Diabetics with previous foot ulcers may benefit from walking program

A University of Missouri research team reported that individuals with diabetic peripheral neuropathy might be able to participate in a graduated walking program under close supervision of a medical professional and thus prevent other life-threatening illnesses through routine exercise.

Diabetic peripheral neuropathy can cause individuals to develop foot ulcers and, in extreme cases, necessitate amputation. Consequently, physicians and scientists previously recommended that individuals with this complication stay off their feet.

“Physical activity is recommended for people with diabetes because it is proven to reduce the risk of mortality and development of cardiovascular disease,” Joseph W. LeMaster, MD, MPH, an associate professor of family and community medicine at the University of Missouri, said in a press release.

Likewise, “Individuals with type 2 diabetes can increase their risk of cardiovascular disease by 34% and their risk of mortality by 39% if they do not participate regularly in some type of moderately intense exercise. People who have diabetes are already less active than most of the population and those with diabetic peripheral neuropathy tend to be even less active,” he said in the press release.

In the University of Missouri study, LeMaster examined the effects of lower-extremity exercise and walking intervention programs on foot ulcer occurrence in people with diabetic peripheral neuropathy. Participants with diabetes and diabetic peripheral neuropathy were assigned to one of two groups: an intervention group — which was frequently monitored and assisted through leg strengthening exercises, a graduated walking program and motivational telephone calls every 2 weeks — or a control group. Both groups received diabetic and regular foot care education and eight sessions with a physical therapist.

During the first 6 months, LeMaster and his colleagues observed an increase in the total number of minor foot lesions and ulcers. However, at the end of the year, the number of lesions and ulcers in the intervention group had started to decrease compared to the control group, indicating a reduced risk.

“Because weight-bearing activity did not lead to a significant increase in foot ulcers, our study suggests that weight-bearing exercise might be appropriate for people with diabetes and diabetic peripheral neuropathy if the patient currently has no foot ulcers, wears proper footwear and is in a walking program that is well-supervised and safely monitored by a medical professional,” LeMaster said in the press release.

Reference:
LeMaster JW, Mueller MJ, Reiber GE, et al. The effect of weight-bearing activity on foot ulcer incidence in people with diabetic peripheral neuropathy: Feet-first randomized controlled trial. Phys Therapy: Diabetes Special Issue. 88;11:1385-1398.