Weight-bearing physical activity in people with diabetes-related foot disease: A systematic review

Abstract

Introduction: Weight-bearing physical activity is important for people with diabetes-related foot disease but may also contribute to ulceration or delayed ulcer healing. No overview of weight-bearing activity of people at different stages of foot disease is available. We aimed to summarise quantitatively measured daily activity levels in people with diabetes-related foot disease.

Methods: We systematically searched peer-reviewed literature for studies reporting objectively measured weight-bearing activity in people with diabetes-related foot disease. We calculated daily step counts' means (over studies) and weighted means (over participants). International Working Group on the Diabetic Foot (IWGDF) risk strata, different climates, and activity indoors versus outdoors were compared.

Results: From 1247 publications, 27 were included. Mean steps/day in people with IWGDF risk 1/2: 6125 (12 studies; 345 participants; weighted mean: 5384). In IWGDF risk 3: 6167 (8 studies; 291 participants; weighted mean: 6239). In those with a foot ulcer: 4248 (6 studies; 186 participants; weighted mean: 4484). People living in temperate oceanic climates are more active compared to those in hotter or more humid climates (mean steps/day for no ulcer: 7712 vs. 5224 [18 studies]; for ulcer: 6819 vs. 2945 [6 studies]). People are more active indoors than outdoors (mean 4047 vs. 2514 [3 studies]).

Conclusion: Levels of weight-bearing physical activity are similar between people with diabetes at various risk levels for foot ulceration but lower for those with a foot ulcer. Weight-bearing activity differs depending on the climatological environment and is higher indoors than outdoors. These findings provide reference for intervention studies or for clinicians aiming to provide mobility advice in this population.

Keywords: diabetic foot disease; exercise; foot ulcer; physical activity; prevention.

FIGURE 1

PRISMA flow chart

FIGURE 2

Mean steps/day in studies in people with diabetes at risk of or with a foot ulcer. Mean (solid line) and weighted mean (dashed line) are shown per group. IWGDF, International Working Group on the Diabetic Foot

FIGURE 3

Mean steps/day in studies in people with diabetes at risk of or with a foot ulcer in different climates. Solid line represents the mean, dashed line the weighted mean (only applicable for groups with >2 studies); BWh = Tropical and Subtropical Desert Climate; Cfa = Humid Subtropical Climate; Cfb = Temperate oceanic climate; Csb = Dry‐summer Subtropical Climate; Dfa = Hot Summer Continental Climate. IWGDF, International Working Group on the Diabetic Foot

FIGURE 4

Mean indoor and outdoor steps/day in studies in people with diabetes at risk of or with a foot ulcer. Mean (solid line) and weighted mean (dashed line) are shown per group