Physiological and psychological challenges of increasing physical activity and exercise in patients at risk of diabetic foot ulcers: a critical review

Abstract

Obesity and a sedentary lifestyle are common challenges among individuals at risk of diabetic foot ulcers (DFUs). While substantial research exists on physical activity interventions in adults with diabetes, those at greatest risk for foot ulceration were often excluded or not well-represented. Both at-risk patients and their clinicians may be hesitant to increase physical activity due to their perception of DFU risks. Physical activity is not contraindicated for those at risk of DFU, yet patients at risk present with unique barriers to initiating increases in physical activity. This review focuses upon the physiological and psychological challenges of increasing physical activity and exercise in patients at risk of DFUs. Offloading, diabetic peripheral neuropathy, depression, pain, self-efficacy and social support, DFU risk-specific beliefs and emotions, and research to date on exercise interventions in this population are all discussed. Additionally, recommendations for implementing and researching physical activity interventions for individuals at risk for DFU are provided.

Differences in the daily activity of patients with diabetic foot ulcers compared to controls in their free‐living environments

“…This suggests that minor amputations do not negatively impact the daily walking activity of patients with DFU (8). Additionally, although we only had a small subsample of DFU patients wearing a non-removable knee-high offloading device, our findings indicate that unlike their significant effect on reducing high plantar pressures, these gold standard devices may not limit daily steps when compared to other offloading devices as much as previously thought (5,9). Overall, these findings indicate that patients with DFU are significantly less active in terms of daily walking activity than patients with DPN and DM.…”

“…Studies have now confirmed that high plantar pressure is a risk factor for developing DFU in people with DPN ; however, in contrast, other studies have identified that it is actually low daily activity that is a risk factor for developing DFU in people with DPN . Subsequently, these low daily activity findings have many hypothesising that interventions that gradually increase daily activity in people with DPN – in combination with appropriate offloading of high plantar pressures – may also improve their rehabilitation, physical fitness, plantar tissue health and prevention of DFU .…”

Diabetic foot syndrome in patients with diabetes. A multicenter German/Austrian DPV analysis on 33 870 patients

“…It is assumed that patients included in our study were older compared with the German Health Update 2009 survey which could be 1 explanation for this discrepancy. Differences between subjects with or without DFS could be explained by mobility restrictions (eg, inability to stand or walk, or therapeutic offloading) resulting from acute DFS or the fear of foot ulcer recurrence . In our analysis, the number of patients stated to be smokers did not differ between subjects with or without DFS (Figure A,B).…”

Global status of diabetes prevention and prospects for action: A consensus statement

“…Physical activity is a broad term, whereas the term exercise refers to structured or planned activities. Any type of exercise and physical activity has been validated to prevent or at least delay the development of T2D and reduce the risk of comorbidities associated with diabetes . Many exercise studies report that while exercise treatment programmes alone may not necessarily result in significant body weight loss, programmes of sufficient intensity and physical activity reduce the risk of progression to T2D in high‐risk populations .…”