Feet First: Promoting Physical Activity in People with Diabetes Mellitus and Insensate Feet
Robert Wood Johnson Foundation
The role of weight-bearing physical activity in the development of diabetic foot ulcers
and the occurrence of falls remains poorly understood. Regular participation in moderately
intense physical activity (e.g. brisk walking ) reduces 8-year cardiovascular mortality in
those with diabetes mellitus by over 30%. The American Diabetes Association (ADA) recommends
at least 30 minutes of daily moderate intensity activity for people with diabetes. However,
the ADA recommends that people with diabetes and insensate feet, which affects up to 40% of those
with diabetes, should limit their walking because of concerns that walking could increase the risk
of foot ulcers and amputation and falls. Firm evidence is lacking to support these concerns; in
fact, while a research fellow I conducted an observational study that showed daily weight-bearing
activity may reduce the risk of foot ulceration among people with diabetic foot problems. A controlled
clinical trial is needed to study these issues further.
The present study is part of my long-term goal to develop safe programs to promote physical activity
and prevent disability for patients with chronic illnesses. Dr. LeMaster is conducting a randomized
controlled trial in 100 older adults with diabetes and insensate feet, 50 of whom will participate in
an individually-tailored behavior-change intervention called "Feet First”, and 50 of whom will be
controls. The intervention is based on the extensively-tested CHAMPS model used by the Robert Wood
Johnson Foundation's Active for Life Program, and is funded by that Foundation. Feet First extends the
target population beyond older adults generally to people with insensate feet due to diabetic peripheral neuropathy.
The specific aims of the study are:
- To determine whether Feet First intervention subjects achieve a greater increase in weight-bearing
activity than control subjects, and
- To obtain preliminary evidence on intervention subjects' foot outcomes (foot function, foot-related self-care,
and risk of foot ulcers), compared to control subjects.
- To obtain preliminary evidence on whether intervention have an increased risk of falls, compared to
control subjects.
Relevance to the School: Dr. LeMaster came to the University of Missouri-Columbia through a University-wide
program to enhance the school's research mission in 2002. Prevention of disability in older adults is one of
the foci of the "Center of Excellence in Aging Research", the cross-departmental research group in which Dr.
LeMaster participates. His research also fits with another aim of the School: to promote diabetes and cardiovascular
research. This Robert Wood Johnson Foundation award develop clinical research skills in grantees and extends the
School's work in these areas.
Relevance to the patient population served: Before people with chronic diseases and related complications
(such as insensate feet) can receive the benefits of an active lifestyle, effective interventions must be developed
and tested to help them become active without increasing their risk of further disability.
Relevance to generalism: General internists and family physicians provide 80% of the health care annually to
12 million U.S. adults with diabetes. Since the U.S. Preventive Services Task Force has not found sufficient
evidence to recommend brief physician counseling to increase physical activity, generalists need an approach
that is safe, well-documented and could be used in primary care practices to help these patients increase phyical activity.
For more information, contact:
Joseph LeMaster, MD, MPH
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