Can Weight Bearing Aerobic Exercise be Done Safely with an Active Diabetic Plantar Foot Ulcer and Can It Improve Healing Time

Abstract

Introduction Diabetic foot ulcer (DFU) is a huge economic burden on the National Health Service (NHS). Research on the benefits of aerobic exercise on the vascular system in diabetics is vast, however research on the benefits of aerobic exercise on diabetics with active plantar DFU is slim. The purpose of this review is to determine whether weight bearing aerobic exercise can be safely undertaken with an active plantar DFU and whether exercise can in fact improve ulcer healing time. Method Five papers that included patients with active DFU taking part in weight bearing or semi weight bearing aerobic exercise programmes >10-weeks were found and reviewed. Findings Non-weight-bearing or semi-weight bearing exercise in the presence of DFU alongside severe diabetic neuropathy (DN) is safer and more feasible in the aim to try and stop the regression of diabetic complications. It has not been concluded whether aerobic exercise improves ulcer healing time. Proposal A pre-test, post-test randomized controlled trial (RCT), 30 participants (15 male, 15 female) with type 2 diabetics (T2D) and active plantar DFU, recruited from the Peter Mount Diabetes and Endocrine clinic at the Manchester Royal Infirmary, randomized into an evenly split intervention group/control group. Intervention group will take part in fully supervised 12-week semi weight bearing aerobic/resistance-based exercise programme: 3×per week working at 40-60% heart rate reserve (HRR) (Karvonen method) at the rehabilitation gym, Manchester Royal Infirmary (MRI). Participants will wear a removable air cast walker or equivalent. Monthly motivational interviewing and bi-weekly foot checks will be undertaken. Control group will continue usual wound care plan from the diabetic clinic. Outcome Measures: Baseline, 6, 12-weeks: transparent ruler measurement, toe brachial pressure index (TBPI) toe pressures, SPO2 , ankle brachial index (ABI), fasting blood glucose (FBG), blood cholesterol levels, Semmes monofilament test, blood pressure (BP), body mass index (BMI). Statistically analysed by statistical package for social sciences (SPSS) version 28 at p<0.05.