title: Effect of weight-bearing activity on foot ulcer incidence in people with diabetic peripheral neuropathy: feet first randomized controlled trial.
abstract: 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.
authors.affiliation: 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
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Lemaster
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mueller
authors.forename: Gayle E
authors.initials: GE
authors.lastname: Reiber
authors.forename: David R
authors.initials: DR
authors.lastname: Mehr
authors.forename: Richard W
authors.initials: RW
authors.lastname: Madsen
authors.forename: Vicki S
authors.initials: VS
authors.lastname: Conn
mesh_terms: 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