Structured Exercise Program for Diabetic Foot

Overseen By Eric J Lew, DPM

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of New Mexico

Disqualifiers: Infection, Transplant, Immunocompromised, Prisoners, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 4

Duration: 12 weeks

60 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial examines how a structured exercise program might help people with Type 2 diabetes heal foot ulcers more quickly. The study compares individuals following their usual wound care routine with those also participating in medically supervised exercise sessions. Participants should have Type 2 diabetes and a foot ulcer that is not too severe. This trial may suit those experiencing foot ulcers and interested in incorporating exercise into their care routine. As an unphased trial, it offers a unique opportunity for patients to explore innovative care options that could enhance their healing process.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What prior data suggests that this structured exercise program is safe for diabetic foot ulcer patients?

Research has shown that exercise can be a safe and helpful treatment for people with diabetic foot ulcers. Patients with these ulcers can safely perform specific exercises, even while in the hospital. One study found that exercise might improve wound healing in individuals with diabetes-related foot ulcers. Additionally, planned exercise programs have been linked to better blood sugar control, which is crucial for managing diabetes.

In summary, evidence suggests that a planned exercise program is generally safe for people with diabetic foot ulcers. However, following medical advice and ensuring that professionals supervise any exercise is always important, especially when managing such health conditions. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the structured exercise program for diabetic foot because it adds a new dimension to the standard wound care routine. Current treatments usually focus on regular wound care appointments and managing daily activities, but this program incorporates a medically-supervised exercise regimen. This approach not only aims to enhance physical health but also potentially improves circulation and healing in the affected areas. By integrating exercise under professional supervision, it offers a comprehensive strategy that could lead to better outcomes for patients dealing with diabetic foot issues.

What evidence suggests that this structured exercise program is effective for diabetic foot ulcers?

Research shows that exercise can aid in healing wounds in people with diabetic foot ulcers. Previous studies have found that exercise helps control blood sugar and improves insulin use, both crucial for healing. In this trial, participants in the treatment-as-usual plus medically-supervised exercise (TAU-EX) arm will engage in a 12-week exercise program, which has improved these factors in patients with diabetic foot ulcers. Exercise has also proven safe for individuals with these ulcers, even during hospitalization. Although direct human data is limited, these findings suggest that exercise could support wound healing in diabetes. ^{1 2 3 4 5}

Who Is on the Research Team?

Eric J Lew, DPM

Principal Investigator

University of New Mexico Health Sciences Center

Are You a Good Fit for This Trial?

This trial is for Type 2 diabetics aged 20-80 with foot ulcers (WIfI stage 2 or lower). Participants must have stable blood glucose and HbA1c levels, be able to communicate in English or Spanish, and have reliable transportation. Those with infections, without medical clearance, unable to consent, immunocompromised individuals, or prisoners cannot join.

Inclusion Criteria

I have been diagnosed with type 2 diabetes.

My foot ulcer is not severe, graded 2 or less.

I am between 20 and 80 years old.

Exclusion Criteria

I do not have a reliable way to get to UNMH.

I have had a transplant or my immune system is weak.

I currently have an infection.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

1 visit (in-person)

Treatment

Participants receive standard wound care and, if in the TAU-EX group, participate in a medically supervised exercise program

12 weeks

2-3 visits per week (in-person)

Follow-up

Participants are monitored for wound healing and safety after the treatment phase

4 weeks

1 visit (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Structured exercise program

Trial Overview The study tests if a structured exercise program speeds up wound healing in diabetic foot ulcers. It's conducted through an outpatient cardiac rehab setup. The main measure is how quickly the ulcer reaches the maturation phase—meaning it's closed and not draining.

How Is the Trial Designed?

Group I: Treatment-as-usual plus medically-supervised exercise (TAU-EX) Experimental Treatment 1 Intervention

This group attends normal wound care appointments as scheduled with the wound care provider, generally 2 - 3 times per week. Coincident with these appointments, ideally, they will also attend a medically-supervised exercise program supervised by the exercise physiologists of the Cardiac Rehabilitation facility. The exercise sessions will last no more than 1-hr per session. The maximum number of sessions possibly attended over the 12-wk intervention period is 36. In addition, participants in this group will maintain their activities of daily life unless contraindicated by the would care provider.

Group II: Treat-as-usual (TAU) Active Control 1 Intervention

This group attends normal wound care appointments as scheduled with the wound care provider, generally 2 - 3 times per week. In addition, participants in this group will maintain their activities of daily life unless contraindicated by the would care provider.

Who Is Running the Clinical Trial?

University of New Mexico

Lead Sponsor

Trials

393

Recruited

3,526,000+

Published Research Related to This Trial

The primary principle of exercise prescription is ensuring that the benefits of exercise outweigh any potential risks, particularly for patients with health conditions.

For individuals with diabetic complications, a comprehensive physical examination is essential before starting an exercise program, as daily moderate aerobic exercise can enhance cardiovascular health and improve insulin sensitivity and blood sugar control.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise options for people with diabetic eye complications. Scheiner, G.[2004]

Exercise training significantly helps in preventing and modifying cardiovascular diseases and reducing mortality, highlighting its importance in patient care.

Patients with acute cardiovascular conditions benefit from structured cardiac rehabilitation programs, while those with chronic conditions should engage in lifelong home-based exercise routines that include aerobic, resistance, flexibility, and balance activities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise in cardiovascular diseases. Perez-Terzic, CM.[2022]

Exercise is crucial for managing heart disease, and patients should undergo careful screening to create a safe and effective exercise prescription based on their test results.

