{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T18:51:31Z","timestamp":1789239091552,"version":"build-2803163510"},"reference-count":60,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,5,2]],"date-time":"2023-05-02T00:00:00Z","timestamp":1682985600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Metabolism Res"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Most interventions to prevent foot ulcers in people with diabetes do not seek to reverse the foot abnormalities that led to the ulcer. Foot\u2010ankle exercise programs target these clinical and biomechanical factors, such as protective sensation and mechanical stress. Multiple RCTs exist investigating the effectiveness of such programs, but these have never been summarised in a systematic review and meta\u2010analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched the available scientific literature in PubMed, EMBASE, CINAHL, Cochrane databases and trial registries for original research studies on foot\u2010ankle exercise programs for people with diabetes at risk of foot ulceration. Both controlled and non\u2010controlled studies were eligible for selection. Two independent reviewers assessed the risk of bias of controlled studies and extracted data. Meta\u2010analysis (using Mantel\u2010Haenszel's statistical method and random effect models) was performed when &gt;2 RCTs were available that met our criteria. Evidence statements, including the certainty of evidence, were formulated according to GRADE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included a total of 29 studies, of which 16 were RCTs. A foot\u2010ankle exercise programme of 8\u201312\u00a0weeks duration for people at risk of foot ulceration results in:\u00a0(a) no increase or decrease risk of foot ulceration or pre\u2010ulcerative lesion (Risk Ratio (RR): 0.56 (95% CI: 0.20\u20131.57)); (b) no increase or decrease risk of adverse events (RR: 1.04 (95% CI: 0.65\u20131.67)); (c) not increase or decrease barefoot peak plantar pressure during walking (Mean Difference (MD): \u22126.28\u00a0kPa (95% CI: \u221269.90\u201357.34)); (d) no increase or decrease health\u2010related quality of life (no meta\u2010analysis possible). Likely results in increases in ankle joint and first metatarsalphalangeal joint range of motion (MD: 1.49\u00b0 (95% CI: \u22120.28\u20133.26)) may result in improvements in neuropathy signs and symptoms (MD: \u22121.42 (95% CI: \u22122.95\u20100.12)), may result in a small increase in daily steps in some people (MD: 131 steps (95% CI: \u2010492\u2010754)), and may not increase or decrease foot and ankle muscle strength and function (no meta\u2010analysis was possible).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In people at risk of foot ulceration, a foot\u2010ankle exercise programme of 8\u201312\u00a0weeks duration may not prevent or cause diabetes\u2010related foot ulceration. However, such a programme likely improves the ankle joint and first metatarsalphalangeal joint range of motion and neuropathy signs and symptoms. Further research is needed to strengthen the evidence base, and should also focus on the effects of specific components of foot\u2010ankle exercise programs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/dmrr.3649","type":"journal-article","created":{"date-parts":[[2023,5,3]],"date-time":"2023-05-03T02:52:21Z","timestamp":1683082341000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Clinical and biomechanical effectiveness of foot\u2010ankle exercise programs and weight\u2010bearing activity in people with diabetes and neuropathy: A systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6420-6046","authenticated-orcid":false,"given":"Jaap J.","family":"van Netten","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine Amsterdam UMC University of Amsterdam  Amsterdam The Netherlands"},{"name":"Amsterdam Movement Sciences Program Rehabilitation  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel C. 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