Effect of Home-Based Foot-ankle Exercises on Ankle-brachial Index value in Patients with Type 2 Diabetes: A Randomized Clinical Trial

Introduction: To date, exercise programs for patients with Diabetic Foot Ulcers (DFUs) have primarily focused on the ankle area, with no exercises that target all leg muscles. The Home-Based Foot-Ankle Exercise (HBFAE) can train all leg muscles by combining the four types of exercises (stretching, strengthening, resistance, and balance exercises) compared to conventional diabetic foot exercises. Objective: The purpose of this study was to determine the effectiveness of HBFAE on the Ankle Brachial Index (ABI) value in patients with type 2 diabetes. Materials and Methods: This is a randomized clinical trial on 38 patients with type 2 diabetes (19 in the intervention group and 19 in the control group). The intervention group received HBFAE, while the control group received the conventional diabetic foot exercise. The exercises for both groups were performed at 24 sessions (once a day, five times a week). A calibrated sphygmomanometer and 8-MHz portable Doppler probes were used for ABI measurement. Paired t-test and independent t-test were used to analyze the ABI differences within and between groups. Multiple linear regression analysis was used to find the predicting variables. Results: The majority of respondents in both groups were male (57.9% in the intervention group and 68.4% in the control group), with a history of foot ulcers (84.2% in the intervention group and 89.5% in the control group). Both HBFAE (P=0.001) and control (P=0.003) groups showed a significant increase in the ABI value after intervention. The HBFAE showed a significantly greater effect on the ABI value (72%) than the diabetic foot exercise (14%). The regression model showed that blood sugar level, duration of DM, history of smoking, and history of foot ulcers were not significantly associated with the changes in the ABI value (P>0.05). Conclusion: The HBFAE is recommended for patients with type 2 diabetes to prevent foot vascular complications, since it is easy to implement and can be performed independently at home.