Moderate-intensity exercise or exercising under medical supervision is recommended for safety, and these programs have been proven to enhance both the quality and quantity of life for heart disease patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise for the cardiac patient. Long-term maintenance phase. Hartley, LH.[2017]

A specialized unit for prescribing physical exercise has been established for patients with chronic heart failure, post-coronary angioplasty, diabetes, and other cardiovascular conditions, addressing the gap in rehabilitation programs after hospital discharge.

Patients undergo a comprehensive evaluation and then participate in supervised aerobic and resistance training, with ongoing support and reassessment to ensure effective and safe exercise regimens tailored to their needs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comprehensive therapeutic program for cardiovascular patients: role of a sports medicine unit in collaboration with local gymnasiums. Sarto, P., Merlo, L., Astolfo, P., et al.[2016]

Regular exercise has long been recognized as a key component of diabetes management, alongside diet and insulin, but research on its specific benefits and risks for diabetic patients has been limited until recently.

There is now a growing interest in defining appropriate exercise prescriptions for diabetic patients, highlighting the importance of exercise as a therapeutic strategy for managing diabetes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise and physical training in the treatment of diabetes mellitus. Schneider, SH., Ruderman, NB.[2011]

Physical activity is crucial for diabetes management, providing benefits like improved blood sugar control, reduced risk of related health issues, and enhanced quality of life for patients with both type 1 and type 2 diabetes.

Caregivers often lack knowledge about exercise recommendations for diabetic patients, which can lead to either unnecessary restrictions on physical activity or increased risk of adverse reactions; therefore, proper assessment of health conditions and safety measures is essential before starting an exercise program.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Exercise prescription for diabetics: more than a general recommendation]. Constantini, N., Harman-Boehm, I., Dubnov, G.[2008]

A 10-year study involving 255 patients with diabetes showed that regular aerobic exercise can be safely implemented in outpatient settings, leading to modest improvements in blood pressure and reduced insulin requirements for those with insulin-dependent diabetes.

Despite some concerns, such as exercise-related proteinuria occurring in 29% of patients, serious complications were rare, indicating that exercise can be an effective part of diabetes management for at least three months.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ten-year experience with an exercise-based outpatient life-style modification program in the treatment of diabetes mellitus. Schneider, SH., Khachadurian, AK., Amorosa, LF., et al.[2022]

A survey of 104 diabetes patients at the Medical University of Vienna found that 43% were interested in exercise programs, with 23% actually participating, indicating outpatient departments can effectively recruit for such initiatives.

Factors like younger age and better economic status increased participation rates, while gender differences showed that more women expressed interest and participated compared to men, highlighting the need for tailored outreach and more accessible exercise programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Recruitment of patients with type 2 diabetes for target group specific exercise programs at an Outpatient Department of a Medical University: A factor analysis. Lackinger, C., Lamprecht, T., Winhofer, Y., et al.[2021]

A 12-week community-based lifestyle program for adults with diabetes or prediabetes showed significant clinical improvements in cardiorespiratory fitness, waist circumference, and exercise behavior, with participants walking an average of 87 meters further in a six-minute test by the end of the program.

The program was well-received, demonstrating good acceptability among participants, and had a low risk of adverse events, suggesting it could be effectively implemented in other communities for similar health conditions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Outcomes of a community-based lifestyle programme for adults with diabetes or pre-diabetes. Higgs, C., Skinner, M., Hale, L.[2017]

A 12-week tailored exercise program for a patient with severe complications from type 2 diabetes was conducted safely, leading to improvements in muscle strength and daily functioning despite challenges with glycemic control.

The study highlights the importance of a comprehensive medical screening and a multidisciplinary team, including specialists in diabetes and exercise physiology, to ensure safe and effective exercise interventions for patients with diabetic complications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The use and safety of combined resistance and aerobic training in a patient with complications related to type 2 diabetes: a case report. Otterman, NM., van der Schaaf, M., Busch-Westbroek, TE., et al.[2013]

A structured exercise program conducted three times a week did not succeed in a regional inner-city referral center, indicating challenges in implementing such programs in certain populations.

In response to the need for exercise training, a new 'Therapeutic Walking Program' was developed, highlighting the importance of adapting exercise interventions to better meet patient needs and suggesting areas for future research.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Therapeutic walking program: an alternative to a formal vascular rehabilitation program. Maune, J.[2004]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8777697/

The Effect of Structured Exercise Compared with Education on ... Eight weeks of exercise training or lifestyle education can improve neuropathic signs and symptoms in people with diabetes and peripheral neuropathy.

2. sciencedirect.com sciencedirect.com/science/article/pii/S149926712500022X

A Systematic Review of Glycemia, Fitness, and Wound ... Exercise may improve wound healing in people with diabetes-related foot ulcers, based on animal studies and limited human data. •. Physical activity guidelines ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12504896/

Home-Based Exercise to Improve Functional Outcomes in ... People with a diabetic foot ulcer (DFU) have a higher 5-year mortality than closely matched people with diabetes but no ulcer―1 in 4 people with ...

4. journals.sagepub.com journals.sagepub.com/doi/abs/10.1177/15347346221149786

A 12-Week Supervised Exercise Therapy Program for ... Exercise therapy helps improve glycaemic control and insulin sensitivity and may be relevant in treating patients with diabetic foot ulcers ...

5. jfootankleres.biomedcentral.com jfootankleres.biomedcentral.com/articles/10.1186/s13047-023-00616-0

Exercise in adults admitted to hospital with diabetes-related ... Targeted exercise appears safe to be undertaken by patients with diabetes-related foot ulcers during and after an acute hospital admission.