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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

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    Diabetic Foot and Exercise Therapy: Step by Step The Role of Rigid Posture and Biomechanics Treatment.
    Francia P, Gulisano M, Anichini R, Seghieri G.
    Curr Diabetes Rev. 2014 May 7.
     
  2. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Exercise improves gait, reaction time and postural stability in older adults with type 2 diabetes and neuropathy.
    Morrison S, Colberg SR, Parson HK, Vinik AI.
    J Diabetes Complications. 2014 Apr 18.
     
  3. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Should patients with active foot ulcers be non-weight bearing or take exercise to improve cardiovascular fitness?
    Ketan Dhatariya, Martin Fox
    Diabetic Foot Canada, 2015, Vol 3, No 1, pages 12–17 (full text)
     
  4. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Diabetic foot prevention: the role of exercise therapy in the treatment of limited joint mobility, muscle weakness and reduced gait speed.
    Francia P, Anichini R, De Bellis A, Seghieri G, Lazzeri R, Paternostro F, Gulisano M.
    Ital J Anat Embryol. 2015;120(1):21-32.
     
  5. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    This clinical trial was just registered:
    Effects of a Exercise Program on Health Outcomes in People With Diabetic Foot Ulcers
     
  6. Admin2

    Admin2 Administrator Staff Member

  7. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The Effect of Foot Exercises on Wound Healing in Type 2 Diabetic Patients With a Foot Ulcer.
    Eraydin Ş, Avşar G.
    J Wound Ostomy Continence Nurs. 2017 Dec 19. doi: 10.1097/WON.0000000000000405. [Epub ahead of print]
     
  8. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Physical activity and exercise on diabetic foot related outcomes: a systematic review
    Monica Matos et al
    Diabetes Research and Clinical Practice 23 February 2018
     
  9. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The Effect of Foot Exercises on Wound Healing in Type 2 Diabetic Patients With a Foot Ulcer: A Randomized Control Study.
    Eraydin Ş, Avşar G.
    J Wound Ostomy Continence Nurs. 2018 Mar/Apr;45(2):123-130.
     
  10. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Effect of Exercise on Risk Factors of Diabetic Foot Ulcers: A Systematic Review and Meta-analysis.
    Liao F et al
    Am J Phys Med Rehabil. 2018 Jul 16
     
  11. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Effect of Exercise on Risk Factors of Diabetic Foot Ulcers: A Systematic Review and Meta-analysis.
    Liao F et al
    Am J Phys Med Rehabil. 2018 Jul 16
     
  12. scotfoot

    scotfoot Well-Known Member

    With regard to post #9 above does anyone know what specific exercises were used ? Did they use exercises which targeted the intrinsics ?

    I have tried contacting the authors for this information , since it costs $39 to view the article in the publishing journal ( which seems excessive ) ,but did not get any reply .

    How gratifying would it be , as a podiatrist , to supervise a foot exercise program in patient with diabetic foot ulceration , and see accelerated healing of the ulcer , over the course of a number of appointments .

    Here is the conclusion from the abstract .

    CONCLUSION:
    The ulcer areas decreased significantly in the study intervention group compared to the control group during the 3 follow-up measurements. An important finding in this study was the DFU area decreased more in those who exercised more. Findings suggests foot exercises should be included in the treatment plan when managing patients with diabetic foot ulcers.





    J Wound Ostomy Continence Nurs. 2018 Mar/Apr;45(2):123-130. doi: 10.1097/WON.0000000000000405.
    The Effect of Foot Exercises on Wound Healing in Type 2 Diabetic Patients With a Foot Ulcer: A Randomized Control Study.

    Eraydin Ş1, Avşar G.
     
  13. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    This is what they did:
    Diabetic Foot Exercises: Instructions to patients with DFU were provided that included the following information: (1) avoid exercises that require weight bearing, 23 ; (2) complete the exercise program in a sitting position at fi rst and in a standing position after the wound heals 24 ; (3) exercises include range-of-motion movements of plantar fl exion, dorsifl exion, inversion, eversion, circumduction, and plantar and dorsal fl exion of toes; (4) exercise series should include, at minimum, 5 to 10 exercises with 10 to 15 repeats 23.24 ; (5) exercise 1 hour after taking insulin and before refreshments; (6) blood glucose level should be 100 to 125 mg/dL before the exercise; (7) defer exercises if the blood glucose level is more than 300 mg/dL and the blood pressure is more than 180 mm Hg before the exercise; and (8) discontinue the exercise if the patient feels nausea, dizziness, or drowsiness during the exercise. 23 Participants completed 18 exercises with 10 repeats.
     
  14. DaVinci

    DaVinci Well-Known Member

    What about aerobic type exercises to generically help the diabetes?
     
  15. scotfoot

    scotfoot Well-Known Member

    Many thanks for the information .

    Some years ago I came across a paper which looked at the effects of range of motion exercises around the ankle joint on blood flow into and out of the foot . I cannot now find the paper in question but if memory serves the exercises did not increase blood flow into the foot .
    In the Eraydin Ş1, Avşar G paper , perhaps toe exercises are key to increasing blood flow into the foot and bringing about more rapid healing of ulcers .
    Intriguingly , the authors found that more exercise of the type they prescribed results in faster healing . What might the limits be on this effect ?

    My understanding is that aerobic exercises help with diabetes at a systemic level but it would appear that site specific exercise may have benefits over and above the whole body approach and so it might be a good idea to use both .
     
  16. scotfoot

    scotfoot Well-Known Member

    So I still can't track down that paper on range of motion exercises , but I did just find something equally as interesting . I do not have access to the Eraydin /Asvar paper and so do not know if they cited the paper listed below , but it is clearly relevant to their work .

