{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T05:15:29Z","timestamp":1788326129852,"version":"build-2803163510"},"reference-count":55,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100020013","name":"NIHR Leicester Biomedical Research Centre","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100020013","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Metabolism Res"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Those at risk of diabetes\u2010related foot ulceration (DFU) must balance sufficient physical activity to maintain glycaemic control and cardiovascular health whilst avoiding excessive trauma to their feet. Our systematic review aimed to assess whether physical inactivity and\/or sedentary behaviour affect DFU outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>Embase, Medline, and Scopus were searched for peer\u2010reviewed studies using the criteria: (\u2018diabetes\u2019 OR \u2018diabetic\u2019) AND (\u2018physical*\u2019 OR \u2018activ*\u2019 OR \u2018inactiv*\u2019 OR \u2018sedentary\u2019) AND \u2018foot\u2019 AND \u2018ulcer\u2019, returning 4650 results excluding duplicates. 16 studies were included and assessed for risk of bias using the Newcastle\u2010Ottawa Scale (NOS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifteen studies assessed physical inactivity and 1 assessed both inactivity and sedentary behaviour and DFU outcomes. Eleven of 16 (69%) studies reported significantly greater likelihood of DFU in inactive participants. Exploratory meta\u2010analysis suggested physical inactivity to be associated with doubled DFU risk (OR 2.09, 95% CI 1.32\u20133.32,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.002). Evidence that sedentary behaviour was associated with tripled DFU risk was based on a single prospective cohort and had a high risk of bias (OR 2.95, 95% CI: 1.5\u20136.4,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.008;\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0175, NOS: poor). Study methodologies were heterogenous (e.g.,\u00a0inconsistent definitions of inactive), with habitual physical activity measured through interviews, patient records, or questionnaires in 14 of 16 studies (NOS rating: poor to fair).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Available evidence suggested that physical inactivity and sedentary behaviour were associated with an increased risk of DFU. Further research is needed to develop thresholds for physical inactivity and sedentary behaviour to reduce DFU risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/dmrr.70198","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T06:06:20Z","timestamp":1783404380000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Less Is More? Physical Inactivity and Increased Risk of\u00a0Diabetes\u2010Related Foot Ulceration\u2014A Systematic Review"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9340-9168","authenticated-orcid":false,"given":"Petra J.","family":"Jones","sequence":"first","affiliation":[{"name":"Leicester Diabetes Centre Leicester General Hospital University Hospitals of Leicester  Leicester UK"},{"name":"Diabetes Research Centre Leicester General Hospital University of Leicester  Leicester UK"},{"name":"NIHR Leicester Biomedical Research Centre Leicester General Hospital  Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1887-9175","authenticated-orcid":false,"given":"David G.","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Keck School of Medicine University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1463-697X","authenticated-orcid":false,"given":"Alex V.","family":"Rowlands","sequence":"additional","affiliation":[{"name":"Diabetes Research Centre Leicester General Hospital University of Leicester  Leicester UK"},{"name":"Alliance for Research in Exercise, Nutrition and Activity (ARENA) Adelaide University  Adelaide Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3510-9594","authenticated-orcid":false,"given":"Harald","family":"Sourij","sequence":"additional","affiliation":[{"name":"Cardiometabolic Trials Unit, Division of Endocrinology and Diabetology Medical University of Graz  Graz Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8479-0497","authenticated-orcid":false,"given":"Afsaneh","family":"Noormandi","sequence":"additional","affiliation":[{"name":"Cardiometabolic Trials Unit, Division of Endocrinology and Diabetology Medical University of Graz  Graz Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1196-539X","authenticated-orcid":false,"given":"George","family":"Theodorakopoulos","sequence":"additional","affiliation":[{"name":"Keck School of Medicine University of Southern California  Los Angeles California USA"},{"name":"Technological Educational Institute of Patras  Patras Greece"},{"name":"Queen Margaret University  Edinburgh UK"},{"name":"University of West Attica  Aigaleo Greece"},{"name":"University of Thessaly  Larisa Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"International Diabetes Federation (IDF) Atlas 11th ed.(2025) https:\/\/idf.org\/about\u2010diabetes\/diabetes\u2010facts\u2010figures\/."},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0239236"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.13054"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11136\u2010018\u20102082\u20102"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.2245"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13047\u2010020\u201000383\u20102"},{"key":"e_1_2_10_8_1","unstructured":"\u201cAmerican Diabetes Association Weekly Exercise Targets \u201d accessed April 17 2026 https:\/\/www.diabetes.org\/healthy\u2010living\/fitness\/weekly\u2010exercise\u2010targets."},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2011.01.014"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464\u20105491.2012.03740.x"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.12438"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.115.002495"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1139\/h2012\u2010024"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12966\u2010017\u20100525\u20108"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.70728"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.2319"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13690\u2010025\u201001816\u20109"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/PHM.0000000000001002"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.2817"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.4103\/ijpvm.IJPVM_410_17"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3552"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3647"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_10_24_1","unstructured":"G.Wells B.Shea D.O\u2019Connell et\u00a0al. 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