Effect of weight-bearing activity on foot ulcer incidence in people with diabetic peripheral neuropathy: feet first randomized controlled trial.
BACKGROUND
Weight-bearing exercise has been contraindicated among people with diabetic peripheral neuropathy (DM+PN). However, recent cohort studies have suggested that daily weight-bearing activity is associated with lower risk for foot ulceration.


OBJECTIVE
The objective of this study was to determine the effect of a lower-extremity exercise and walking intervention program on weight-bearing activity and foot ulcer incidence in people with DM+PN.


METHODS
This was an observer-blinded, 12-month randomized controlled trial.


METHODS
The settings were physical therapy offices in part 1 of the intervention and the community in part 2 of the intervention.


METHODS
The participants were 79 individuals with DM+PN who were randomly assigned either to a control group (n=38) or an intervention group (n=41) group.


METHODS
Intervention components included leg strengthening and balance exercises; a graduated, self-monitored walking program (part 1); and motivational telephone calls every 2 weeks (part 2). Both groups received diabetic foot care education, regular foot care, and 8 sessions with a physical therapist.


METHODS
Total and exercise bout-related daily steps at baseline and at 3, 6, and 12 months were measured by accelerometers. Foot lesions/ulcers were photographed and classified by an independent panel of dermatologists. Use of adequate footwear was monitored.


RESULTS
At 6 months, bout-related daily steps increased 14% from baseline in the intervention group and decreased 6% from baseline in the control group. Although the groups did not differ statistically in the change in total daily steps, at 12 months steps had decreased by 13% in the control group. Foot ulcer rates did not differ significantly between groups.


CONCLUSIONS
Promoting weight-bearing activity did not lead to significant increases in foot ulcers. Weight-bearing activity can be considered following adequate assessment and counseling of patients with DM+PN.
Lemaster
Joseph W
JW
Department of Family and Community Medicine, School of Medicine, University of Missouri, MA306-K Medical Science Building, DC032.00, Columbia, MO 65212, USA. lemasterj@health.missouri.edu
Mueller
Michael J
MJ
Reiber
Gayle E
GE
Mehr
David R
DR
Madsen
Richard W
RW
Conn
Vicki S
VS
D000368:Aged; D003929:Diabetic Neuropathies / Q000150:complications*; D005260:Female; D016523:Foot Ulcer / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016138:Walking; D016474:Weight-Bearing