Effect of Exercises on Healing Dynamics and Physical Activity Levels in Individuals With Diabetic Foot Ulcer: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Objectives: The burden of diabetic foot ulcers (DFUs) is increasing, causing morbidity and mortality. The management of DFUs involves surgical, pharmacologic, offloading, and lifestyle interventions. Reviews have suggested that exercise is safe in individuals with DFUs, but the evidence is variable and limited. The objective of this review was to examine the effect of exercise on DFU healing as well as physical activity levels. Methods: This review was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Checklist 2020. Studies were included if they were randomized controlled trials (RCTs) in active DFUs with exercise intervention and measured DFU healing parameters and/or physical activity. The Cochrane RoB2 tool was used to assess the risk of bias. RevMan version 5.4.1 was used to perform the meta-analysis, with the random-effects model and suitable tests for heterogeneity. Results: Six RCTs were included in our review. The meta-analysis revealed that exercise intervention was effective in reducing the ulcer area in DFUs. However, the 12-week intervention was not sufficient to achieve a statistically significant difference (standardized mean difference −0.56 cm², 95% confidence interval −1.35 to 0.22; 280 participants, 5 studies; I²=90%). The studies had an overall risk of bias with “some concerns.” None of the studies reported physical activity as an outcome. Conclusions: This review highlighted that non–weight-bearing exercises reduced wound area in DFUs; however, a 12-week intervention was insufficient to reveal a significant change (Wagner grades 1 and 2). A trend toward improvement could be observed. High-quality RCTs are needed to transition the evidence into clinical practice.