Abstract
Exercise has been demonstrated to improve health in people with diabetes. However, exercise may increase risk for foot ulcers because of increased plantar pressure during most weight-bearing physical activities. To date, there is no study investigating the effect of various walking speeds and durations (i.e., the most common form of exercise in daily living) on the plantar foot. The objective of this study was to investigate the effect of various walking intensities on plantar tissue stiffness. A 3 × 2 factorial design, including three walking speeds (1.8, 3.6 and 5.4 mph) and two durations (10 and 20 min), was tested in 12 healthy participants. B-mode and elastographic ultrasound images were measured from the first metatarsal head to quantify plantar tissue stiffness after walking. Two-way ANOVA was used to examine the results. Our results showed that the walking speed factor caused a significant main effect of planar stiffness of the superficial layers (p = 0.007 and 0.003, respectively). However, the walking duration factor did not significantly affect the plantar stiffness. There was no interaction between the speed and duration factors on plantar tissue stiffness. Regarding the walking speed effect, there was a significant difference in the plantar stiffness between 1.8 and 3.6 mph (56.8 ± 0.8% vs. 53.6 ± 0.9%, p = 0.017) under 20 min walking duration. This finding is significant because moderate-to-fast walking speed (3.6 mph) can decrease plantar stiffness compared to slow walking speed (1.8 mph). This study suggests people at risk for foot ulcers walk at a preferred or fast speed (3.6 mph) rather than walk slowly (1.8 mph).
Highlights
Diabetic foot ulcers (DFUs) are the most recognized complication in people with diabetes mellitus (DM)
Five percent of people with newly developed DFUs died within 12 months, and 42.2% of people with newly developed DFUs died within five years [2]
The results of this study demonstrated that the walking speeds (1.8, 3.6 and 5.4 mph) significantly affected plantar tissue stiffness and the walking durations (10 and 20 min) did not
Summary
Diabetic foot ulcers (DFUs) are the most recognized complication in people with diabetes mellitus (DM). The global prevalence of DFUs was 6.3% in 2016 [1]. DFUs are correlated with an increased risk of death. Five percent of people with newly developed DFUs died within 12 months, and 42.2% of people with newly developed DFUs died within five years [2]. Prevention of DFUs is imperative in people with DM. The American Diabetes Association (ADA) recommends that people with DM with or without peripheral neuropathy should perform moderate-intensity aerobic exercise at least 150 min/week or vigorous aerobic exercise at least 75 min/week [3]. Exercise has been demonstrated to improve glycemic control [4], maintain body weight [5] and reduce the risk of cardiovascular disease [6].
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