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Effect of Weight-Bearing Activity on Foot Ulcer Incidence in People With Diabetic Peripheral Neuropathy: Feet First Randomized Controlled Trial

JW LeMaster, MD, MPH, is Assistant Professor, Department of Family and Community Medicine, School of Medicine, University of Missouri, MA306-K Medical Science Building, DC032.00, Columbia, MO 65212 (USA).
MJ Mueller, PT, PhD, FAPTA, is Associate Professor, Program in Physical Therapy and Department of Radiology, Washington University School of Medicine, St Louis, Missouri.
GE Reiber, MPH, PhD, is Professor, Department of Health Services and Epidemiology, School of Public Health and Community Medicine, University of Washington, and VA Puget Sound Health Care System, Seattle, Washington.
DR Mehr, MD, MS, is Professor, Department of Family and Community Medicine, School of Medicine, University of Missouri.
RW Madsen, PhD, is Emeritus Professor, Department of Statistics, University of Missouri.
VS Conn, PhD, RN, FAAN, is Professor, Sinclair School of Nursing, University of Missouri.

lemasterj{at}health.missouri.edu

Background: Weight-bearing exercise has been contraindicated among people with diabetic peripheral neuropathy (DM+PN). However, recent cohort studies have suggested that daily weight-bearing activity is associated with lower risk for foot ulceration.

Objective: The objective of this study was to determine the effect of a lower-extremity exercise and walking intervention program on weight-bearing activity and foot ulcer incidence in people with DM+PN.

Design: This was an observer-blinded, 12-month randomized controlled trial.

Setting: The settings were physical therapy offices in part 1 of the intervention and the community in part 2 of the intervention.

Participants: The participants were 79 individuals with DM+PN who were randomly assigned either to a control group (n=38) or an intervention group (n=41) group.

Intervention: Intervention components included leg strengthening and balance exercises; a graduated, self-monitored walking program (part 1); and motivational telephone calls every 2 weeks (part 2). Both groups received diabetic foot care education, regular foot care, and 8 sessions with a physical therapist.

Measurements: Total and exercise bout–related daily steps at baseline and at 3, 6, and 12 months were measured by accelerometers. Foot lesions/ulcers were photographed and classified by an independent panel of dermatologists. Use of adequate footwear was monitored.

Results: At 6 months, bout-related daily steps increased 14% from baseline in the intervention group and decreased 6% from baseline in the control group. Although the groups did not differ statistically in the change in total daily steps, at 12 months steps had decreased by 13% in the control group. Foot ulcer rates did not differ significantly between groups.

Conclusion: Promoting weight-bearing activity did not lead to significant increases in foot ulcers. Weight-bearing activity can be considered following adequate assessment and counseling of patients with DM+PN.

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