Combined Effects of Foot-Ankle Therapeutic Exercises and Mindful Walking in Patients With Diabetic Polyneuropathy

A 12-week foot-ankle therapeutic exercise program has been found to show positive effects compared to usual care on fast-gait speed, foot-ankle range of motion, vibration sensitivity, and quality of life in people with diabetic neuropathy.

Mindful walking's efficacy for chronic low back pain management has been investigated, with a randomized controlled trial of 55 patients yielding no significant improvements in pain intensity, back function, or stress after 8 weeks.

Exercise therapy has been found to significantly improve gait function in patients with diabetic peripheral neuropathy. A systematic review of 9 randomized controlled trials (370 participants) showed that exercise therapy enhances 6-minute walk test, 10-meter walk test, and Tinetti scale outcomes, improving mobility and reducing fall risk.

Exercise shows therapeutic potential for sensory nerve disorders, improving symptoms in most cases. Benefits are seen in diabetic pain and nerve damage, with varying mechanisms underlying these effects. Exercise therapy enhances outcomes for various nerve-related disorders, improving symptoms by at least two times compared to no exercise.

A 12-week study found significant improvements in glycemic control and vascular function in patients with type 2 diabetes who practiced Buddhist walking meditation, whereas traditional walking only improved blood glucose levels and cardiovascular fitness.

A study on sensor-based interactive balance training with visual joint movement feedback found significant improvements in postural stability in patients with diabetic peripheral neuropathy. The intervention group demonstrated a 62.68% reduction in CoM sway with eyes closed.

Physical therapy has been shown to impact limited joint mobility in diabetic neuropathy patients. A study found significant joint mobility improvements after 10 sessions of passive joint mobilization, with near-normal mobility achieved after 20 sessions.

A 4-week multimodal treatment program (treadmill, muscle strengthening, balance training) significantly improved gait endurance and functional independence in diabetic neuropathy patients, with sustained benefits at 2-month follow-up.

Foot biomechanics in diabetes mellitus patients has been studied, with an observational study of 281 patients finding no significant differences in joint mobility between patients with and without neuropathy.

Diabetic neuropathy significantly impairs ankle strength and balance recovery in older women, despite normal clinical muscle testing.

Despite the established benefits of exercise and physical therapy in managing diabetic polyneuropathy (DPN), significant knowledge gaps persist. Existing studies have primarily focused on isolated interventions, such as foot-ankle exercises or mindful walking, without exploring their combined effects. The synergistic potential of integrating therapeutic exercises with mindfulness-based walking remains uninvestigated. Insufficient evidence supports optimal exercise protocols and mindfulness-based interventions for DPN management. This study addresses these gaps, paving the way for evidence-based DPN management strategies.

Inclusion criteria

• Diagnosed with diabetic polyneuropathy (DPN) confirmed by medical history and clinical examination.
• Experience pain and disability in foot/ankle, with a Numeric Pain Rating Scale (NPRS) score ≥ 4.
• Independent walking ability for at least 10 m.
• Age (40-75) years.
• Ability to understand and follow exercise instructions.
• A maximum of one amputated toe, not being the hallux.
• Willingness to participate in the study and provide informed consent.

Exclusion criteria

• Presence of an active plantar ulcer or gangrene.
• History of surgical procedure at the knee, ankle, or hip or indication of surgery throughout the intervention period.
• Arthroplasty and/or orthosis of lower limbs or indication of lower limb arthroplasty throughout the intervention period.
• Participating in other exercise programs or studies.
• Dementia or inability to give consistent information.
• Diagnosis of neurological diseases.
• Neuropathic pain due to other causes (e.g., HIV, chemotherapy).
• Major vascular complications and/or severe retinopathy.