Effect of Exercise Volume on Plantar Microcirculation and Tissue Hardness in People With Type 2 Diabetes.

Weiyan Ren,Hongmei Liu,Yih-Kuen Jan,Yijie Duan,Fang Pu,Wenqiang Ye,Jianchao Li,Junchao Guo,Yubo Fan,Wei Liu

doi:10.3389/fbioe.2021.732628

Abstract

Objective: Exercise has been reported to be beneficial for people with type 2 diabetes (T2DM), but exercise, especially weight-bearing exercise, may increase the risk of diabetic foot ulcers (DFUs). This study aimed to explore the associations between different volumes of weight-bearing physical activities and plantar microcirculation and tissue hardness in people with T2DM. Methods: 130 elderly people with T2DM were enrolled for this cross-sectional study. They were classified into the high exercise volume group and the low exercise volume group based on their weekly energy expenditure (metabolic equivalents per week) in the past year. Weekly energy expenditure was calculated using the International Physical Activity Questionnaire and the Compendium of Physical Activities. The plantar oxygen saturation (SO2) and soft tissue hardness of each participant’s right foot were measured. Results: A total of 80 participants completed the trial. The average exercise energy expenditure of the high exercise volume group and the low exercise volume group were significantly different (p < 0.05). The results showed that the SO2 of the high exercise volume group (67.25 ± 6.12%) was significantly higher than the low exercise volume group (63.75 ± 8.02%, p < 0.05). The plantar tissue hardness of the high exercise volume group was lower than the low exercise volume group in the big toe, midfoot and hindfoot regions (p < 0.05). Conclusion: This study demonstrates that higher volumes of exercise are associated with better plantar microcirculation and lower plantar tissue hardness in people with T2DM. The findings of this study indicate that weight-bearing exercise may not increase risk of developing diabetic foot ulcers.

Highlights

Diabetic foot ulcers (DFUs) are one of the most common and serious complications of diabetes mellitus (DM)
There was no significant difference in these parameters between the high exercise volume (HEV) group and low exercise volume (LEV) group
The results showed that the mean tissue hardness in the HEV group was lower than that of the LEV group, with a significant difference at the big toe region (HEV: 27.89 ± 7.72°Shore, LEV: 32.25 ± 9.94°Shore; p 0.030), midfoot (HEV: 26.59 ± 7.59°Shore, LEV: 31.20 ± 9.30°Shore; p 0.034), TABLE 2 | Plantar SO2 and Temp for Non-diabetic peripheral neuropathy (DPN) and DPN participants in the HEV and LEV groups, and for Non-DPN participants performing different physical activities in the HEV group (Participants in LEV group did not engage in any form of exercise other than walking; Mean ± standard deviation (SD))

Summary

Introduction

Diabetic foot ulcers (DFUs) are one of the most common and serious complications of diabetes mellitus (DM). Microvascular dysfunction (Greenman et al, 2005; Chao and Cheing, 2009), abnormal plantar stress (Jan et al, 2013b; Pu et al, 2018), increased plantar tissue hardness (Mithraratne et al, 2012; Jan et al, 2013a) and peripheral neuropathy (Bowering, 2001; Caselli et al, 2002) are major factors causing the development of DFUs. Research studies have shown that people with diabetes exhibit microvascular dysfunction, including a lower level of oxygen saturation of plantar tissue (Greenman et al, 2005; Chao and Cheing, 2009). The relationships among oxygen saturation, plantar tissue hardness, neuropathy, and the occurrence of ulcerations are still unclear, these factors may play an important role in predicting and assessing the risk of DFUs

Methods

Results

Discussion

Conclusion