Expert considerations to guide the development and delivery of an exercise intervention in people with type 2 diabetes‐related foot ulcer disease

OBJECTIVE: Engaging in exercise presents unique challenges for those with type 2 diabetes (T2D) and diabetes-related foot ulcer disease (DFUD). This brief report describes the development of practical considerations aiming to support exercise in people with T2D and DFUD. RESEARCH DESIGN AND METHODS: An expert group of multidisciplinary healthcare professionals (HCPs), researchers and individuals with DFUD reviewed available evidence and developed practical considerations for the assessment, prescription and monitoring of exercise within an ongoing randomised controlled trial. RESULTS: Key considerations include screening for contraindications, individualising exercise prescription, determining weight-bearing status and initial supervision by HCPs. Self monitoring of exercise and appropriate foot protection advice and care are also encouraged. CONCLUSIONS: We have developed practical considerations to use when delivering an exercise intervention within a study aiming to improve cardiovascular health for people with T2D and DFUD. For this specific population, these recommendations include prescribing non-weight bearing physical activity (such as arm ergometry or chair-based upper limb exercises) for those with active foot ulcers, educating and encouraging footcare self-management (including how to check feet and when to seek advice), monitoring glucose levels in participants at high risk of hypoglycaemia or hyperglycaemia and reducing the barriers to exercise. Pragmatic measures aimed at maintaining safety include determining the level of pre-assessment and individualised monitoring based on clinical presentation and/or risk as well as equipment and staff resource. This approach may also be helpful when supporting exercise in a wider population.