title: 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. 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 because of their perception of diabetic foot ulcer risks. Physical activity is not contraindicated for those at risk of diabetic foot ulcer, 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 diabetic foot ulcers. Offloading, diabetic peripheral neuropathy, depression, pain, self-efficacy and social support, diabetic foot ulcer 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 diabetic foot ulcer are provided. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Center for Lower Extremity Ambulatory Research (CLEAR) at Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA. ryan.crews@rosalindfranklin.edu.
authors.forename: Ryan T
authors.identifier: 0000-0001-6352-1960
authors.initials: RT
authors.lastname: Crews
authors.affiliation: Department of Psychology, College of Health Professions, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Schneider
authors.affiliation: Center for Lower Extremity Ambulatory Research (CLEAR) at Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
authors.forename: Sai V
authors.initials: SV
authors.lastname: Yalla
authors.affiliation: School of Healthcare Science, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK.
authors.forename: Neil D
authors.initials: ND
authors.lastname: Reeves
authors.affiliation: Department of Medicine, University of Manchester, Manchester, UK.
authors.forename: Loretta
authors.initials: L
authors.lastname: Vileikyte
mesh_terms: D017719:Diabetic Foot / Q000209:etiology / Q000523:psychology* / Q000628:therapy*; D005081:Exercise Therapy; D006801:Humans; D012307:Risk Factors
keywords: depression; offload; peripheral neuropathy; self-efficacy; social support