Department of Podiatry, Eastern Health, Melbourne, Victoria, 3128, Australia.
Department of Aged and Complex Medicine, Eastern Health, Melbourne, Victoria, 3128, Australia.
J Foot Ankle Res. 2021 Mar 20;14(1):19. doi: 10.1186/s13047-021-00456-w.
For patients with diabetic foot ulcers, offloading is one crucial aspect of treatment and aims to redistribute pressure away from the ulcer site. In addition to offloading strategies, patients are often advised to reduce their activity levels. Consequently, patients may avoid exercise altogether. However, it has been suggested that exercise induces an increase in vasodilation and tissue blood flow, which may potentially facilitate ulcer healing. The aim of this systematic review was to determine whether exercise improves healing of diabetic foot ulcers.
We conducted a systematic search of MEDLINE, CINAHL and EMBASE between July 6, 2009 and July 6, 2019 using the key terms and subject headings diabetes, diabetic foot, physical activity, exercise, resistance training and wound healing. Randomised controlled trials were included in this review. Three randomised controlled trials (139 participants) were included in this systematic review. All studies incorporated a form of non-weight bearing exercise as the intervention over a 12-week period. One study conducted the intervention in a supervised setting, while two studies conducted the intervention in an unsupervised setting. Two studies found greater improvement in percentage wound size reduction in the intervention group compared with the control group, with one of these studies achieving statistically significant findings (p < 0.05). The results of the third study demonstrated statistically significant findings for total wound size reduction (p < 0.05), however results were analysed within each treatment group and not between groups.
This systematic review found there is insufficient evidence to conclusively support non-weight bearing exercise as an intervention to improve healing of diabetic foot ulcers. Regardless, the results demonstrate some degree of wound size reduction and there were no negative consequences of the intervention for the participants. Given the potential benefits of exercise on patient health and wellbeing, non-weight bearing exercise should be encouraged as part of the management plan for treatment of diabetic foot ulcers. Further research is required to better understand the relationship between exercise and healing of diabetic foot ulcers.
对于糖尿病足溃疡患者，减压是治疗的一个关键方面，目的是将压力从溃疡部位重新分布。除了减压策略外，还经常建议患者降低活动水平。因此，患者可能完全避免运动。然而，有人认为运动可引起血管舒张和组织血流增加，这可能有助于溃疡愈合。本系统评价的目的是确定运动是否能改善糖尿病足溃疡的愈合。
我们于 2009 年 7 月 6 日至 2019 年 7 月 6 日在 MEDLINE、CINAHL 和 EMBASE 中使用关键词和主题词进行了系统搜索，包括糖尿病、糖尿病足、体力活动、运动、抗阻训练和伤口愈合。本综述纳入了随机对照试验。本系统评价纳入了 3 项随机对照试验（139 名参与者）。所有研究均在 12 周内采用某种非负重运动作为干预措施。一项研究在监督环境下进行干预，而两项研究在非监督环境下进行干预。两项研究发现，干预组的伤口面积百分比缩小程度优于对照组，其中一项研究得出了统计学上显著的结果（p<0.05）。第三项研究的结果表明总伤口面积缩小有统计学意义（p<0.05），但结果是在每个治疗组内进行分析的，而不是在组间进行分析的。
本系统评价发现，没有足够的证据能明确支持非负重运动作为改善糖尿病足溃疡愈合的干预措施。尽管如此，研究结果表明伤口面积有一定程度的缩小，且干预对参与者没有不良后果。鉴于运动对患者健康和福祉的潜在益处，应鼓励非负重运动作为糖尿病足溃疡治疗管理计划的一部分。需要进一步研究以更好地了解运动与糖尿病足溃疡愈合之间的关系。
