The effect of exercise, physical activity, stepping characteristics, and loading on diabetic foot ulcer healing: a systematic review.

The aim of this review was to investigate the effect of exercise, physical activity, stepping characteristics, and loading on DFU healing. A systematic review using proprietary software and a PRISMA 2020 checklist was performed by searching MEDLINE, ProQuest, Scopus, CINAHL, Ovid, and the Cochrane Library for eligible articles from 1960 to December 2020. The primary outcome was time to wound closure. Other outcomes included percentage of DFU healed and time to percentage reduction in DFU. Of the 9 articles included, 6 addressed step activity during the off-loading phase of healing and 3 investigated the addition of NWB exercise on wound healing. Reduced loading via lower daily step activity, less standing duration, and shorter walking bouts in combination with wearing an off-loading device facilitated more rapid wound healing. Exercise seemed to facilitate more rapid healing, as well. Reduced limb loading via daily activity and use of offloading devices improved DFU healing rates. Additional research is necessary to determine the optimal thresholds for exercise, activity, step characteristics, and loading to improve healing outcomes in persons with DFU.