Importance of physical activity and frailty in diabetic foot ulcer: from observational research to a clinical trial

BackgroundDiabetic foot ulcer (DFU) is a serious diabetes complication. Physical frailty is also a serious condition which is a risk factor and a consequence of diabetes. However, there is limited evidence on how frailty impacts on the risk of ulceration and mortality. Furthermore, physical activity and exercise are powerful therapies for improving physical function and cardiometabolic health. However, the activity profiles of people with DFU are largely unknown and there is a need for more exercise interventions in this population.Aims1. Use Clinical Practice Research Database (CPRD) data, to explore the observational associations between frailty and DFU, taking into account the of competing risk of mortality.2. Analyse physical activity data, measured via accelerometers, to provide a more detailed understanding of the physical activity profiles in those diagnosed with a DFU.3. SIT and be FIT study: Conduct an RCT to investigate a 12-week seated exercise programme on cardiorespiratory fitness (CRF) in people with DFU.Key findings1. Greater frailty was associated with higher rates of DFU and mortality. In women with type 2 diabetes diagnosed at the age of 60, the 10-year adjusted probability of DFU was 2.1%, 1.9%, 2.9%, and 3.2% for fit, mild, moderate, and severe frailty, respectively; corresponding estimates in men were 2.6%, 2.7%, 3.7%, and 4.4%. Risks were similar for different diagnosis ages (50 or 70 years) or diabetes duration (up to 20 years).2. Physical activity, particularly the intensity of sustained activity, was lower in those with DFUs compared to non-DFUs. Moderate to vigorous physical activity was lower in the DFU group (9 min/day [5, 17] vs. 18 min/day [16, 21], p ≤ 0.003).3. 12-weeks of seated arm ergometry improved CRF in a cohort of people diagnosed with DFU. The mean change difference for VO2peak was 2.9 ml.kg.min-1 (p = .004) adjusted for baseline.