripheral neuropathy between the treatment group and the control group after treatment p=0.039.

    Conclusion: Diabetic foot exercises can be used as an alternative measure to improve sensory peripheral neuropathy.

    ARTICLE HISTORY Received: Dec 26, 2019 Accepted: Dec 31, 2019 doi:http://dx.doi.org/10.20473/jn.v14i3(si).17263
     
  24. scotfoot

    scotfoot Well-Known Member

    "Foot exercise and foot care can be one of the independent nursing interventions used to prevent the complications of diabetes mellitus, as they have been proven to improve the peripheral vascular status of patients with diabetes mellitus by 70-80%." Really ?


    Effect of Foot Exercise and Care on Peripheral Vascular Status in Patients with Diabetes Mellitus Selpina Embuai1, Hani Tuasikal2 and Moomina Siauta1 1 Universitas Kristen Indonesia Maluku, Indonesia 2 Akper Rumkit Tk III Dr. J. A. Latumeten Ambon, Indonesia


    ABSTRACT

    Introduction:
    Diabetes mellitus is a cause of health problems which occurs in most countries. Approximately 13 - 15% of all patients with diabetes mellitus will experience peripheral circulatory disorders. Foot exercise and foot care are interventions that can be implemented to prevent foot ulcers.

    Methods This study employed a pre-post-test quasi-experimental design with a control group. The sample consisted of 94 patients with diabetes mellitus who were assigned to the intervention group (n=47) and the control group (n=47) respectively. Consecutive sampling was used to recruit the samples. The instruments used to collect the data included 10- g monofilament for the diabetic neuropathy test, a HbA1c test and a sphygmomanometer. The collected data was analyzed using a paired t-test.

    Results: The results of this study showed there to be significant effects from foot exercise and foot care on the HbA1c test, in relation to the frequency of the dorsalis pedis artery and diabetic neuropathy with a significance value of 0.00 (p<0.05). However, in the ankle-brachial index measurement, there were no significant differences between the intervention and control groups with a significance value of 0.26 (p>0.05).

    Conclusion: Foot exercise and foot care can be one of the independent nursing interventions used to prevent the complications of diabetes mellitus, as they have been proven to improve the peripheral vascular status of patients with diabetes mellitus by 70-80%.
     
    Last edited: Feb 9, 2021
  25. scotfoot

    scotfoot Well-Known Member

    Still on the subject of the rates of healing of diabetic foot ulcers and supervised foot exercises ,I have spent a bit of time looking into the topic and can't find a more convincing paper on the subject , for or against ,than Eraydin /Avsar .

    Yes, physicians must be sure that their treatment of foot ulcers does not make the condition worse , but Eraydin found supervised foot exercises makes the situation better .

    It is entirely reasonable for advisory bodies to require a substantial amount of evidence before making treatment recommendations and ,taken on its own , the Eraydin paper is not substantial ,but here is what I just don't get .
    Why , when an apparently ground breaking paper is published ,showing that a few simple exercises can improve the lot a large group of patients , are other researchers in the field not all over the concept like a rash ?

    The Eraydin paper drew a lot of attention including 2 letters to the editor and even a paper on the Eryadin paper itself ( for clarity an individual produced a study of the Eraydin study ) but , as far as I can see no major studies have yet been produced into the foot exercise effect subsequent to Eraydin .

    Why not ?
     
  26. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    This clinical trial was just registered:
    Exercise Enhances Wound Healing in Patients With Diabetic Foot Ulcers
     
  27. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Does exercise improve healing of diabetic foot ulcers? A systematic review
    Morica M. Tran & Melanie N. Haley
    Journal of Foot and Ankle Research volume 14, Article number: 19 (2021)
     
  28. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Effect of Foot-Ankle Flexibility and Resistance Exercise in the Secondary Prevention of Plantar Foot Diabetic Ulcer
    MariaSuryani et al
    Journal of Diabetes and its Complications; 28 May 2021, 107968
     
  29. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Feasibility of a home-based foot-ankle exercise programme for musculoskeletal dysfunctions in people with diabetes: randomised controlled FOotCAre (FOCA) Trial II
    Érica Q Silva et al
    Sci Rep. 2021 Jun 11;11(1):12404
     
  30. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The effects of foot exercise with audiovisual and group support foot exercises to diabetes mellitus patients
    Rohmatul Faizah et al
    J Diabetes Metab Disord. 2021 Feb 22;20(1):377-382
     
