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Effect of Exercise on Risk Factors of Diabetic Foot Ulcers

A Systematic Review and Meta-Analysis

Liao, Fuyuan, PhD; An, Ruopeng, PhD; Pu, Fang, PhD; Burns, Stephanie, PT, PhD; Shen, Sa, PhD; Jan, Yih-Kuen, PhD

American Journal of Physical Medicine & Rehabilitation: February 2019 - Volume 98 - Issue 2 - p 103–116
doi: 10.1097/PHM.0000000000001002
Original Research Articles

The objectives of this study were to examine the effectiveness of different types of exercise on risk factors of diabetic foot ulcers, including glycated hemoglobin, peripheral arterial disease, and diabetic peripheral neuropathy, in people with type 2 diabetes mellitus. PubMed, Web of Science, Cochrane Library, Scopus, and CINAHL were searched from inception to January 2018 for relevant articles. Eligible studies were randomized controlled trials that examined effects of exercise on the selected risk factors. Twenty randomized controlled trials with 1357 participants were included in the meta-analyses. The differences in postintervention values of glycated hemoglobin and ankle brachial index between exercise and control groups were synthesized, yielding mean differences of −0.45% (P < 0.00001) and 0.03 (P = 0.002), respectively; the differences in within-group changes in glycated hemoglobin were synthesized, yielding mean differences of −0.19% (P = 0.1), −0.25% (P = 0.0006), and −0.64% (P = 0.006) for aerobic versus resistance, combined versus aerobic, and combined versus resistance exercise, respectively. Exercise has a significant effect on reducing glycated hemoglobin, whereas combined exercise is more effective compared with aerobic or resistance exercise alone. Exercise also improves ankle brachial index. However, evidence regarding the association between exercise and peripheral neuropathy and risks of diabetic foot ulcers in people with type 2 diabetes mellitus remains insufficient.

From the Department of Biomedical Engineering, Xi'an Technological University, Xi'an, China (FL); Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois (RA, Y-KJ); Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China (FP, Y-KJ); Department of Physical Therapy, Langston University, Langston, Oklahoma (SB); and Center for Health, Aging, and Disability, University of Illinois at Urbana-Champaign, Champaign, Illinois (SS).

All correspondence should be addressed to: Yih-Kuen Jan, PhD, Rehabilitation Engineering Research Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 1206 S Fourth St, MC-588, Champaign, IL 61820.

No funding was received.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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