Table 1 Study characteristics of included studies
From: Does exercise improve healing of diabetic foot ulcers? A systematic review
Author | Participants/Age (Years) | Â | 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 | ||