    The paper from 2010 looks at non weight bearing ankle exercises and the healing rates of diabetic foot ulcers . The author found no statistical differences between exercise and non exercise groups .

    This is in marked contrast to the more resent study of Eraydin /Asvar which clearly showed improved healing rates in the exercise group .

    So why the difference ? Well , compliance may have been better with Eraydin /Asvar .

    But what else did Erayin /Asvar have that Flahr didn't ? Answer; Toe flexion exercises .

    So is that really all it takes to accelerate diabetic foot ulcer healing ? Usual care coupled with something as easy as flexing the toes backwards and forwards under appropriate supervision ?



    Ostomy Wound Manage. 2010 Oct;56(10):40-50.
    The effect of nonweight-bearing exercise and protocol adherence on diabetic foot ulcer healing: a pilot study.

    Flahr D1.
    Author information

    Abstract


    Innovative approaches to the prevention and treatment of foot wounds in persons with diabetes mellitus are needed and preliminary research suggests that exercise therapy may increase joint mobility and blood flow. A 12-week, prospective, quasi-experimental pilot study was conducted to evaluate the potential influence of nonweight-bearing ankle exercises, and adherence to same, on the size of neuropathic, diabetic foot wounds in community-dwelling older adults. Nineteen patients were recruited. Of those, 10 (88.9% men) were randomized to ankle exercise treatments and nine (50% men) continued their previous care regimen. Patients randomized to the exercise program were younger and had smaller wounds than those in the control group (average age 62.2 ± 8.54 versus 74.25 ± 16.25 years and measurement 0.94 cm2 ± 1.89 versus 2.53 cm2 ± 3.647, respectively). Thirty percent (30%) of the patients in theexercise and 33.3% in the control group healed. The percent wound reduction between groups was not significantly different (Mann Whitney U test, P = .696). Adherence to the recommended exercise program was variable but 70% performed some exercises. The results of this pilot study provide important lessons for future studies, including the need to enroll more patients and provide more exercise guidance. Considering the increasing prevalence of diabetes mellitus and resultant complications, as well as the potential benefits of this non-invasive treatment regimen, larger studies are warranted.
    acess to the
     
  17. scotfoot

    scotfoot Well-Known Member

    I completely missed this . It's a study which shows that the intrinsic foot muscles can be redeveloped in the diabetic foot by toe flexion exercises . The paper , and a link to an article about the paper are listed at the end of the post.

    The article from which the following quotes are taken was written by an Australian podiatrist called Matt Dilnot .

    Quotes

    " 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. "

    The implications of the above are enormous . Huge .

    In my humble opinion it would be of great help if this paper were openly available .


    Links To Matt Dilnot article https://www.mytoepro.com.au/blog

    And
    Journal of Biomechanics | Proceedings of ESB2012 - 18th Congress ...


    https://www.sciencedirect.com/journal/journal-of-biomechanics/vol/45/.../S1?page...

    4 Jul 2012 - INCREASED STRENGTH OF INTRINSIC FOOT MUSCLES IN DIABETES AND PERIPHERAL NEUROPATHY. Page S201. Angela Höhne ...
     
  18. scotfoot

    scotfoot Well-Known Member

    Looking at the posts above it seems likely to me that the primary mechanism by which foot muscle atrophy occurs in diabetes is not due to motor nerve neuropathy , but rather metabolic problems within the muscle itself .

    Recent research has shown that diabetes affects the contractile proteins within the muscle and that this may be caused by an inflammatory process which can be reduced by exercising the specific muscle in question .

    Hohne's paper ( 2012) demonstrated that TARGETED , FOOT SPECIFIC , isometric exercise can actually promote muscle growth , as well as strengthening , in a foot with diabetic neuropathy and intrinsic muscle atrophy .

    If these results can be achieved with isometric exercise , then how much better would the results be with concentric exercise . For example the theraband exercises used by Karen Mickle in other types of trial ?

    Worth saying again TARGETED , FOOT SPECIFIC .
     
    Last edited: Oct 13, 2018
  19. scotfoot

    scotfoot Well-Known Member

    Dr Hohne and her group used a toe dynamometer ( under supervision ) to strengthen the intrinsic foot muscles .

    So targeted , foot specific exercise becomes TARGETED , TOE FLEXOR SPECIFIC exercise under supervision .
     
  20. scotfoot

    scotfoot Well-Known Member

    So the isometric exercises used by Hohne and her colleagues can rebuild muscle within the foot . So what ?

    In people with diabetes , atrophy of the intrinsic foot muscles often occurs before any signs of neuropathy are present . The mechanism by which this muscle wasting is caused is increasingly believed to be due to autoimmune related inflammatory reactions which are ameliorated by specific exercise of the muscles involved . It not much of a stretch to hypothesis that this same muscle specific exercise might also reduce autoimmune related inflammatory reactions in motor nerve fibers within the muscle concerned slowing or even halting motor nerve damage .

    Thus it may be possible , if diabetes related atrophy of the intrinsic foot muscles is caught at an early stage ,to greatly influence for the better , the pathological progress of this aspect of the disease , since it may be that targeted toe flexor exercise of a concentric type , done under supervision , may restore lost muscle to near former levels and prevent rapid decline of the neuro , muscular and vascular systems in the foot .

    It is also worth pointing out that the plantar venous plexus , an integral part of the circulatory system in the lower leg and foot , is dependent on the presence of the intrinsic musculature for its effective functioning . If the intrinsics are severely atrophied then the output from the PVP becomes much reduced and sporadic (seen in paraplegic feet ) .

    So it's possible that in the future targeted toe flexor exercise , done under supervision , coupled with supervised mobility exercises , may become a vital part of the treatment of feet affected by diabetes .

    Any thoughts ?
     
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