Consensus-based recommendations on physical activity and exercise in patients with diabetes at risk of foot ulcerations: a Delphi study.
Alba Gracia-Sánchez, Adriana López-Pineda, José Luis Lázaro-Martínez and 5 others
PMID 37079949WHAT IT FOUND
International experts agreed on 86 foot-risk exercise recommendations, including checking feet before activity, using seamless socks, and avoiding weight-bearing with open ulcers.
These are expert consensus, not tested interventions.
Key findings
01The panel reached consensus on 86 items, which formed the basis of the final recommendations.
02For people with IWGDF 2 or 3, consensus included inspecting feet before and after exercise and wearing therapeutic footwear before exercise.
03Patients with an open ulcer were advised not to put pressure on the lesion, and patients with a recent ulceration history of less than 15 days were advised to start with at least 10 minutes of daily activity using a plantar orthosis and assistance.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study measured expert agreement, not patient outcomes. No patients were included or consulted. Experts were recruited by convenience and voluntary participation, so selection bias is possible. Sixty professionals were invited, and 29 responded to the first round. Most panelists were Spanish; 16 were from Spain. No consensus was reached on 23 items, leaving some foot-care and exercise details unresolved. The survey used close-ended items, although free-text comments were allowed. Experts outside their own specialty may have taken neutral positions on specific items.
Declared interests
The authors declared no known competing financial interests or personal relationships.
The easy way to misread this
Do not read these recommendations as proof that the exercise plan prevents foot ulcers or is safe. The paper reports expert agreement on survey items, not patient outcomes, and the authors state it is not a replacement for clinical trials.