Physiotherapist-guided, wearable-informed exercise improves 6-minute walk distance in patients with type 2 diabetes, including those with diabetic kidney disease: a prospective study

Background: Evidence for wearable-guided physiotherapy in diabetic kidney disease (DKD) is limited. This study evaluated the effects of physiotherapist-supervised exercise supported by wearable device feedback in patients with type 2 diabetes, including those with DKD. Methods: In this single-center, prospective study, 58 outpatients were allocated to an intervention group (IG) or non-intervention group (NIG). The per-protocol set included 45 participants completing six months (IG = 25, NIG = 20). IG wore a wrist-worn device and received monthly physiotherapist-led guidance; NIG received standard care. The primary endpoint was 6-min walk distance (6MWD); secondary outcomes included weight-bearing index (WBI), phase angle (PhA), HbA1c, and eGFR. Analyses used linear mixed-effects models adjusted for covariates. Results: = 0.78). Conclusions: Monthly physiotherapist-led exercise supported by wearable feedback improved functional capacity and glycemic control in patients with DKD. This pragmatic, scalable model may enhance outpatient rehabilitation strategies. Graphical abstract: Values represent adjusted between-group differences in change from baseline to six months, estimated using linear mixed-effects models with group, time, and group × time interaction, adjusted for age, baseline 6-min walk distance, HbA1c, eGFR, cardiovascular disease, and smoking status. Error ranges indicate 95% confidence intervals. Arrows indicate direction of change favoring the intervention group. Supplementary Information: The online version contains supplementary material available at 10.1007/s13340-026-00900-x.