ESSA 2021 Research Grant Winner
Associate Professor Nathan Johnson
The University of Sydney
Supported by project researchers: Professor Stephen Twigg, University of Sydney; Mr Callum Baker, University of Sydney; Dr Danquing Min, University of Sydney; Professor Viv Chuter, University of Western Sydney.
In Australia approximately 50,000 people with diabetes develop a foot ulcer each year, which leads to increased risk of hospital admissions and amputations. People who develop a “diabetic foot ulcer” (DFU) are often advised to avoid physical activity. Yet, regular exercise has significant metabolic and cardiovascular benefits for people with diabetes, and may even benefit foot ulcer healing. There is a great need to find safe and effective ways for people with DFUs to engage in exercise, and to evaluate the effects of exercise on health and wound healing in people with DFUs.
Our proposed research will use a “randomised controlled design” to compare the effects of 12 weeks of regular exercise versus usual care on metabolic, cardiovascular, and wound health in adults with DFUs. Our multidisciplinary research team which includes AEPs, physician, scientists and podiatrists from the University of Sydney, Western Sydney University and Royal Prince Alfred Hospital, will lead this translational exercise-based study at the Charles Perkins Centre (University of Sydney). This world first study is aimed at finding benefits for patients and providing clear, practical guidance for clinicians and exercise specialists managing people with diabetes and its complications.
Why is this beneficial?
The results of this randomised control trial (RCTs) will provide important new evidence concerning the efficacy of regular, combined resistance and ergometry-based aerobic exercise training on glycaemic control, fitness, cardiovascular health and wound healing people with diabetes-related foot ulcers. These are important insights into an area of practice that AEPs do not routinely operate, despite plausible reasons to believe that exercise can be safe and effective.
Accredited Exercise Physiologists (AEPs) are best positioned to provide exercise therapy for people with diabetic foot ulcers, representing an important and so-far missed opportunity for the profession to impact on the national burden of diabetes. However, to date quality exercise studies in people with diabetes who have foot ulceration are lacking. Subsequently there is little evidence to guide exercise assessment and delivery. Also, there are practical challenges to implementing exercise for people with diabetes-related DFU: weight-bearing exercise increases plantar foot pressure and skin shear stress and may negatively impact ulcer healing. Moreover, people with DFU cannot undertake water-based exercise due to active ulceration.
Our multidisciplinary research team which includes AEPs, physicians, scientists and podiatrists will trial a novel approach to combined resistance and aerobic exercise assessment and training, which we anticipate will provide guidance for exercise specialists to implement safe and effective exercise in practice. Ultimately, this may help improve health and reduce the burden of DFUs for many people.