Investigation of the effect of different exercise trainings on wound healing in patients with diabetic foot ulcer

This study was planned to investigate the effect of exercise approaches on ulcer healing in individuals with diabetic foot ulcer (DFU).Our study included 51 individuals aged 35-65 years, who were diagnosed with DFU in the Endocrinology Clinic of Şanlıurfa Harran University Hospital, and meeting the inclusion criteria.Individuals were divided into three groups by simple closed-envelope randomization method: control (standard treatment) group (n=17), protocol group (n=17) and aerobic group (n=17). All individuals included in the study were taught the necessary practices for ulcer care and diabetes management and diaphragmatic breathing exercises. In the aerobic group, exercise was performed with an ergometer in the sitting position. In the protocol group, an exercise protocol consisting of movements advanced according to ulcer healing status was applied. The exercises were performed with a physiotherapist for 40 minutes, 2 days a week, for 12 weeks. Ulcer surface and depth measurement, blood tests, Pittsburg Sleep Quality Index (PSQI), Tampa Scale for Kinesiophobia (TSK) and Ferrans & Powers Quality of Life Index Diabetes Version were used to evaluate the problems of patients and post-treatment recovery. Ulcer assessments were repeated at the beginning of the treatment, at the 4th, 8th, 12th weeks, and at the end of the 3-month follow-up. Other evaluations were made at the beginning, end of the treatment and at the end of the 3-month follow-up. When the pre-treatment, post-treatment and follow-up data of each three groups were compared, it was observed that ulcer area, ulcer depth and biochemistry values improved in all three groups (p<0.05). In the dual evaluation of the groups, it was observed that the protocol group was more successful in healing the ulcer area and depth than the standard treatment (p<0.05). The protocol group had a faster effect on ulcer area, depth, and biochemistry values than other approaches. While improvement was observed in the protocol and aerobic groups in PSQI values (p<0.05), it was not observed in the control group (p>0.05). In the pairwise comparison of the groups, it was determined that the increase in sleep quality in the protocol group was better than the other two groups (p<0.05). While there was a significant difference in TSK scores from baseline in all groups (p<0.05), no difference was found between the groups (p>0.05). In the pairwise comparison of Ferrans&Powers Quality of Life Index data, a difference was determined between the protocol and the control group in favor of the protocol group in terms of quality of life, health and functioning, and psychology (p<0.05). As a result, in this study, it was observed that the exercise approach, which was advanced according to the ulcer healing rate, was more effective than standard therapy and aerobic exercises in accelerating ulcer healing, reducing ulcer depth, normalizing blood values, improving sleep and quality of life. It may be recommended to add this protocol approach, which is advanced according to ulcer healing, to the treatment of individuals with DFU and to conduct new studies with larger participation on the subject, investigating the effects of exercise on blood parameters that are effective in ulcer healing.