Effectiveness of Exercise Interventions for Diabetic Foot Ulcer Healing: A Systematic Review

Abstract

Background: Diabetic foot ulcer is a serious complication of diabetes mellitus that is frequently associated with delayed wound healing, infection, and an increased risk of lower-limb amputation. Despite standard wound care and off-loading, outcomes often remain suboptimal, prompting interest in exercise as an adjunct therapy. 
Objective: This systematic review evaluated the effectiveness of exercise interventions on wound-healing outcomes in patients with diabetic foot ulcers. 
Methods: PubMed, Scopus, Google Scholar, and Semantic Scholar were searched for randomized controlled trials and controlled clinical trials of structured exercise in adults with diabetic foot ulcers. Two reviewers independently screened studies and extracted data. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. Because of heterogeneity, results were synthesized narratively. 
Results: Five studies with intervention durations of 8–12 weeks were included. Non–weight-bearing aerobic exercise and structured foot exercises generally produced greater wound-area reduction and/or faster healing progression than standard care, with several trials reporting significant between-group differences (p < 0.05). Resistance training and passive lower-limb movement exercises yielded mixed results and were often non-significant for wound closure, although some studies reported improvements in metabolic or perfusion-related outcomes. 
Conclusion: Exercise may be a feasible adjunct to standard diabetic foot ulcer care, particularly non–weight-bearing aerobic and structured foot exercise programs; however, evidence is heterogeneous and of low-to-moderate methodological quality, supporting the need for well-designed trials with standardized outcome reporting.