Discussion
diabetes
ADVERSE EVENTS, BEST, OVER-EXERTION, COMPLICATIONS, DIABETES
The undertaking of an exercise intervention in a patient group hospitalised with a DFU was a novel feature of this pilot study. We chose to include patients during their acute hospital admission for a DFU as an opportunity to provide enhanced multidisciplinary care during the early, active phase of treatment. The results of this study suggest that the inclusion of an exercise programme is feasible and safe for people hospitalised with a DFU.No adverse events occurred during exercise sessions. Providing supervision during exercise sessions was believed to be key in achieving this safety outcome. Supervision allowed for monitoring of vital clinical parameters (such as BGLs, heart rate and blood pressure) as well as subjective parameters (such as level of exercise intensity), thereby minimising potential risks associated with over-exertion in this population. Furthermore, supervision enabled the authors to provide exercise specifically tailored to individual wound offloading needs. Previous research has trialled non-weight bearing exercises to achieve offloading requirements [Weight bearing is an important consideration in this patient group. Whilst it is a recognised mode of protection for wound healing, the off-loading of a limb comes with its own health risks. A recent study has demonstrated bilateral reductions in bone mineral density (BMD) of 1.4–2.8% at the femoral neck and total BMD at the hip 12 weeks after hospital admission for DFU [The potential for exercise and its role in reducing the risk of complications associated with DFU has been identified as a research priority by health providers and consumers [The short exercise intervention trialled in the current study did not result in a change in overall physical activity levels from the IPAQ survey, nor perceived barriers to exercise as assessed by the EBBS. Conversely, we did note a reduction in the perceived benefits of exercise. As there is a no documented minimally clinically important difference for this scale that we were able to find, we cannot determine if this change is clinically relevant. Satisfaction with the exercise programme was acceptable as recorded by the satisfaction survey. There is a possibility of participant bias in these results. Best efforts to control for this included ensuring participants knew data was confidential and providing the survey electronically to optimise anonymity. small sample size bias is also likely to have impacted these results.Behaviour modification interventions have been trialled in studies of people with diabetes but without DFU with some success. These types of interventions may have applicability in the DFU population. A literature review and practice guideline outlined that the inclusion of behaviour change interventions, with a focus on self-efficacy and motivation to exercise, could be effective when added to exercise to increase physical activity levels in people with diabetes [Another interesting finding in this study was the disproportionately high numbers of participants that lived regionally or rurally and were unable to attend in-person follow up sessions. This is a unique situation for Western Australia where the population is spread over an area of more than two-million square kilometres. It presents a challenge when delivering healthcare, particularly when using supervised or group exercise as a potential treatment modality. Provision of a home exercise programme rather than utilising an in-person supervised exercise environment is one way of combatting this, however innovation and improvements in healthcare delivery, including the ongoing use of telehealth modalities to monitor performance, are necessary to improve healthcare outcomes.