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Table 1 Study characteristics of included studies

From: Does exercise improve healing of diabetic foot ulcers? A systematic review

Author Participants/Age (Years)   Mean Diabetes Duration (Years) Presence of Neuropathy Previous Ulceration BMI (Kg/m2) Presence of Co-Morbidities
Intervention Group (IG) Control Group (CG) Male
Flahr [43] 10
Mean age = 61.9
Age range = 49–74
8
Mean age = 74.25
Age range = 54–94
67% Not reported 50% of participants reported to have 100% loss of sensorya Not reported Not reported IG = 6b CG = 3c
Eraydin and Avsar [44] 30
Mean age = 61.03 ± 9.97
Age range = 41–80
30
Mean age = 65.76 ± 8.57
Age range = 49–80
62% IG = 16.23 ± 8.57 CG = 17.46 ± 8.79 Not reported 70% IG = 31.36 ± 7.62 CG = 28.58 ± 4.66 Not reported
Joseph et al. [45] 31
Mean age = 69.06 ± 4.79
Age range = Not reported
30
Mean age: 68.50 ± 5.01
Age range = Not reported
51% IG = 21.77 ± 7.77 CG = 18.73 ± 7.16 Not reported Not reported IG = 27.66 ± 5.44 CG = 22.96 ± 3.23 Not reported
Author Setting Description of Intervention Frequency/Duration of Intervention/Delivery Mode of Intervention Outcome Measures Primary Outcome Secondary Outcome
Wound Measurements
IG = Intervention Group
CG = Control Group
Adherence to Exercise in Intervention Group/Complication and Adverse Events
Flahr [43] Home Non-weight bearing exercises including ankle inversion, eversion, flexion and extension - 4 in total. 10 times each, twice daily
12 weeks
Education session in clinic. Provision of written material.
Unsupervised exercise
Percentage wound size reduction by participant, self-reported number of days of exercise frequency Final wound measurement and percentage wound size reduction after 12 weeks:
IG1 = 0.22 cm2 (− 88%); CG1 = 0.79 cm2 (+ 25%)
IG2 = Withdrew (− 59%); CG2 = 0.49 cm2 (+ 14%)
IG3 = 0.09 cm2 (− 67%); CG3 = 0.14 cm2 (− 88%)
IG4 = Closed (− 100%); CG4 = Closed (− 100%)
IG5 = 0.12 cm2 (− 25%); CG5 = 9.18 cm2 (+ 2%)
IG6 = Closed (− 100%); C6G = Closed (− 100%)
IG7 = 0.05 cm2 (− 69%); CG7 = Withdrew
IG8 = 0.09 cm2 (− 67%); CG8 = Closed (− 100%)
IG9 = Closed (− 100%); CG9 = 0.06 cm2 (− 95%)
IG10 = 2.36 cm2 (− 131%)
(p = 0.70)
1 time/day = 1 (10.0%)
2 times/day = 2 (20.0%)
3 times/day = 1 (10.0%)
2 times every 3rd day = 1 (10.0%)
Stopped after 8 weeks = 2 (20.0%)
Didn’t exercise = 1 (10.0%)
Unknown = 2 (20.0%)
1 participant in IG withdrew due to Osteomyelitis
Eraydin and Avsar [44] Home Non-weight bearing foot exercises to be completed seated: plantar flexion, dorsiflexion, inversion, eversion, circumduction and plantar dorsiflexion of toes - 18 in total.
Exercises to be completed standing once wounds healed.
10 repeats, twice daily
12 weeks
20–30 min education session in clinic. Provision of written material.
Unsupervised exercise
Mean DFU area, DFU total depth, self-reported exercise frequency Baseline and final measurements:
Distribution of DFU Area Averages (SD):
IG: 12.63 cm2 (14.43) IG: 3.29 cm2 (3.80)
(p = 0.00)d
CG: 24.67 cm2 (20.70) CG: 18.52 cm2 (21.49)
(p = 0.00) d
Distribution of DFU Total Depth (SD):
IG: 0.56 cm (0.85) IG: 0.28 cm (0.38)
(p = 0.01) d
CG: 0.61 cm (0.84) CG: 0.80 cm (1.26)
(p = 0.37) d
0–30 days = 8 (26.7%)
31–60 days = 15 (50.0%)
61–90 days = 7 (23.3%)
Joseph et al. [45] Exercise clinic Participants rode on a bicycle ergometer with foot interaction kept constant with standard gym pedal and specialised offloading insole padding to relieve pressure to ulcer. 3 times per week at exercise clinic
12 weeks
Participants encouraged to increase
their exercise time by 5 mins each 2 weeks until they reach 50 mins at the 9th week, which was maintained
until the end of the program.
Supervised exercise
Percentage wound size reduction Percentage Wound Size Reduction after 12 weeks (SD):
IG: 94.08% (18.50) CG: 54.76% (17.19)
(p < 0.05)
Not reported
  1. aData break down not available
  2. b 30% had arthritis, 10% had a history of cerebral vascular incident, 10% had a history of back surgery, 10% reported a history of a herniated disc
  3. c 38.5% had arthritis
  4. dIntragroup comparison