Fall and Balance Outcomes After an Intervention to Promote Leg Strength, Balance, And Walking in People with Diabetic Peripheral Neuropathy: "Feet First" Randomized Controlled Trial (Research Report) (Report‪)‬

In patients with diabetes, regular participation in physical activity can improve glycemic control and reduce cardiovascular mortality. (1,2) Exercise that improves lower-extremity balance and strength (force-generating capacity) has been shown to be effective in reducing falls in older adults. (3-7) However, people who are sedentary and people with insensate feet (8) have an increased risk of falling. Although 1 nonrandomized study of a small sample of older adults with peripheral neuropathy showed that lower-leg strengthening and balance exercises improved tandem and one-leg stance time and functional reach (clinical balance measures), (9) we are aware of no prior randomized controlled trial of activity in people with peripheral neuropathy and in which fall incidence was an outcome. Although there have been concerns that weight-bearing exercise could place people with diabetes mellitus and peripheral neuropathy (DM+PN) at higher risk of foot ulcers and amputation, (10,11) there also is evidence suggesting that daily weight-bearing activity may decrease the risk of foot ulceration. (12,13) In our recently completed randomized trial to increase weight-bearing activity in people with DM+PN, compared with participants in a control group, participants in the intervention group experienced an increase in weightbearing, bout-related physical activity without an increase in foot ulcer rates. (14) The change in total daily steps, as measured with an accelerometer, did not differ significantly between the study groups at either 6 or 12 months. In the control group, however, total steps decreased by 13% over 12 months (P.01). Steps taken during 30-minute exercise bouts increased 14% between the baseline and 6 months in the intervention group but decreased 6% in the control group (P.05); however, the difference did not remain statistically significant at 12 months. The number of days of participating in an exercise program (ie, walking) increased from 0 days per week in both groups at the baseline to 3 days per week in the intervention group and 1.5 days per week in the control group by 6 months (P.05) but no longer differed between the groups at 12 months. Foot ulcer rates did not differ significantly between the groups.