An exercise program for people with severe peripheral neuropathy and diabetic foot ulcers - a case series on feasibility and safety

PURPOSE: To examine a non-weightbearing exercise program for persons with severe peripheral neuropathy (PN) and a diabetic foot ulcer in terms of feasibility and safety.

MATERIALS AND METHODS: Five men (mean (SD) age of 68.2 (7.1) years) with diabetes, severe peripheral neuropathy and an active foot ulcer, participated in a 10-week exercise program. Program adherence, patient satisfaction, healing of foot ulcers, adverse advents, ability to perform activities of daily life, and changes in muscle strength were assessed.

RESULTS: All participants completed the program with a session attendance from 85 to 95%, and with high satisfaction (≥9 points on a 10-point numeric rating scale). Only minor adverse events occurred, and ulcers were reduced for all participants, from a median of 1.9 (IQR, 1.1-7.3) cm2 to 0.0 (0.0-3.0) cm2. The distance on stationary bike was improved from a mean (SD) of 3.30 (1.1) to 5.36 (0.5) kilometers, and strength training loads were progressed. Ability to perform in self-selected activities of daily living improved from a median of 4.3 (2-5) to 6.7 (5-8) on the Patient Specific Functional Scale (0-10 points), while maximal isometric knee-extension muscle strength improved with 23%.

CONCLUSIONS: A non-weightbearing exercise program for people with diabetes, severe peripheral neuropathy and foot ulcers seems feasible and safe. Further studies are needed to confirm these findings. Implications for rehabilitation An exercise program designed for people with severe peripheral neuropathy and diabetic foot ulcers can be safe by means of not compromising healing of foot ulcers. Feasible in terms of attendance and progression. An alternative to passive waiting for ulcer to heal in a population already deconditioned.