  31. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Physical Activity Participation in People with an Active Diabetic Foot Ulceration: A Scoping Review
    MagaliBrousseau-FoleyMD, MSc, DPM et al
    Canadian Journal of Diabetes; 10 July 2021
     
  32. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The Effect of Exercise on Gait Biomechanics of the Neuropathic Diabetic Foot
    Alfred Gatt et al
    Focus on Medical Sciences Journal
     
  33. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    This clinical trial was just registered:
    Exercise Therapy for People With a Diabetic Foot Ulcer - a Feasibility Study
     
  34. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The Application of Exercise Training for Diabetic Peripheral Neuropathy
    Clifton J Holmes, Mary K Hastings
    J Clin Med. 2021 Oct 28;10(21):5042
     
  35. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Remaining Question: Does Exercise Improve Healing of Diabetic Foot Ulcers?
    Magali Brousseau-Foley , Virginie Blanchette
    Int J Low Extrem Wounds. 2021 Dec 8
     
  36. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The Role of New Technological Opportunities and the Need to Evaluate the Activities Performed in the Prevention of Diabetic Foot with Exercise Therapy
    Piergiorgio Francia et al
    Medicines (Basel). 2021 Dec 2;8(12):76
     
  37. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Exercise and Neuropathy: Systematic Review with Meta-Analysis
    Fiona Streckmann, Maryam Balke, Guido Cavaletti, Alexandra Toscanelli, Wilhelm Bloch, Bernhard F. Décard, Helmar C. Lehmann & Oliver Faude
    Sports Medicine (2021)
     
  38. scotfoot

    scotfoot Well-Known Member

    New review paper - "restores small sensory nerve damage"

    "Among the exercise-based solutions, aerobic training improves neural structure and function and ameliorates neuropathic signs and symptoms. Resistance training induces marked improvement of muscle performance and may alleviate neuropathic pain. A combination of aerobic and resistance training (i.e., combined training) restores small sensory nerve damage, reduces symptoms, and improves muscle function. The evidence so far suggests that exercise training is highly beneficial and should be included in the standard care for DPN patients."

    . 2021 Dec 17;183:109183.
    doi: 10.1016/j.diabres.2021.109183. Online ahead of print.
    Neuromuscular dysfunction and exercise training in people with diabetic peripheral neuropathy: A narrative review

    Giorgio Orlando 1, Stefano Balducci 2, Andrew J M Boulton 3, Hans Degens 4, Neil D Reeves 5
    Affiliations expand

    Abstract

    Diabetic peripheral neuropathy (DPN) is a common condition that is associated with neuromuscular dysfunction and peripheral sensory impairment. These deficits predispose patients to sensory and motor system limitations, foot ulcers and a high risk of falls. Exercise training has been proposed as an effective tool to alleviate neural deficits and improve whole-body function. Here we review the effects of DPN on neuromuscular function, the mechanisms underlying this impairment, and the neural and muscular adaptations to exercise training. Muscle dysfunction is an early hallmark of DPN. Deficits in muscle strength, power, mass and a greater fatigability are particularly severe in the lower extremity muscles. Non-enzymatic glycation of motor proteins, impaired excitation-contraction coupling and loss of motor units have been indicated as the main factors underlying muscular dysfunction. Among the exercise-based solutions, aerobic training improves neural structure and function and ameliorates neuropathic signs and symptoms. Resistance training induces marked improvement of muscle performance and may alleviate neuropathic pain. A combination of aerobic and resistance training (i.e., combined training) restores small sensory nerve damage, reduces symptoms, and improves muscle function. The evidence so far suggests that exercise training is highly beneficial and should be included in the standard care for DPN patients.
     
  39. scotfoot

    scotfoot Well-Known Member

    The Holne study mentioned above involved 14 diabetic patients with feet that had toe flexor strengths of about 1/3 normal.
    Using isometric exercise ( no change in muscle length, so a bit like pushing against an immovable wall), and a force of 70% of the maximum pts could manage, for 10 mins 3x a week for 8wks, toe flexor strength was increased by 55% in the trial group, and muscle mass was also increased .

    30 mins a week is not that much of a commitment especially with so much at stake .
     
  40. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Effects of an isometric exercise training program on muscular strength, ankle mobility, and balance in patients with diabetic peripheral neuropathy in the lower legs in South Africa
    Ronél du Plessis, Nadia Dembskey, Susan H Bassett
    Int J Diabetes Dev Ctries. 2022 Apr 5
     
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