Physical activity as an adjunct therapy in the treatment of persons with diabetic foot ulcer; an umbrella review.

Abstract

This umbrella review aims to appraise and summarize systematic reviews to support a recommendation of physical activity as an adjunct therapy in the treatment of persons with diabetic foot ulcers. An <i>a priori</i> protocol guided the systematic search and inclusion process. We searched MEDLINE, Embase, and CINAHL for quantitative and qualitative systematic reviews investigating the effectiveness of physical activity on diabetic foot ulcer (DFU) healing and persons' experiences with physical activity (PA). Study selection and data extraction were conducted independently by two reviewers. A critical appraisal of included reviews was performed using the Joanna Briggs Institute guidelines for umbrella reviews. Six high- to moderate-quality systematic reviews were included representing primary studies with a total of 881 participants. Supervised exercise showed promising effects on wound healing; however, evidence was insufficient to conclude effectiveness. Low levels of activity with off-loading devices may be feasible. Evidence remains limited. Even based on this study's extensive literature search, there is no basis to conclude which physical activities promote or inhibit wound healing in or are valued by persons with DFUs. Future research should include high-quality, person-centred studies to explore how physical activity can be integrated into care without compromising wound healing.